Health And Nutrition In India

HEALTH AND NUTRITION IN INDIA

by the same author
*

War and Agriculture

Problems of Rural India

iNotes on Indian Constitutional Reforms-.

India: What Now?

Indian Peasant and his Environment
The Making of Federal India

HEALTH AND NUTRITION
IN INDIA

by
N. GANGULEE

Formerly Professor of Agriculture and Rural

Economy, University of Calcutta (1929-31);

Ex-Member of the Royal Commission on

Indian Agriculture (19268)

With a foreword by
Sir John Orr, K.R.E., F.R.S.

There is but one temple in the world.,
and that temple is the body of man.

NOVALIS

FABER AND FABER LTD

24 Russell Square

London

.First published in March Mcmxxxix

by Faber and Faber Limited
24 Russell Square London W.C.i

Printed in Great Britain by

Latimer Trend & Co Ltd Plymouth

All Rights Reserved

To

Pandit Jawaharlal Nehru and other leaders
of the Indian National Congress, who have
undertaken the responsibility of shaping a
national policy, based upon directed eco-
nomy, for the rehabilitation of my Country,
where 'for every three mouths, there are
only two rice bowls', this book is respectfully
dedicated.

CONTENTS

Foreword by Sir John Boyd Orr page 3

Preface 1 1

I. The Problem 15

II. The Science of Nutrition 35

History and Theory of Nutrition Basal Metabolism
The Protein Component Carbohydrates and Fats
Vitamins (A,B,C,D,E) Inorganic Substances (Calcium,
Phosphorus, Iron and Iodine) Two Main Groups of Food
Substances Dietary Standards Practical Deductions
from Nutritional Research

IIL Some Consequences of Dietary Deficiencies 77

Diet and Disease Concepts of Malnutrition Methods
of Detecting Malnutrition Consequences of Underfeed-
ing Consequences of Overfeeding Deficiencies in
'Energy-bearing 5 Foods: .(a) Proteins, (b) Carbohy-
drates, (c) FatsDeficiencies in 'Protective* Foods: (a)
Proteins, (b) Vitamins A, B, C, D, E, (c) Inorganic Sub-
stances, Calcium, Phosphorus, Iron, Iodine Problem
of Deficiency Diseases

IV. Public Health and Deficiency Diseases in India 1 13

General State of Public Health Infant Mortality-
Mothers of 'Mother India' Health of Schoolchildren
Prevalence of Diseases caused by Nutritional De-
ficienciesPublic Health Services and Organizations in
India Pure Food Acts Maternity and Child Welfare-
Health Education and Propaganda Conclusion
vii

CONTENTS

V. A Brief Account of Indian Foodstuffs 162

Foods of Animal Origin: (a) Milk and milk products,

(b) Eggs, (c) Fish, (d) MeatFoods of Vegetable Origin:
(a) Leaf and Flower Vegetables, (b) Stems and Bulbs,

(c) Roots and Tubers, (d) Fruit vegetables, (e) Seeds:
(f ) Cereals, (it) Legumes, (/) Fruits and Nuts Sugar-
Fats Food Adjuncts, (a) Salts and Condiments, (b} Tea
and Coffee, (c) Drinks and Drugs

VI. Diets of the Peoples of India 197

Hindu Concepts of Diet Moslem Concepts Dietary
Habits Cooking Regional Characteristics of Indian
Dietaries The Cult of Vegetarianism The Diet of
Schoolchildren of the Industrial Worker of the
Peasantry and Plantation Labour Discussion on Indian
Dietaries

VII. Nutritional Research and Practice in Different 235
Countries

The Responsibility of the State Organization of Nutri-
tional Research: (a) International, (b) Great Britain,
(c) Japan, (d) Soviet Union Nutrition of Mother and
Infants Nutrition of Children of School Age Nutrition
of Adults

VIII. Facing the Problems in India 269

Overcoming Inertia Problem of Overpopulation-
Nutrition and Agriculture Reorientation of Indian
Agriculture Introduction of New Food Crops Horti-
culture: Production of Fruits and Vegetables Animal
Husbandry: Production of Milk and Milk Products
Development of Indian Fisheries Research, Training,
and Propaganda

Appendices 309

List of References Quoted 319

Index 325

viii

ILLUSTRATIONS

I. Osteomalacia: it is with great difficulty that the
patient is able to stand as straight as this

facing page 104

II. Osteomalacia victim, showing chest deformity

facing page 104

III. Typical appearance of angular stomatitis in a

girl aged 20 facing page 138

IV. A closer view of rickets facing page 138

V. Rickets, which cripples Indian children by the

thousand facing page 140

VI Xerophthalrnia, an eye trouble caused by defi-
ciency of vitamin A. The cause of thousands of
cases of blindness annually in India facing page 140

VII. The improvement of South Indian diets by

skimmed milk facing page 168

VIII. The dry and atrophic skin (Phrynoderma) in a
man aged 20 also suffering from kerato-
malacia facing page 2 1 4

IX. Diet and physique of Indian races facing page 230

X. Successful dry farming in Bombay Presidency:

the crop grown is millet facing page 278

XL The adjoining land where dry farming is not

adopted facing page 278

I

ILLUSTRATIONS

XII. The wasteful practice of using dung for fuel re-

moves one of the possible means of restoring soil
fertility facing page 282

XIII. Sowing seeds with a country drill facing page 282

FOREWORD
by Sir John Boyd Orr

M.D., D.Sc., LLD., F.R.S.

The 'newer knowledge of nutrition' has opened up a new era
in the history of medicine comparable in importance with the
era introduced by the work of Pasteur, which led to the control
of many infectious diseases, and the beginning of modern sur-
gery. The application of the more recently acquired knowledge
of the influence of food on health will lead to another great
advance in human welfare. Mankind will get rid of deficiency
diseases such as bcri-beri and pellagra, which still take a heavy
toll of human life in many countries, and be freed from many
physical disabilities, much indefinite ill-health and poor phy-
sique, which arc prevalent in all countries,

We have already begun to apply the knowledge with most
encouraging results. Thus, for example, in the United King-
dom, due partly to the spread of the knowledge, partly to a
rise in the standard of living and partly to the supply of milk
and other protective foods, free or at reduced rates to mothers
and children of the poorer class, there has been a marked
improvement in the national dietary. Compared with pre-War
years, the consumption per head of some of the protective
foods has increased by over 50 per cent. Accompanying that
improvement in nutrition, there has been a corresponding
improvement in health. The worst cases of malnutrition, such
as gross rickets and scurvy in children, have almost disappeared.
Infant mortality has been reduced from in per 1,000 live
births to 58 in 1937. The death rate from tuberculosis, which
is so much affected by diet that it might almost be considered
a disease of malnutrition, has been reduced by half. The expec-

3

FOREWORD

tation of life at birth has been extended by as much as seven
years. In addition to the reduction in mortality and morbidity
rates and in deficiency diseases, there has been an improve-
ment in health and physique, most marked in the case of chil-
dren. The children of to-day are both bigger and of better
physique than their parents were at the same age. While many
factors have contributed, each to some degree, to this rise in
the standard of health, the results obtained from feeding ex-
periments on animals under controlled conditions and the
results of tests in which deficiencies in the diets of human
beings were made good by the addition of protective foods-
without any other change in environmental factors affecting
health, suggest that the improvement in national health is to be
attributed mainly to the improvement in the national dietary.

A similar improvement in health, due to better feeding, is-
taking place in most civilized countries. Indeed, there is reason
to believe that the rate of improvement in some European
countries and the British Dominions is more rapid than in the
United Kingdom. This improvement in the last twenty-five
years shows how easily ill-health and suffering can be reduced
and life saved.

But, though such a great improvement in feeding and health
has taken place, the standard of health is still far below what
it would be if every family enjoyed a diet fully adequate for
health. Sir William Crawford, from the results of a recent
investigation of family dietaries of all classes of the community,,
estimates that the food expenditure of about eight million
people is still below the minimum standard of the British
Medical Association. It is doubtful whether the diet of half of
the population reaches the League of Nations' standard, which
is not a minimum but an optimum diet.

The application of the newer knowledge of nutrition to the
improvement of national health and physical fitness is now
recognized to be a political problem of the first importance.
In the last three years a number of countries have set up
National Committees to investigate the food position and ad-
vise their respective governments of the measures needed to
bring the national dietaries up to the standard required for
health. It is already being found that this is not an easy task.
The first difficulty is that there are not sufficient protective

4

FOREWORD

foods, e.g. .milkj eggs, fruit, and vegetables, in any country,
even the wealthiest, to provide a diet on this standard for the
whole population. The second difficulty is that, even if the
foodstuffs were available, a large proportion of the population
could not afford to purchase sufficient, at present prices, to
bring their* diet up to the standard.

The first of these difficulties can be overcome. Thanks to the
advances of agricultural science we can produce in abundance
all the foodstuffs which we need. It has been estimated that
with the knowledge we now have, it is physically possible for
the world to produce sufficient food for twenty times its present
population. Nor is there any insuperable physical difficulty
with regard to distribution. We can transport food easily and,
with modern methods of preservation, we can carry over food
from a season of plenty to a season of scarcity with little or no
loss of nutritive value.

The second difficulty, that of bringing a diet adequate for
health within the purchasing power of the poor, is more for-
midable. It can be overcome only by adjustments of the
economic system or by a great extension of social services. The
adjustments needed are difficult to make because they conflict
with certain existing economic interests and, what is more
important, they are contrary to the ideals we have inherited
from the past. In the nineteenth century we were largely
dominated by the ideal of commercial prosperity. It was
assumed that if trade flourished every one would ultimately
benefit. And, indeed, there is a great deal of truth in this
assumption, provided no restrictions are placed on production
or distribution. But the nineteenth-century economic system
of laisser faire has broken down and governments have been
forced to take measures to control and direct trade and industry
and to plan for their future development. These measures, in
many cases, involve restrictions on the production and flow of
wealth. The fundamental issue at the present time is the objec-
tive of government measures. What are we planning for? In
democratic countries we are still so obsessed by the idea of the
overriding importance of trade as if it were an, end in itself that
the measures taken so far have been directed mainly to pro-
tecting existing trade interests. In the United Kingdom the
legislation of the last five or six years, dealing with the produc-

5

FOREWORD

tion and trade in food, has been directed, not to ensuring that
a sufficient amount of food is available to meet national needs
for health and physical fitness, but to controlling the supply in
the financial interests of existing producers and traders.

Those who have appreciated the importance of the newer
knowledge of nutrition for the promotion of human welfare
realize that this policy of restriction is bad for public health
and bad even for trade itself, for if the national dietary is to
be brought up to the standard required for health, there must
be a great increase in the production of and trade in the pro-
tective foods.

But in a democratic country the government cannot legis-
late in advance of public opinion. Until a majority of the
people see the necessity for making a change, no change is
likely to be made. There is always a lag between the acquisi-
tion of knowledge and its application to the advance of human
welfare. It took two generations for the discoveries of Pasteur
to be applied through modern sanitation for the elimination
of preventable infectious diseases. But knowledge spreads faster
to-day than it did in Pasteur's time. The 'newer knowledge' of
the influence of food on health is already widespread and there
is a growing demand for the elimination of malnutrition. Both
in this and in other countries some of the means which are
available are now being used to increase the consumption of
protective foods and there is every indication that, in the near
future, in dealing with food, the main concern of some govern-
ments at least will be the bringing of national dietaries up to
the optimum standard.

The most important work which can be done at the present
time by those who wish to see the new science of nutrition
applied is to spread the knowledge. There is no lack of good-
will. So soon as people realize the extent to which ill-health
and all the accompanying human misery can be prevented by
better feeding, the old idea of the supreme importance of trade
as an end in itself will be replaced, at least so far as trade in
food is concerned, by the more modern ideal of the promotion
of human welfare, and governments will take the necessary
steps to ensure that a diet adequate for health is available for
the whole community.

The new knowledge is spreading fast in European countries,

6

FOREWORD

in the United States, and in the great British Dominions. A
Committee was recently appointed by the British Government
to get the knowledge applied for the welfare of the native
inhabitants of the British Colonial Empire. In India, the re-
searches of'SmRobert McCarrison gave some indication of the
vastness of the problem in that sub-continent and his work is
being carried on and extended by his successor. Dr. Aykroyd,
and his colleagues at Coonoor and other centres. The move-
ment to get the new science of nutrition applied in practice is
thus world-wide.

In no part of the world is the movement more needed than
in India, where there are e only two rice bowls for three mouths'.
The fundamental difficulty in India is shortage of food, and
from the administrative point of view the problem is one of
agricultural reorientation and development to provide more
food, especially more milk and other protective foods, for
human consumption. This book should prove of value by
bringing the facts with regard to nutrition and health in India
before those responsible for the government of the country.
Professor Gangulee is himself an authority on agriculture and
was a member of Lord Linlithgow's Royal Commission 01
Agriculture in India. He has a first-hand knowledge of tfo
position and those who read this book must be convinced tha
the most urgent political problem in India at the present timk.
is to devise ways and means of improving the national dietary.
The health and physique of the great bulk of the population
'in India is far below the average of other civilized countries.
If the politicians in India have the welfare of their fellow
countrymen at heart, they should sink all political differences
and unite in working out and applying a policy which will
provide the food needed to enable the people of India to attain
their full inherited capacity for physical fitness. Lord Linlith-
gow, the present Viceroy of India (who was Chairman of
the Royal Commission on Agriculture in India) has given
an excellent lead to all classes in India in a speech at Simla
inaugurating a scheme for providing milk for children. That
expression of the new ideal of the Government, referred to on
page 217, is well worth re-quoting here in part: 'What indeed,
is the use of spending public funds on objects such as education,
welfare schemes and the like if the people have not the health

7

FOREWORD

and vigour of mind and body to take full advantage of them
and to enjoy them? What indeed can we hope from a political
constitution unless we apply ourselves without delay and with
persistence, vision, and courage to the improvement of the
physical constitution of the common run of man.and woman? 5

Professor Gangulee's book deals specifically with India but
the world has become so small and all countries so closely
connected in trade and commerce that India's problem is
really part of the world problem. Unfortunately., there is no
world-wide government and co-ordinating authority which
can adjust the world's food supply to the needs of all the
different countries in the world. But we have a British com-
monwealth of nations and India's food problem is an impor-
tant aspect of the food problem of the British Empire. We hear
of a glut of butter in New Zealand and Australia. In India
there are thousands of people going blind every year because
of a deficiency of the vitamins found in butter. If we are a
commonwealth of nations and if governments exist for the
welfare of the people, surely it should not be beyond the wis-
dom of the governments to prevent the misery of blindness
and other associated disabilities by using the surplus in one
part of the commonwealth to remove the scarcity which causes
these deplorable conditions in another part.

In a speech at Geneva two years ago, the Rt. Hon. Stanley
Bruce, High Commissioner for Australia, advocated an agri-
cultural and trade policy based on the needs of the people and
coined the much-quoted phrase, "The marriage of health and
agriculture.' If government measures affecting production and
distribution of foods were designed to bring the diets of all
people within the British Empire up to the standard now
known to be necessary for health, there would soon be a great
improvement in health and physical fitness. The production
and distribution of the additional foodstuffs needed would
involve an expansion of agriculture and inter-imperial trade.
If governments would put first things first and have for their
supreme overriding objective in planning for the future, the
health, happiness, and welfare of the people, they would have
another era of prosperity and expansion in trade and industry
and a stable economic and social system based on justice and
goodwill between man and man.

8

FOREWORD

The British Empire needs more statesmen like Lord Linlith-
gow and Mr. Bruce, men with vision and a wide economic
outlook, to guide us by wise measures towards the new era of
plenty irv which undernourishment and malnutrition, with all
the suffering and loss of life these involve, will be no more, and
in which man will be able to develop his full inherited capacity
for physical and mental health, for happiness to himself, and
for service to his fellow men.

Professor Gangulee's account of the food shortage and of the
other conditions associated with poverty which cause so much
misery and loss of life in India, and his constructive suggestions
for remedying these, especially for the improvement of the
Indian diet, are valuable contributions to the information
which our statesmen used as a guide to the planning for a
better future. It is to be hoped that this book will be read by
those responsible for the administration of the country, and,
indeed, by all interested in the future of India.

Preface

If any explanation were required of me for venturing to write
upon a subject which includes the special preserves of the
students of medicine and public health, it might be found,
firstly, in the fact that the problems of human nutrition em-
brace agriculture and animal husbandry, in the study of which
I have spent a greater part of my life. Secondly, the science of
animal nutrition was one of the major subjects of my studies in
the University of Illinois (U.S.A.). I was able, as a student, to
follow closely the experiments conducted in the University of
Wisconsin in 1907-11. The impetus to such studies came from
the assurance given to some of us, then being trained in agri-
cultural colleges of the United States of America, that on our
return to India facilities would be available for the establish- 1
ment of dairy industries in Bengal. Although the proposal for
organizing a dairy farm on a large scale did not proceed any
further than the expression of good intentions from those who
had^the necessary resources, my interest in the cultivation of
fodder crops and in the problems associated with animal nutri-
tion remained unabated.

During the tenure of my service in the University of Calcutta
I undertook to survey the food resources of Bengal in relation
to both animal and human nutrition; but owing to lack of
proper facilities, this work could not be completed. In 1926-8,
as a member of the Royal Commission on Agriculture in
India, I became closely acquainted with the pioneer work
of Lieut.-Colonel (now Sir) Robert McCarrison and his col-
leagues. Since then I have pursued the study of the problem of
human nutrition in India in its scientific, economic, social, and
medical aspects.

In 1935 when the League of Nations set up a committee to

A* II

PREFACE

investigate into the state of nutrition of all countries in Europe,
it occurred to me that a compilation presenting the subject
from a comprehensive point of view might be helpful to those
who are now assuming responsibility for the bettermjent of the
public health, nutrition and general economic conditions of
my country. I felt that one of the effective means of awakening
public opinion in India was to present scientific facts regarding
health and nutrition in correlation to the prevailing economic
conditions and social backwardness of the Indian masses. In
this volume the emphasis is therefore laid upon those aspects of
our socio-economic life which are most germane to an under-
standing of the problem. If I have attempted too much in the
way of scientific detail or if discussions appear rather prolix,
my excuse is that in undertaking the task involved in the appli-
cation of the knowledge of nutritional research to communities,
leaders of Indian public life should be in possession of all rele-
vant facts which are of the utmost significance for the main-
tenance and development of health. I crave their indulgence
in asking them to go through these pages; for here I present a
case for immediate action. If this book be of any assistance to
them in understanding the ravages of disease and devitaliza-
tion which are rapidly reducing the great bulk of our popula-
tion to 3 category, I shall feel that my labour has not been
in vain. To the members of the medical profession I would
submit, as a justification of my excursion into their problems,
that in exploring a promising path of investigation into health
and nutrition, their special knowledge has to be integrated
and correlated with the entire field of social phenomena. A
clear understanding of social pathology is no less important
than pure aetiological problems.

Finally I invite constructive criticism and comment from
my readers that may be likely to improve the efficiency or use-
fulness of this book.

I owe a great debt to Sir John Orr, F.R.S., Director of the
Rowett Institute, for writing a foreword to the book. My thanks
are due to Dr. Et. Burnet, Director, the Pasteur Institute at
Tunis, Dr. W. R. Aykroyd, M.D., Director of Nutrition Research,
India, Sir John Russell, F.R.S., Director of Rothamstccl Experi-
mental Station, Sir John Mcgaw, LM.S., and Mr. F. Lc Gros
Clark, B.A.J Secretary to the Committee against Malnutrition,

12

PREFACE

for their encouragement and support, and to Sir Robert
McCarrison, M.D., for his constructive criticism. I am indebted
to Mr. Hilary Sumner-Boyd, M.A., for assisting me in research
and for revising the manuscript for the press. Acknowledge-
ment is also due to various scientific reports and journals
referred to in this book, especially to those who have lent me
photographs, charts, and graphs.

N. GANGULEE
London

CHAPTER ONE
The Problem

1 he emergence of the question of underfeeding and mal-
nutrition as an issue of international importance is a significant
recent event. The advance in our knowledge of nutrition and
of the consequences of dietetic deficiency upon the health of
the community has added a new sharpness to the problem of
social injustice which tolerates a wide disparity in the standard
of living among the different classes of society. On the one
hand we have become to-day Nutrition conscious', that is, we
have realized that the problem of adequate and rational feed-
ing is not the simple matter of consuming enough food which
it was thought to be hardly a generation ago, but, on the
contrary, that it is a science with laws of its own and problems
which are still unsolved. On the other hand, it has become
increasingly clear that the problem of nutrition is not isolated,
and that scientific research alone cannot provide an adequate
solution. The problem is bound up with the whole economic
organization of society which, notwithstanding the great
advances in science and technology, has failed to relieve the
world from the underfeeding of a large proportion of the
population. Thus there are two sides to the problem; the
scientific side which enquires what are the laws and standards
of rational diet; and the broader social side which must attempt
to answer the question, how can the optimum diet indicated
by the science of nutrition be ensured to the community as a
whole. Only when an answer is provided to both these ques-
tions can we consider the problem of nutrition solved.

THE PROBLEM

i

It was not until the time of the industrial revolution at the
end of the eighteenth century that the problem of nutrition
began to attract the attention first of scientists and philan-
thropists, later of governments themselves. Until .this period,
the countries of Europe had consisted for the most part of
small agricultural communities which produced their own
foodstuffs in the required quantities and were largely self-
sufficing. The towns were small and were easily provisioned
with the food they required from the adjacent country districts.
There was no sharp division between the country and the
town.

The rapid rise of the factory system and the concentration
of an ever-increasing population in industrial centres had the
effect of breaking up the community into two opposing sec-
tions, rural and urban. It suddenly became necessary for the
rural communities greatly to expand their production of food-
stuffs in order to satisfy the enormously increased demand of
the urban population. This increase in the demand for agricul-
tural produce in its turn necessitated a great change in the
agricultural economy of the West. Subsistence farming with its
antiquated methods and traditional customs had to be replaced
by organized farming for the market, and the farmers, follow-
ing the lead of the manufacturers, called upon science to come
to their aid in increasing agricultural production.

Among other farming problems which attracted the atten-
tion of scientists was that of producing the maximum amount
of meat in the shortest possible time and with a minimum
expenditure on fodder. Out of the search for a solution to this
problem arose the study of animal nutrition. On the one hand
it was necessary to determine what were the essential con-
stituents in the diet of animals, and on the other hand what
quantity of food was required to produce the requisite energy.
In this way was born that important branch of nutritional
science known as the theory of calories.

The industrial revolution gave rise not merely to the concen-
tration of the population in urban centres, but also to a great
increase in the actual numbers of the population. By the close
of the nineteenth century the demand for food products from
cities, towns, and industrial centres had increased to such an

16

THE PROBLEM

extent that the supply had to be supplemented by food pro-
cessing and manufacture. Foodstuffs coming from all quarters
of the globe were subjected to various treatments; cereals were
milled and loaded with 'improvers'; milk was sterilized, dried,
condensed, or mixed with other food constituents; meat and
fish were frozen, tinned, or prepared with varieties of mixtures;
fruits and vegetables were preserved in numerous forms, and
vast quantities of synthetic articles labelled as nutrients ap-
peared on the world's food-counter. Thus the urban popula-
tion came increasingly to depend on processed and even
synthetic foods, and was forced more and more to forgo the
natural diet, that is, a diet of foodstuffs as they are produced
by nature.

The manufacture of food products led to further investiga-
tions into food values and gave a great impetus to another
branch of the science of nutrition, namely, the biochemical
analysis of foodstuffs. The nature of the various constituent
parts of food was examined, and their different functions in
relation to the nutritional requirements of man were investi-
gated. Thus once more the practical exigencies of the moment
led to a great advance in scientific knowledge.

Meanwhile, although the development of manufactured
foods brought forth rich harvests of profit to the manufacturers
and vested interests, it gave rise to grave maladjustments in the
nutrition of a great part of the population. The transformation
of a community from an agricultural to a predominantly
industrial society, as it has taken place first in Great Britain
and subsequently in other materially advanced nations, has
perceptibly affected the physique of the race. The food supply
of the expanding urban and industrial areas offered oppor-
tunities to unscrupulous dealers and manufacturers not only
for adulterating foodstuffs but also for profiteering through
monopoly enterprises. Moreover, between the producer and
the consumer there arose a host of intermediaries or middle-
men, and this further increased the price of food. Thus under
the stress of circumstances created by urbanization and indus-
trialism the triple factors of production, distribution and con-
sumption became increasingly unrelated, and a greater and
greater disharmony between them began to appear. On the
side of production this disequilibrium was manifested in a

THE PROBLEM

semi-chronic state of depression in agriculture, for the advances
in scientific methods of farming had increased output but had
reduced prices to such an extent that agricultural production
-was no longer profitable. On the side of distribution there was
a chaotic reduplication of services on a small scatewhich added
out of all proportion to the cost of food products 'to the retail
consumer. Finally, owing to the low income of the mass of the
population combined with the relatively high' cost of foodstuffs,
there was a continuous tendency to underconsumption.

The state was no longer able to remain completely passive
in the face of such a situation. If no other motives had forced
it to act, it was at least compelled to take notice of the rising
spirit of revolt and the growth of strong popular movements
which demanded measures for ensuring a healthy life to the
workers. The sacrosanct principles of laisser faire were first
infringed in this sphere by the passage of acts regulating the
adulteration of foodstuffs, prohibiting the addition of injurious
ingredients, and forbidding the use of lying or misleading des-
criptions and labels. Later the rudiments of a public health
service were established which, among many other duties, had
also to deal with the problem of malnutrition, especially among
mothers and infants. Finally, in the more advanced countries,
a system of school-feeding for malnourished children was intro-
duced. In this way the first tentative steps were taken by the
state to tackle the increasingly grave problem of malnutrition.

Such measures on the part of the state gave rise in their turn
to a more intensive scientific research into the constituents of
diet. The application of the Food Adulteration Acts required
a closer study of the chemistry of foods and of the conditions
of food preservation, while the activities of the public health
service demanded an investigation of the methods of curing
and preventing the more pronounced physical effects of mal-
nutrition. Thus, pan fassu with the deterioration of the food
conditions of the people, and especially of the working class,
medical and scientific knowledge of nutrition advanced; and
it is the glaring contradiction between the norms of science and
the actual dietary conditions of the working class which has
given rise in recent years to the widespread interest in the
problem of nutrition.

THE PROBLEM

n

If, toward the close of the nineteenth and the beginning of
the twentieth century, the problem of malnutrition had already
taken on national importance, the War of 1914-18 transferred
the problem^ to the international arena. Hitherto the effects of
malnutrition had been limited in extent and sporadic in
incidence. During the War and the years immediately follow-
ing, however, the actual problem of the food supply of the
civilian population in European countries became acute. The
serious scarcity of food necessitated careful rationing. Even in
those countries which were least affected by the shortage,
alarming symptoms of undernourishment, especially among
women and children, became evident. Sheer hunger and des-
pair of finding a solution under the existing economic system
led to revolution first in Russia and then in Germany, Austria,
and other Central European countries. The failure of the
revolutions in Central Europe brought the mass of the working
population to the point of actual starvation. Forced by circum-
stances, the Germans devised new synthetic methods of pro-
ducing proteinous foods, as, for example, various preparations
based on a combination of yeast with other food constituents.
But the food scarcity during the War and the blockade, which
was maintained by the Allies even after the Armistice, very
seriously injured the generation born during the period. The
mass of the population had to live on black bread and potatoes,
the supply of meat, eggs, milk, and milk products being prac-
tically non-existent. Rickets, 'hunger osteomalacia', nutritional
oedema, and other acute symptoms of dietary deficiency were
widespread. The death rate from tuberculosis increased by 70
per cent, and there were indications of grave deterioration in
the physique of the young members of the community. It is
estimated that in the countries seriously affected by the War
and its aftermath about 60 per cent of the children showed
signs of arrested growth, and 40 per cent of tuberculous glands.
Such was the state of affairs where actual famine did not exist.
But famine itself was widespread in Eastern Europe, and pro-
duced a grim spectre of misery reminiscent of Indian famines.
One example will suffice to show the horrifying increase of
disease which was an indirect result of famine conditions: in
south-eastern Russia in 1923 more than thirteen million cases

19

THE PROBLEM

of malaria were reported as compared with the maximum
figure of three and a half million before the War.

To add to the havoc caused by the War, the Armistice
was followed by economic and financial reprisals. Instead of
accepting Wilson's Utopian formula of Teace without Victory 5
the conquerors wanted victory with vengeance. The peace
treaties not only failed to make provision for supplying the
minimum essentials of life to the peoples exhausted by war;
on the contrary, they were used to intensify the economic
conflict which, precisely, had caused the war. Tariffs, embar-
goes, war debts, financial restrictions, and every weapon that
can be forged under the existing economic system simply
replaced the machine-guns, tanks, artillery, and gas of the
preceding years. It has been truly said that c the supreme
illusion of the post-war world lies precisely in the assumption
that armed conflict alone is war 5 . Thus the inevitable disloca-
tion of world economy incident to any great war was intensi-
fied a hundredfold by the action of the victorious Powers.

From a scientific point of view, the War and post- War
periods offered unrivalled opportunities to observe and study
the effects of malnutrition. In the clinics of starving Vienna
immense progress was made in the diagnosis of undernourish-
ment and its attendant diseases. It was during this period that
the scales and standards for assessing the existence and extent
of malnutrition were greatly improved. Of wider scope, inves-
tigations were carried out into the relation between the food
supply and the actual conditions of nutrition prevailing in
countries both more and less affected by the economic debacle.

The period of acute distress was followed by a few years of
relative stability, and the illusion that conditions had returned
to normal was sedulously fostered by interested parties. In
1929, however, a crisis of unprecedented dimensions occurred;
debts mounted up, channels of trade and commerce became
dislocated or choked, and industrial nations found themselves
unable to buy from each other their essential requirements.
Excessive production and diminished consumption were at
once the cause and the paradox of the world depression the
paradox inherent in the crises of capitalism. Particularly im-
portant from the point of view of the food supply of the masses
was the tendency already noted in. the nineteenth century

20

THE PROBLEM

toward disequilibrium between agricultural and industrial
production which gave rise to a semi-chronic state of depres-
sion in agriculture. The world depression very greatly aggra-
vated this tendency, and the languishing state of agriculture
changed suddenly into acute crisis. Hence the paradoxical
situation of malnutrition and undernourishment in the midst
of plenty.

In these conditions, governments were forced to sacrifice
what still remained after the War of the principles of laisser-
faire, and their first efforts were directed at doing so without
restricting the profits of the big farmers and industrialists.
Some of the food-producing countries adopted measures for
the restriction of agricultural production, others for the actual
destruction of foodstuffs. Thus was it hoped to save the farmer
at the expense of the community, and to cure the disease of
'poverty in the midst of plenty by eliminating the plenty
instead of the poverty'. It will be interesting to mention here
a few examples of these expedients to show to what incredible
lengths this suicidal policy was taken. Owing to the restrictions
imposed on the export of meat by the Ottawa Agreement in
1932, the Government of Chile considered it expedient to kill
500,000 sheep for the manufacture of tallow on condition that
the carcases should be burnt. In Denmark the Government
created a special destruction fund to kill and burn about 5,000
cattle per week. The Spanish Government thought it necessary
to dump into the sea thousands of cases of oranges and many
tons of vegetables. In America, the farmers of Kansas and
Nebraska were subsidized for burning their grain; ten million
acres of cotton and some thousands of tobacco were ploughed
under, on the ground that these harvests would further have
depressed the world market. For the sake of National prosperity'
the Federal Government ordered the slaughter of some five
million pigs and some 200,000 prospective mother sows. Brazil
burnt its coffee crop; herrings were dumped into the sea in
English ports. These examples could be greatly multiplied.
Yet, at the beginning of 1932, in the midst of this period of
feverish destruction of food, it is estimated that there were
more than 25,000,000 unemployed in Europe and America,
and the majority of these were suffering from all degrees of
undernourishment and malnutrition. The absurdity, not to

B 21

THE PROBLEM

speak of the iniquity, of an economic system which permitted
such a state of affairs began to make itself felt, and govern-
ments were gradually forced to abandon the more extreme
excesses to which their desire to maintain the system of private
profit had led them.

Weary of the orgies of destruction, the governments at-
tempted to find some more rational solution of the problem.
In some cases instead of destroying the 'surplus' of production
it was bought by the State and distributed as relief to the
unemployed. But it had become clear that the problem was no
longer national and that the isolated efforts of a single country,
whether to destroy its wealth or to husband it, would ulti-
mately prove ineffective. Only international co-operation
could, under the favourable circumstances of economic re-
covery, provide a solution. The question was taken up by the
League of Nations.

In September 1935 the Assembly of the League had a long
discussion of the problem of defective nutrition and of 'the
effects of improved nutrition on the consumption of agricul-
tural products'. General recommendations were made on the
subject of the removal of tariff barriers and other impediments
to international trade and on the necessity of ensuring a larger
purchasing power to the general consumer. The Health
Organization was instructed to include the study of nutrition
in its regular programme of research. And finally a Special
Committee was set up to investigate the problem of nutrition
both in its scientific and its social and economic aspects. The
preliminary investigations carried out by this Special Com-
mittee have emphasized the fact that the problem of nutrition
is not merely a scientific problem, but that its solution lies in
formulating the social and economic policies of each nation
with due regard to the health and normal development of the
population. Whether this recommendation can be realized in
an economic system where organized planning is impossible is
a question open to doubt.

Recapitulating the argument thus far, we may say: the prob-
lem of nutrition was posed in the first instance by the contra-
dictions inherent in the capitalist mode of production. Step by
step with the appearance of the symptoms of undernourish-
ment, the science of nutrition advanced and provided the

THE PROBLEM

medical and technical basis for a solution of the problem. The
deeper economic causes, however, remained. The Great War
and the recent world depression brought the question into
sharp relief and thrust it upon the notice of public opinion as
a whole. The definitive solution of the problem is one of the
vital tasks of the day.

in

If, in the advanced industrial countries, the consequences of
dietary deficiency have become alarming, it may easily be
imagined what serious proportions they assume in countries
of a low economic development. India with her widespread
poverty is such a country. The world depression has created
in the advanced countries of the West a class of 'new poor';
but in India we have to face the problem of the chronic poor
with all the distressing symptoms resulting from continuous
undernourishment and malnutrition. And where poverty,
serious maladjustments in economic life, age-worn social cus-
toms and ignorance coincide, these problems assume a charac-
ter altogether different in proportion from those that confront
Western humanity.

The economic position of India differs profoundly from that
of the advanced Western countries. There, the economic sys-
tem, however great its disequilibrium and contradictions, is at
least homogeneous and highly developed. In India, on the
other hand, the economic system is a mixture of at least three
different and conflicting elements: the decaying feudal sub-
structure, the slowly advancing Indian capitalist organization
of industry, and the fully developed foreign imperialism.

India is a predominantly agricultural country. The organiza-
tion of rural economy is still largely feudal, although the rapid
increase of speculative capitalist landowners is beginning to
transform the relations of production in the agricultural field
as well as in the industrial. Agricultural production is low, not
merely because of the primitive methods adopted in cultiva-
tion or of limitations imposed by climatic conditions but par-
ticularly on account of the circumstances under which the
Indian peasant works. The ownership of the land under the
existing agrarian system is unequal and unjust, more than
five-sevenths of the cultivable land being in the hands of less

23

THE PROBLEM

than one-third of the landowners, who take full advantage
of the financial embarrassment of the cultivator and gradually
reduce him to a position where, to quote the Royal Commis-
sion on Indian Agriculture (1928), Tor land he must plead
before a creditor to whom he probably already owes more than
the total value of the whole of his assets'. For his bare subsis-
tence, he has thus to depend on the mercy of landlords and
usurers.

According to conservative official estimates, a holding of
about fifteen acres is required to yield an income sufficient to
supply the necessities of life; yet more than three-fourths of the
holdings are less, and for the most part considerably less, than
this size, the average holding being only five acres. Moreover,
the holdings of the smallest size (below one and a half acres)
are increasing out of all proportion to the larger and more
adequate holdings.

The productivity of the soil shows a steady decline through-
out India; the tracts renowned for their natural fertility (e.g.
the Gangetic Valley) have themselves reached a 'dead level*.
Even for the irrigated areas in the Punjab, Darling estimates
that eight or ten acres c are wholly insufficient, under present
conditions, to maintain him (the cultivator) in decency, inde-
pendence, and comfort 5 .

The disintegration of the old agricultural system is not com-
pensated, as it was in the West, by a very rapid expansion in
industry. On the contrary, the growth of Indian industry,
though appreciable, is slow compared with the decline in
agriculture. The superfluous agricultural population, even if it
were in a position to emigrate to the towns, is not readily
absorbed in the industrial enterprises. The conditions of indus-
trial employment, moreover, are such as have disappeared
from the advanced Western countries many decades ago:
incredibly low wages, excessively long hours, and wretched
working conditions. The productivity of Indian labour is ex-
tremely low, partly because of the vast surplus population
which floods the labour market and makes it cheaper for the
manufacturers to employ human labour than machines, partly
because of the crude methods which are still prevalent in the
mining and other organized industries.

This lamentable situation in agriculture and industry, which

24

THE PROBLEM

to some extent approximates to conditions in the West during
the early stages of the industrial revolution, is exacerbated by
the third distinctive feature of Indian economy, the domination
of British imperialism. From the point of view of the metropolis,
the fundamental purpose of a colonial empire is to supply a
source of raw materials as well as to provide a market for
manufactured gqods. It is not therefore to the advantage of the
imperialist country to foster the growth of either agriculture or
industry in the countries under its control deliberately for the
benefit of the indigenous peoples. For if agricultural produc-
tion exceeds that which is required by the metropolis, so that
the surplus can be exported to other countries, the former will
lose its privileged position as owner of cheap raw materials.
On the other hand, if there is a large development of indi-
genous industries, the colonial market for the manufactured
products of the mother country will contract.

Thus British Imperialism seeks to keep the population on the
land. In 1880 the Famine Commission observed that c the
numbers who have no other employment than agriculture are
greatly in excess of what is really required for the thorough
cultivation of the land 3 . But this tendency has been increasing
since that date. The census figures for the proportion of the
population supported by agriculture are instructive: from
6 1 per cent in 1891, the figure rose to 71-6 per cent in 1921
and 73-9 per cent in 1931. The vast irrigation works in the
Punjab, the United Provinces and Sind, involving the invest-
ment of over 100 millions which, at an average interest of
7-3 per cent, implies the financial enslavement of India to
Britain in perpetuity, while they open up many millions of
acres to agriculture, do not advance by one step the really
vital problems of the redistribution of the land and the intro-
duction of modern methods of cultivation.

Irrigation under feudal economy cannot benefit the actual
cultivator. Even in the Punjab the proportion of the landlords'
share to total income shows that the cultivator receives less
than 1 8 per cent as against 82 -4 per cent enjoyed by the land-
lord. As regards the progress of agriculture, only a small pro-
portion of the land is now cropped with improved varieties.
Agricultural research has chiefly been directed to crops of
commercial value and little has so far been done for the better

25

THE PROBLEM

cultivation of essential food crops such as rice, millet, fruits
and vegetables, and for the development of dairying. Agricul-
ture in India is thus essentially dominated by the motive of
producing cheap raw produce for the benefit of British com-
merce and the Indian bourgeoisie.

If the natural process of development from feudalism to
capitalism in the West produced serious nutritional problems,
it is clear that in India, where the transition from one economic
system to another is complicated and made more difficult by
imperialist domination, similar but more acute problems must
result. Here the alliance of foreign imperialism with the pro-
pertied classes, the establishment of complicated legal systems
for the protection of their rights, the maintenance of an agra-
rian system based largely on the renting of land, the consequent
separation of landownership from cultivation, the drastic trans-
formation of the village community through a centralized and
rigid administration, the policy of that administration to lend
support to a structure of rural economy which functions to the
disadvantage of the tillers of the soil, and, in fact, the whole
trend of development in the nineteenth century favoured the
growth of a complex variety of factors which created dis-
harmonies and intensified antagonisms between all classes and
between various religio-social groups.

But things cannot go on indefinitely in such a state of
anarchy. No matter where one looks in India one sees chronic
starvation, ill-health, and premature death. And if a very large
proportion of her peoples are beset with poverty of a kind
which finds no parallel in a civilized country, there can be no
security, no stability, and no peaceful adjustments in social
relations.

It is often argued that in the various Indian communities
there exists a sort of adjustment with the environment, and
that the food supply is both qualitatively and quantitatively
regulated in accordance with the needs of the peoples. In
reality there is every reason to believe that this is not the case.
The results of a number of local surveys of dietaries show that
the Indian communities have not been able to adjust their food
requirements to the circumstances of their life and labour.
Even if we admit the existence of some sort of equilibrium with
the environmental factors which include food supply, it cannot

26

THE PROBLEM

be denied that the standard of the adjustment falls far short of
any reasonable efficiency. After all, the mere survival of a
community is not an indication of the adequacy of its food
supply, and health is something more than mere survival. c lt
is often forgotten 5 , observes Sir Frederick G. Hopkins, 'that
such environment is fortuitous, and that the equilibrium
reached is one in which the community, while managing to
survive, may yet be functioning at levels far below those pos-
sible to its innate capacities.'

In some responsible quarters in India it is believed that the
'question of nutrition is primarily the problem of the urban
population on whom the pressure of all the complicated factors
of the civilization impinges' . * But it is sheer delusion to imagine
that the conditions of life and labour in our rural areas can
'keep the peasantry healthy and robust', and that our rural
population f eat well and sleep well'. The idea that in their
simple dietaries the villagers provide themselves with adequate
nourishment is a myth.

Even a casual visitor to India cannot fail to observe the poor
physique, under-developed muscles, stunted growth, and
anaemic condition of the bulk of her population. The majority
of the labouring class is starved, nervous, weakly, and morose;
derelicts, semi-derelicts, youths with the premature appear-
ance of old age crowd the industrial centres and mining areas
of India. If one cares to investigate further, it becomes evident
that the Indian masses have low powers of endurance, that
they are very susceptible to infectious diseases and that their
pessimistic outlook on life may even be due to their being
habitually undernourished or malnourished.

There is no proper survey of the composition of the dietaries
of the different races and communities in India; nor are we in
possession of sufficient data to estimate the degree of mal-
nutrition or chronic undernourishment of the peoples. But
there is an abundance of evidence that the ill-health from
which they suffer is largely due to defective diet. c lt must be
realized', writes Sir Robert Me Garrison, fi that normal nutrition
and health cannot be maintained on many of the diets now
used by millions of the people of India.' Facts are being
brought to our knowledge which show that many of the diseases
* Current Science, India, 1936.

27

THE PROBLEM

in India are due to nutritional maladjustments. Even when the
diets used by various communities in India are barely sufficient
in quantity, they are markedly deficient in quality. If inade-
quate in quantity, the lower food intake results in under-
nourishment; if deficient in some essential constituents, the
diet is not protective, and leads to ill-health <md disease. Or
againjif the necessary constituents are present but not in the
right proportions, the diet is not balanced and the symptoms
of malnutrition become manifest. The effects of such a state of
imperfect nutrition may not be evident at the outset in the
form of definite diseases, and they may not be reflected in the
vital statistics of the country. Nevertheless, a widespread con-
dition of health may prevail which can be described as the
'threshold state'. It is in this state of health that the bulk of the
Indian people ekes out its existence. With the advent of an
epidemic or an economic crisis the existence of this borderline
of actual malnutrition reveals itself not only in the high death
rate, but in greatly increased morbidity among the masses.

IV

In the preparation of the present volume two definite objec-
tives have been sought; first, to place before Indian students
a general summary of the findings of nutritional research;
secondly, to invite Indian public opinion to consider the prob-
lem of nutrition as a whole in all its implications. The diffi-
culties inherent in a proper solution of the problem arc many,
but in India they are rendered extremely complex by being
interwoven with the texture and custom of varied social struc-
tures. Indeed the roots of poverty are so welded with some of
our social customs, that sometimes it is difficult to discriminate
one from the other. The progress in the application of nutri-
tional science to dietary habits must depend not only upon the
raising of the standard of living but also upon the social
evolution of the peoples of India. The broader understanding
of the food requirements of the country and the formulation
of its economic policy in relation to those needs should result
in accelerating the process of that evolution.

In 1876 Carl Voidt, to whose contributions to the science of
nutrition we refer in tracing the history of its development,
observed in a moment of despair that 'the proper nutrition of

28

THE PROBLEM

man concerns no one, not even those classes which should take
the subject most to heart, and it is rare to find any one who has
a proper understanding of the subject. This shortsighted atti-
tude is due to the fact that such knowledge cannot be expressed
in terms of money. It is analogous to the shortsightedness of
the peasant who gives more attention to the nutrition of his
cattle, whose meat and milk he sells, than he does to that of
his children.' Since his time, however, there has been no abate-
ment in the enthusiasm for research on animal nutrition and
both the State and public opinion in advanced countries have
been making efforts to improve human nutrition.

In India nutritional research and education have only
recently received some attention from the Government; but
under the special circumstances of the country, there can be
no positive advance in these directions unless an alert public
opinion becomes fully aware of the dire consequences of leav-
ing the great bulk of the population to such a lamentable
condition. In India we are faced not only with the inertia of
the masses but also with the apathy of the educated communi-
ties. With the introductions of the new Governments Federal
and Provincial there have been definite changes in the ad-
ministrative systems of Public Health, agriculture, animal
husbandry, and other allied subjects with which the problem
of nutrition is interrelated. The direction of these subjects has
passed into the hands of Indians, and it is now time for them
to face the problem with courage and circumspection and with-
out ambiguity. They should bear in mind that thebalance sheet
of social economy in India shows a state of bankruptcy and
that it cannot be settled by any compromise with a medieval
social system or with the combined forces of imperialism and
complicated forms of landlordism to which we have already
referred. Our foremost need is to bring about a new orientation
in agriculture the only source of human nutrition. Time and
again, our attention has been drawn to the problem which is
presented in this volume; but as we have not overcome the
influence of those inhibitory factors which breed apathy and
conservatism, no solution of any consequence has been arrived
at. The decentralized scheme of administration under the new
Constitution should not be allowed to interfere with the policy
of considering the food economy of the country as a whole; for

29

THE PROBLEM

any policy designed to achieve substantial progress in nutrition
and health can only be effective if it embraces within its scope
all essential aspects of the economic and social problem.

v

It is not possible to discuss intelligently the problem of
health and nutrition without a basic knowledge of certain
fundamental principles upon which the science of nutrition
is based. Therefore in Chapters Two and Three I have
attempted to set out in non-technical language the broad
scientific aspects of the problem.

The fourth chapter of the book contains a brief account of
the prevailing conditions of public health in India with special
reference to our main theme. This is followed by a survey of
Indian foodstuffs. Data regarding the caloric arid biological
values, vitamin content, and inorganic constituents arc being
accumulated by the Nutrition Research Laboratories at
Coonoor and the All-India Institute of Hygiene and Public
Health in Calcutta. I have used these data whenever possible
in order to impress upon the educated Indian public that
researches of this character arc not of academic, interest only
but offer us a reliable guide to our dietetic requirements. In
writing this book I aimed at providing the reader with an
adequate knowledge of the essential facts of nutrition and of
the nutritive values of various foodstuffs so that he may appre-
hend their importance in adjusting his own as well as the
nation's dietaries to the best advantage.

A chapter is devoted to describing the salient features of the
diets of different Indian communities; but, owing to the
inadequate data available at the moment, it has not been
possible to show the relationship between their diets and
incomes. I have, however, endeavoured to analyse a number
of family budgets of our industrial workers in order to empha-
size the fact that the problems of nutrition cannot be divorced
from economic realities. It is greatly to be hoped that investi-
gations on a broad scale by appropriate organizations will be
made throughout India to correlate the state of nutrition of
the people with their incomes. Such a survey would reveal not
only the extent of the inadequacy of diet but also the varied
aspects of the problem of nutrition.

30

THE PROBLEM

For the guidance of my countrymen who are now at the helm
of the Provincial Governments I have given a brief resume of
what is being done in certain advanced countries, within the
limits set by political, social, and economic conditions, for
raising the standard of health through improved nutrition.
Although India- can draw upon the accumulated experience
of these countries, there are obviously many special problems
which have to be investigated under different and varying
conditions. It will, however, be seen that scientific investiga-
tion and the development of institutional feeding, important
as they are, can but touch the fringe of the problem, and that
its real solution depends upon far-reaching changes in the
forms of production, distribution, and consumption. Even in
the advanced countries of the West, it is being realized that the
problem of malnutrition and undernourishment is not entirely
or even largely a medical one and that its solution rests with
the capacity of nations to revalue and adapt their economic
and social structures in conformity with the circumstances of
modern life. The education of the people in the principles of
nutrition is, of course, helpful; but the capacity of choosing
food to the best physiological advantage is not enough. The
people must have the means of providing themselves with
adequate and proper diet, and should be given the opportunity
of purchasing it in the cheapest markets.

In the concluding chapter I have indicated how a substantial
advance may be made in India towards the solution of her
nutritional problems. Here the factual knowledge in regard to
nutrition, health, and income is incomplete. But the preva-
lence of widespread malnutrition and undernourishment
among our peoples cannot escape a discerning eye, and the
economic and social conditions under which the vast majority
are now suffering must remain a challenge to Indian states-
manship. While it is difficult to lay down precise methods of
approach to the problems of health, physique, and nutrition
of all the Indian communities and classes, some of the essential
steps towards the solution of widespread malnutrition may be
indicated. This I have attempted to do.

Our agricultural industry must be made alive to the urgent
need of adjustment to the optimum nutritional requirements
of the people. We have not only to find enough food but also

THE PROBLEM

the kind of food that is required for the maintenance of health.
India's diverse soils, climates, and methods of farming offer
conditions under which the natural subsistence of the peoples
should be abundant. Here Nature is not niggardly but the
system under which her resources are exploited is irrational.
However, the task of harmonizing both productive and dis-
tributive techniques is not easily attained and would, under
the politico-economic circumstances in India, require a pro-
longed and sustained effort. Meanwhile the symptoms of
degradation consequent upon poverty and ill-health have to
be arrested, the tillers of the soil and the workers in industry
must live and their children must find adequate nourishment.

It is imperative that Indian public opinion should realize
the importance of each and all aspects of the problem of
health and nutrition. The need for an organized drive towards
a solution is overwhelmingly urgent. It is not an exagger-
ated statement of Sir Robert McCarrison that 'The proper
nutrition of her people, the adjustment of the food supply to
the population and of the population to the food supply, the
provision of efficient sanitation in her towns and villages; these
are India's needs; all else is of secondary importance. 5

Medical science alone cannot arrest the physical deteriora-
tion of the human race without the active co-operation of the
social and economic sciences. The word Ayurveda literally
means the science of life and shows that the Hindus looked
upon health from a comprehensive point of view. The evolu-
tion of medical science in the West has led to the appreciation
of its relationship with various aspects of social life. 'Health is
recognized', observes Lieutenant-Colonel Stewart in address-
ing the Indian Science Congress, 'to be something more than
reaction of body to surroundings or to the mere absence of
disease. Man is a personality and an entity, a combination of
body, mind, and spirit. These are not really divisible parts of
men, however, but merely the results of analysis; it is the
indivisible combination that makes up the man. The concep-
tions of health now envisage the full development of these
powers, physical, mental, and spiritual, of which man is
possessed. 3

It is with the attainment of this positive health that the
science of nutrition is concerned and it is in positive health

32

THE PROBLEM

that life finds c the vital principle of bliss 3 . Its close relationship
with nutrition led the Aryan-speaking settlers in India to
regard food (Anna) as a source of cosmic energy (Brahma).
Even among the primitive races (e.g. Maori) food (Ha-o) is
synonymous With the breath of life.

The joy of living is man's precious heritage, and the science
of nutrition indicates how it can be restored to him. If econo-
mic and social circumstances prevent him from the realization
of positive health. Nemesis is sure to overtake the society in
which he ekes out an existence. When it does overtake, as it
has in India, social life loses its vigour and signs of moral and
religious debility become conspicuous. A great cause of India's
social backwardness may indeed be traced to widespread ill-
health of the masses, and if they view disease as an instrument
of divine wrath and consequently beyond human control, it
is because no sustained efforts have yet been made for health
education. The need of educating the public in matters relating
to nutrition is now stressed in every civilized country, and that
task involves, as Dr. Aykroyd puts it, the education of those
responsible for keeping the public well informed and the edu-
cation of the public itself. Both aspects are interdependent.

The time has therefore come for a nation-wide movement
for health education integrating both state and voluntary
activities. The structure of Indian agriculture can no longer
be left with conspicuous defects which seriously handicap the
application of science to that industry. Indeed some radical
reorganization of our agricultural system is overdue. Then,
with the appearance of the social circumstances inherent in
the growth of organized industries, we have a great responsi-
bility in maintaining a healthy population, without which
India will not be able to realize the full value of her man-
power.

But there is a deeper reason for our instituting an extensive
campaign for better health. We are engaged in a struggle for
India's liberation and aspire to reach our goal through unique
efforts based on non-violence. Essentially it is a spiritual
struggle and therefore its success is dependent upon the
achievement of a harmony between body, mind, and spirit.
Poverty, ignorance, malnutrition, undernourishment, ill-
health, disease all these are potent factors which render

33

THE PROBLEM

this harmony difficult to attain. As Dr. E. P. Cathcart observed,
malnutrition of the spirit is as prevalent as malnutrition of the
body and the one reacts upon the other. Since the momentum
of our national movement must come from the realm of the
spirit, there is no problem more urgent than tJtiat of health
and nutrition in India.

34

CHAPTER TWO

The Science of Nutrition
*

The History and Theory of Nutrition

Nutrition is defined as c the sum of the processes by which an
organism is nourished by absorbing substances different from
itself and assimilating them to substances identical with itself.
We should lay stress upon the word c sum 3 , because the con-
sumption of food is not identical with nutrition. It involves a
series of co-ordinated processes, such as mastication, digestion,
absorption, assimilation, excretion, and so on. The function of
the digestive system, for example, is to render food soluble,
diffusible, absorbable, and finally assimilable so that the body
may pick out those constituents it needs for reconstruction and
for fuel, and reject those materials which are useless. The body
functions through the energy released by the different food
constituents, and nutrition is nothing but energy exchange
through which the mechanism of the body and of its constitu-
ent parts is kept in proper running order. Food, as McCarrison
puts it, c is the instrument of nourishment; nutrition is the act
of using it ? . Nutrition is indeed synonymous with existence; or,
as Claud Bernard (1867) defined it, 'perpetual creation 5 .

The science of nutrition is one of the youngest of the sciences.
A hundred years ago practically nothing was known with
scientific accuracy about either the composition of the various
foodstuffs or the precise function which food plays in the
maintenance of the human organism.

It is true that from time immemorial there have been
theories about diet, and certain foods have been prohibited as
injurious or prescribed as health giving. Many of these taboos

35

THE SCIENCE OF NUTRITION
or recommendations, such as the prohibition of pork among the
Jews or of beef among the Hindus, are of a primarily religious
character and make no pretence to scientific principle. Pytha-
goras, on the other hand, with a parade of science, alleged that
it was deleterious to eat beans; while the German philosopher,
Feuerbach, ascribed most of the evils of civilization to the fact
that not enough beans were consumed. In his book, Castel of
Helth (1534)5 Sir Thomas Elyot recorded a few examples of
what food it was advised to avoid in the Middle Ages. 'Bean
skins cause constipation, dry the phlegm, injure the stomach
and eyes 5 ; 'Figs breed lice and stir up lust'; cheese by the
whole sentence of all ancient writers 'letteth [hinders] digestion
and is enemy to the stomach; also it engendereth ill humour
and breedeth the stone.'

In 15993 an Oxford physician, Henry Buttes, published a
treatise containing a number of cookery recipes and gave
solemn advice as to the dietary value of foodstuffs. To him
carrots were 'of small nourishment, slowly digested', but radish
/causeth leannesse, belchings, headache and lice'. Spinach
would 'cure the cough, make the belly soluble . . .'. He warned
us about pork, which caused c the gowte and sciatica', but the
meat of hare had a special virtue of 'procuring beautic, fresh
colour and cheerfull countenance'.

From that treasury of ancient and medieval lore, Burton's
Anatomy of Melancholy, we may learn all that was known of
nutrition up to the seventeenth century. Burton does indeed
ascribe great weight to diet as a cause of 'melancholy', and
quotes no less than twenty-seven authorities, ancient and
modern, on the subject. But a glance at some of his remarks
on individual foods will show his approach to the problem:
'Milk, and all that comes of milk, as butter and cheese, curds,
etc., increase melancholy (whey only excepted, which is most
wholesome) ; some except asses' milk.' 'Among herbs to be eaten
I find gourds, cowcumbers, coleworts, melons disallowed, but
especially cabbage. It causeth troublesome dreams, and scndeth
up black vapours to the brain.' Even our modern diet faddists
would hardly go so far as this! Fortunately there is no reason
to believe that anybody followed the advice of Burton and his
authorities; but it is interesting as showing what a depth of
ignorance of the very rudiments of nutrition existed even

36

HISTORY AND THEORY OF NUTRITION
among the learned at that time. There was as yet, in nutrition
as in the other sciences, no thought of empirical investigation,
of making experiments with foods and actually observing their
effects.

But Burton was a contemporary of Bacon, and with Bacon
the method of modem experimental science began. The seven-
teenth century, the Century of Genius', as Professor White-
head calls it, saw the rebirth and the triumphant progress not
only of the mathematical sciences but also of physics, astronomy
and preventive medicine. The scientific spirit which then arose
has continued to our own day and is continually making fresh
contributions to the sum of human knowledge.

Here at the very beginning of our study of nutritional
science, however, a warning must be given against hasty and
unscientific conclusions. This is especially necessary since diet
is a happy hunting ground for quacks and faddists, and is
easily exploited in advertisements by manufacturers of patent
food preparations. The scientific knowledge of nutrition which
we possess to-day, though in many respects incomplete and
even fragmentary, is quite sufficient to prevent us from jump-
ing to unwarrantable and unsound conclusions; and indeed
its very incompleteness should put us on our guard against the
grandiloquent claims that are made by the faddists for their
particular brand of diet. It is possible to lay down certain
broad scientific principles of diet with precision and certainty;
it is not yet possible to enter into the minutiae of diet, prohibi-
ting this, that or the other particular foodstuff, except in the
case of certain definite and limited therapeutic dietaries. Any
suggested diet which banishes some well-known and univer-
sally consumed foodstuff from the table, or segregates the
types of foodstuffs and insists on their being consumed separ-
ately, while it may embody some dietary principles that will
sometime be shown to be correct, is based, so far as our present
knowledge goes, on no scientific evidence whatsoever.

It is the purpose of this chapter to set out those principles of
nutrition that are known with certainty and based on trust-
worthy and tested evidence, showing in brief how the science
has developed from its first beginnings in the eighteenth cen-
tury, and indicating where clear knowledge is still lacking and
where further research is needed.

c 37

THE SCIENCE OF NUTRITION
Curiously enough the first scientific approach to the study
of nutrition was made not through medicine, as one might
have expected, but through chemistry. Already in the eigh-
teenth century Lavoisier (1743-94) showed that when an
organic substance burned, the products of combustion were
equal to the sum of the original substance plus oxygen, and
discovered that the process of heat production in man was
related to that of oxidation. That is, the oxidation or combus-
tion of food in the cells was similar to the combustion of coal
or wood to furnish heat. Oxygen is furnished by the lungs, and
carried by the blood to all the cells of the body. From the
process of combustion which takes place inside the body there
results the production of animal heat.*

It was not till more than half a century later that this impor-
tant discovery was put to practical use. By about the middle
of the nineteenth century the principle of the Conservation of
Energy had been definitely established; and in 1850 the
English physicist Joule (1818-89) proved that heat and energy
were interchangeable entities and that one could be measured
in terms of the other. The establishment of this principle made
possible the researches of PettenkofTer and Voit (1871) into the
energy output of living beings. Their experiments resulted in
the exact correlation of the energy output of an organism with
the energy supplied to it in food.

They devised a method of measuring the precise amount of
energy (or heat) given off by a living body under various
conditions. Every one knows how when several people are
sitting in a closed room the air becomes gradually warmer
and the atmosphere grows close and stuffy. This was the very
simple principle of PettenkofTer and Voit's celebrated animal
calorimeter 5 . They placed a man or animal in a carefully con-
structed chamber whose temperature could be kept perfectly

* Commenting upon his discoveries Lavoisier wrote during the hard
time of the French Revolution: 'Does it not seem a great injustice of
Nature that the poor labourer uses more of his body substance, while
superfluity, which is unnecessary for the rich, should be his portion? 3 He
hoped that the Revolution might bring about such circumstances as would
tend 'to equalize all incomes, to raise the price of labour, and ensure its
just reward'. It is said that he begged for two weeks more of life in order to
enable him to complete his experiments but was executed promptly. Such
was the fate of the man who laid the foundations of the modern science of
nutrition.

38

BASAL METABOLISM

even and which was supplied with instruments for measuring
on the one hand any rise in temperature owing to the presence
of a body in the chamber that is, the body's loss of heat
and, on the Bother hand, the exact volume of oxygen taken in
and of carbon dioxide given off- that is, the amount of com-
bustion that had taken place. From these measurements it was
possible to calculate exactly the amount of energy used up in
the processes of life.

Basal Metabolism

The energy was measured in 'calories',* or units of heat; and
it was shown that a man at rest expends approximately (food
equivalent to) 1,800 calories a day to keep his heart beating
and his respiratory muscles moving. This is called c basal
metabolism 3 , that is, the amount of energy required simply to
live, at rest in a warm atmosphere. In other words, the mini-
mum demand for energy is the amount which is required for
basal metabolism. Since the problem of estimating a diet in
relation to its energy value is dependent upon accurate infor-
mation about the basal metabolism, we shall consider it in
further detail.

It represents c the irreducible minimum 5 of the body's de-
mand for energy. Consequently the need for the energy repre-
sented in functional activities has to be superimposed upon
the basal metabolic rate. Benedict points out 1 that the basal
metabolism of an individual is a function of the total mass of
active protoplasmic tissue, and second, of the stimulus to
cellular activity existing at the time the measurement of the
metabolism was made. The technique employed in determin-
ing the rate of metabolism in a subject is by the measurement
of 'the quantity of energy expended per hour and per square
metre of the surface of the body of a subject completely at rest
and having fasted from 12 to 14 hours at 16 degrees G. and
sufficiently clothed to prevent reaction to external cold.'

The basal metabolism is dependent upon several variable
factors such as body-weight, age, sex, habits, profession, and
racial characteristics. But the variations influenced by weight

* A calorie equals the amount of heat required to raise a litre of water one
degree centigrade; or a pound of water four degrees F.

39

THE SCIENCE OF NUTRITION

and build, or by sex, are negligible. Age is of course an impor-
tant factor. Whether race per se is a factor influencing normal
metabolic rate is still an open question. An investigation car-
ried out in the Department of Zoology and Physiology at the
Women's Christian College, Madras, 2 on the basal metabo-
lism of South Indian women of ages ranging from 17 to 31
years, shows their basal metabolism is considerably lower than
the Western standards. The authors suggest that while this
difference indicates the influence of the racial factor, it may
also be related to a low protein metabolism so characteristic
among South Indian women.

According to other investigations, there is no essential differ-
ence in the basal metabolism in people whether living in the
tropics or in the temperate zones; nor is there a wide disparity
in its rate between vegetarian and non- vegetarian. It is of
course influenced by certain pathological conditions. Pro-
longed semi-starvation reduces and food intake raises the
metabolic rate.

The energy requirements of the body have been the subject
of extensive investigation and it is found that they vary accor-
ding to the size of the individual, the temperature of the en-
vironment and the amount of work he is doing, etc. Any
increase of physical exertion therefore leads to an increased
expenditure of calories. It has been estimated, for example,
that an average man doing sedentary work expends about
2,500 calories a day; while an active manual worker, e.g. a
farmer, expends 3,500. 3

Now since, according to the law of the conservation of
energy, energy cannot be newly created by the body, it must
be supplied from without; that is, it must be obtained from
the food taken in and oxydized or burned inside the body, or,
alternatively, from the food stored up in the body in the form
of fat. This combustion is the source of the energy which per-
mits the body to carry on its activities. Voit and Pettenkoffer
further showed that food burned inside the body produced
exactly the same amount of energy as food burned outside it.
It is therefore possible to determine the energy value of a
foodstuff by burning a known amount of it under definite
conditions and noticing the number of calories given off.

When, therefore, the amount of energy daily expended by

40

THE PROTEIN COMPONENT

persons in various occupations is known, the amount of food
required to supply this energy is also known, for both are
measured in calories and both are equal. If more food is eaten
than is required to produce the amount of energy expended it
will be stored up in the body in the form of fat. And, vice
versa, if less food is eaten than is required the extra energy will
have to be supplied by the use of some of the fat that has
already been stored up.

Thus the technique of calorimetry enables us to determine
the caloric requirements of individuals and also provides the
equivalent caloric value of food substances. It was then held
that the science of nutrition had come to a stage where the
knowledge in regard to nutritional requirements and diets was
complete. Indeed, Rubuer, in the last part of the nineteenth
century, declared that there was little further to be learnt in
the field of nutrition.

The Protein Component

But at the same time that these researches into the energy-
producing functions of food in general were being carried out,
investigations into the various foodstuffs in particular, their
classification and individual functions, were also being made.
The first step was again taken by a Frenchman, Francois
Magendie (i 783-1855), who showed that foods differ in chemi-
cal content. He was able to differentiate between the nutritive
values of the three substances protein or albumins, fats or
hydrocarbons, and carbohydrates (starches, sugars, and cellu-
lose) contained in foodstuffs, and made the distinction between
the nitrogenous and non-nitrogenous groups clear. His dis-
coveries were carried further by the great German biochemist,
Justus von Liebig (1803-73), who proved that carbon and
hydrogen, which are the fundamental elements of food, are
present in the various foodstuffs in the form of certain definite
chemical compounds. These compounds, discovered less than
a hundred years ago, are the now universally known substances,
protein, carbohydrate, and fat. It is they that form the major
nutritive constituents in food, and each must be separately
discussed.

The term 'protein 5 was coined by the Dutch physiological

41

THE SCIENCE OF NUTRITION

chemist Mulder (1802-80) from a Greek verb meaning c to take
first place 5 , in order to signify that it was an indispensable con-
stituent of every living cell. His observations upon this nutrient
element may be of interest. c ln both plants and animals a
substance is contained, which is produced within ,the former,
and is imparted through their food to the latter. To both, its
uses are numberless. It is one of the most complicated sub-
stances, is very changeable in composition under various cir-
cumstances, and hence is a source of chemical transformation,
especially within the animal body, which cannot even be
imagined without it. It is unquestionably the most important
of all known substances in the organic kingdom. Without it no
life appears possible on our planet. Through its means the chief
phenomena of life are produced. . . . This substance has
received the name of protein, because it is the origin of so
many dissimilar bodies, and is itself therefore a primary sub-
stance. 54

The chemical structure of proteins, which is very compli-
cated, was independently discovered by Kossel, Hofmeister,
and Fischer. The complex protein molecule is built up of a
large number of 'ammo-acids 5 .* Thus the proteins found in
different foodstuffs differ in chemical structure: that is, they
all have different combinations and different amounts of
amino-acids. This is a fact of great importance, for some
amino-acids are essential nutritive elements, others are value-
less. For example: ovitellin, protein of egg yoke, contains
5 per cent of the important amino-acid lysin, which is neces-
sary for growth; while zein, protein of maize, contains none.
Some proteins, such as gelatine, for example, are almost com-
pletely useless; others such as those of milk, meat, and eggs are
ideal. Thus in arranging diets it is not sufficient to allow
enough protein in general, but care must also be taken that
the proteins consumed do in fact contain the essential amino-
acids.

The specific function of protein is to build tissue, that is, to

create flesh and blood in the growing organism and to make

good the continuous destruction of tissue that takes place in

the body. Protein alone of all the food substances can build

tissue, and it is therefore of extreme importance, especially to

* See Table II 5 p. 60.

42

THE PROTEIN COMPONENT

children and persons who have not yet completed their growth.
It is not, indeed, protein itself out of which tissues are made,
but rather the amino-acids which compose it. When protein
enters the body it is split up in the process of digestion into
its constituent acids, which are then assimilated with the
flesh and blood. Thus it has been well said that 'amino-acids,
not proteins, are the bricks out of which the body builds new
tissue 5 . But these acids are not found in carbohydrate, fat, and
other food substances, and protein is therefore an essential
element in diet.

The body is subjected to a continuous drain of protein.
Tissue destruction and the consequent loss of protein go on
whatever the diet may be, and it is therefore necessary to
consume enough at least to make good this loss. Protein con-
tains about 1 8 per cent of nitrogen, and the 'protein exchange'
of the body is calculated by nitrogen measurements. That is,
the rate of tissue destruction can be measured by the amount
of nitrogen excreted by the body. In starvation the excretion
of nitrogen will be about four to five grains a day, for the body
will continue to metabolize protein derived from the breaking
down of its own tissue cells. In the case of adequate food intake,
on the other hand, a state of 'nitrogenous equilibrium 5 is
attained, in which the output of nitrogen will exactly balance
the intake, the loss due to destruction being made up by con-
sumption. The index of protein intake furnished by the exis-
tence of nitrogenous equilibrium is of importance as providing
a sure standard of adequate consumption of protein.

It is customary to divide the proteins into two groups accor-
ding to whether they are derived from animal or from vegetable
products. The questions, which group of proteins is superior,
and whether a reasonable diet must contain some of each, are
still under discussion, and a certain disagreement exists among
the authorities, though a definite conclusion appears to be now
in sight. Some authorities assert not only that protein require-
ments can be fully satisfied by a diet composed of vegetables,
especially cereals, potatoes, fruits, vegetable oil, etc., but further
claim that meat products are deleterious in other respects.
Hindhede is the chief supporter of this view, and his assistant
Madsen is said to have lived on a regime consisting largely of
potatoes and margarine for many months and to have kept his

43

THE SCIENCE OF NUTRITION

health and vitality. Other authorities, on the contrary, stress
the need for the animal proteins, milk, eggs, and meat, and
recommend that a high percentage of the proteins consumed
(from one-third to one-half) should be provided by these food-
stuffs. The ground for this contention is that the animal
proteins contain more of the essential amino-acids than do
vegetable proteins, and that they are on the whole easier to
assimilate. That is, the proteins derived from animal foods
have a higher biological value than those of vegetable origin.
The balance of informed opinion appears to be in favour of the
animal proteins both on the above grounds and because it is
very difficult to devise a diet from which milk, eggs, and meat
have been excluded which will be satisfactory not merely as
regards proteins but also as regards other essential dietary
needs (especially vitamins). Thus the recent 'Report on the
Physiological Bases of Nutrition 5 submitted to the Health
Organization of the League of Nations by twelve leading
authorities of six countries, declares without discussion that
'During growth, pregnancy and lactation some animal protein
is essential, and in the growing period it should form a large
proportion of the total protein. 5

On the other hand, the most recent and exhaustive study of
proteins, contained in a 'Report on the Protein Component of
the Human Diet' by Professor E. F. Terroine, 5 comes to the
conclusion that 'There is no need to include proteins of animal
origin in the diet of man, whatever the stage of life considered
and whatever the nature of the need to be satisfied.' This con-
clusion is based on exhaustive investigation, and M. Terroine
remarks that 'In recent years, attention has been so much
concentrated upon the provision of an adequate supply of
minerals, and especially of vitamins that certain physiologists
and a fair number of dietitians seem to have forgotten, if not
discounted, the predominant importance of energy require-
ments.'

We must pause a little longer over M. Terroine's remarkable
report, for it contains much that is new and important. Ter-
roine is able to shed much light on the hitherto unsolved
problem of the optimum protein intake; indeed, he appears to
have arrived at a definite solution of this question. By means
of various formulae it is possible to determine exactly the pro-

44

THE PROTEIN COMPONENT

tein requirements at various periods of life growth, main-
tenance, pregnancy, and lactation. First of all a table of
coefficients of 'digestive utilization 5 is drawn up for the various
common foods containing protein. This table shows the pro-
portion of protein in each foodstuff which the organism can
digest. A second .table is then drawn up giving the 'biological
value' of the foodstuffs. The biological value is the c degree of
ability of proteins to satisfy nitrogenous needs', or in other
words the proportion of protein which, when digested, can
actually be used by the organism for the creation or main-
tenance of tissue. As we saw above, the body daily expends
a certain amount of nitrogen, and in theory the amount of
nitrogenous substances absorbed would be exactly equivalent
to the loss. 'If, however, whilst containing all the necessary
constituents . . . the food proteins contain them in proportions
very different from those demanded by the body, then, clearly
and inevitably, the organism will have to waste the useless or
over-abundant components in order that a sufficiency of the
other requisite materials may be provided. In such a case a
given amount of protein destroyed in the organism cannot be
fully replaced by an exactly equal amount in the food; more
will be required, and the quantity will be the greater the less
the composition tallies with the needs of the body. 3

Now when the coefficient of digestive utilization and the
biological value are known, and when the nitrogen expendi-
ture (which, in the case of a man weighing 70 kilogrammes,
is approximately 3 grammes per day) has been determined, it
is possible to calculate accurately the quantity of protein,
whether of a single substance or of a mixture of substances,
which will satisfy the maintenance requirements of the organ-
ism. The formula is as follows:

, , . specific endogenous nitrogen expenditure x i oo x i oo

Maintenance^::-; : -, ^ ~--r p : ^-. -:

Biological value x coemcient 01 digestive utilization

Terroine works out this formula in the case of wheaten flour:
The protein content (of wheaten flour) is 1 1 1 grammes per
kilogramme, the Digestive Utilization coefficient is 96-8, the
biological value 50. For body maintenance in an adult of 70
kilogrammes weight, we shall therefore need:

45

THE SCIENCE OF NUTRITION

i8-7R grammes x ioox 100 c

^L? =42 grammes of protein, or

y o

42 X 1,000 f , ^ n 9

=379 grammes of wheaten flour.

The formulae of protein requirements for growth and for
pregnancy and lactation naturally differ from the one given
for maintenance, since in the case of the former the body needs
nitrogen not merely for making good the wear and tear of
tissue, but also for the creation of new tissue. It would be tire-
some here to go into the details of these other formulae, nor is
it necessary: the general principles are the same.

Thus, by means of these formulae, the protein requirements
of man at any period of his life, and for any proteinous food or
combination of foods, can be accurately determined. This is a
very great advance; we shall see its practical consequences
when we come to discuss the question of dietary standards.

Another important and novel result of Terroine's investiga-
tions is his demonstration, on the basis of these formulae, that
any food substance, with three negligible exceptions, which
contains protein at all, is capable of satisfying fully the nitro-
genous needs of the organism if it is taken in sufficient quantities
to cover the calorie requirements. Terroine illustrates this fact
by an examination of two substances maize and rice which
are both relatively poor in proteins.

c lf maize flour is taken/ he says, c the low biological value of
which shows it to be the least satisfactory of protein foods, the
quantity required to cover the 2,400 calories of body mainte-
nance and energy expenditure in an adult would be about 650
grammes. These 650 grammes contain 60 grammes of proteins,
whereas the needs can be satisfied by 38 grammes of a biologi-
cal value of 50, which is that of maize. 5

'Again, if rice is taken which is very poor in proteins
about 700 grammes will be needed to meet energy expendi-
ture, and this amount will provide 43 grammes of proteins.
Now, on the basis of the biological value (85) of the total
proteins of this cereal, 19 * s l - equals 22.3 grammes would be
needed. The margin between the actual intake and the mini-
mum requirement thus remains considerable. And if the food
intake is increased for energy reasons low temperature leaving
a deficit of heat production to be made up, or intensive work

THE PROTEIN COMPONENT

the protein supply will follow the upward trend and still
further exceed the nitrogen needs of the body. 5

Professor Terroine does not, however, deduce from these
facts that a diet consisting of a single food substance is to be
recommended. Quite apart from the fact that such a diet
would not supply the required vitamins and minerals, it is
undesirable also from other points of view, not least of which
is its unpalatability and monotony. Indeed, not the least
interesting and important part of Terroine's report is his
observations on 'supplementing', which we must now briefly
consider.

The problem of supplementing, Terroine declares, is c to
ascertain whether the mixing of various proteins in a composite
diet has any effect upon their respective properties and, if so,
in what way and to what extent'. The biological value of
proteins, on which as we have seen their usefulness depends,
varies greatly between the different food substances, ranging
from around 100 for meat and milk, to around 50 for certain
grains. The question then is: is it possible by combining in the
diet proteins of high with those of low biological value appre-
ciably to raise the biological value of the total proteins con-
sumed? Whether or not this is possible depends, of course, on
the amino-acid composition of the (two or more) proteins in
question; that is, on whether the amino-acids of the combined
proteins supply the nitrogen needs of the body more satisfac-
torily than either protein separately or at least as well as the
better of the two proteins. For in order properly to constitute
supplementing, the biological value of the combination should
be definitely higher than the arithmetic mean of the individual
values of the proteins.

Now, by determining the amino-acid composition of the
various foodstuffs, it is in fact possible to discover definite
combinations which will greatly increase the biological value
of the proteins concerned. A striking example is given by
Terroine: 'Supplementing may be asserted to occur as between
white flour (biological value of 52) and beef (biological value
69), since a mixture of these two, in proportions of two-thirds
for the former and one-third for the latter, gives a biological
value of 73, whereas the arithmetic mean would be 57. On the
other hand', he continues, c no supplementing can be said to

47

THE SCIENCE OF NUTRITION

occur as between white flour (52) and ovalbumin (85), since,
when mixed in the same proportions, they yield a biological
value of 66, whereas the arithmetical mean would be 62.'
Professor Terroine gives the following table of typical protein
combinations in which supplementing has be.en shown to
occur, and which are suitable for body maintenance:

White flour + whole egg
White flour + milk
White flour + meat
Maize flour + milk.

Thus, by judicious combinations of proteins, such as those
suggested in the table, in which supplementing takes place, 'it
is possible to raise the mediocre or medium protein to the level
of the best'.

The main conclusions of his investigation of supplementing
Professor Terroine sums up as follows: The certain superiority
of all mixed diets and the necessity of recommending, in human
nutrition, the use of foods from the greatest variety of sources;
the futility of including large quantities of protein of animal
origin in the diet, since its presence greatly enhances the value
of vegetable protein; the certainty that food protein require-
ments, as calculated above on the basis of a monotonous diet
of a single vegetable food having a comparatively low protein
quality, can be still further diminished by providing a mixed
diet consisting either of various vegetable products (cereals and
legumes) or a small admixture of animal products (milk or
meat).'

Carbohydrates and Fats

The chief nutritive function of carbohydrates and fats is to
supply energy. Unlike proteins they cannot create tissue; they
are 'the food of organisms rather than their living substance'.

Carbohydrate is produced by the action of the sun on the
chlorophyl of green plants which causes a reaction between
carbon dioxide and water and thus forms the organic com-
pounds that we call carbohydrates. The most important of the
carbohydrates are sugar and starch. These are changed into
glucose by digestive ferments in the mouth and stomach. It is
from glucose that the energy for muscular movement is derived.

CARBOHYDRATES AND FATS

Carbohydrate is, indeed, useful for other purposes besides the
production of energy; it may be transformed into fat and
stored in the body in this form ready to be used for the produc-
tion of energy when required; it serves to spare the breakdown
of protein; and it helps in metabolizing fat.

It is uncertain whether fat serves any other purpose than the
production of energy. There is some reason to believe that it
may, but the evidence is vague and inconclusive. Meanwhile
fat and carbohydrate are to a large extent 'isodynamically
interchangeable' 3 that is, the proportions of each in the diet
c may vary within wide limits without producing metabolic
disturbance 5 ; although too high a proportion of fat may lead
to ketosis. Fat is useful and pleasant as a concentrated form of
fuel, having a far higher caloric value than either carbohydrate
or protein; thus it reduces the bulk and adds to the palatability
of the diet.

Thus far we have been treading sure and solid ground. The
theory of calories and of the functions of proteins, carbohy-
drates, and fats was well established and even in part perfected
by the end of the nineteenth century. The view of the body as
a thermodynamic machine and of foodstuffs as the upkeep and
the fuel of this machine has been proved with the lapse of time
to be essentially correct, and the details of the picture have
been filled in and in many cases completed. Graham Lusk, the
great American authority on the physiology of nutrition, has
written: In the fuel factor and the repair factor lie the essence
of the science of nutrition.' 'The thermodynamic principles 5 ,
Burnet and Aykroyd declare, 6 'established by Lavoisier and a
long series of scientific workers rest on a secure foundation and
provide the basis of indispensable methods of measurement.'

As far as this part of the science of nutrition is concerned the
only important question that still remains open and in which
extensive research and experiment is still needed is the prob-
lem of standards, that is, the amounts of the various food sub-
stances to be eaten in order to insure the best possible state of
health and well-being. It is obvious, for example, that the
nutritional requirements must vary according to age, sex,
environment, physical condition, and occupation; but few
precise conclusions have yet been reached in this field. We

49

THE SCIENCE OF NUTRITION

shall discuss this question at a later stage, and shall find that
even here substantial agreement of a provisional character at
any rate has been achieved on a number of important points,
and the possibility of exact measurement is in sight.

But students of nutritional science were becoming increas-
ingly conscious of the fact that a diet which contained all of
the known essential food constituents did not insure optimum
health. In 1881, Lunin, a German investigator, had discovered
that mice fed on a synthesized diet composed of proteins,
carbohydrates, fats, and inorganic constituents could not live
and that something else in addition was necessary for the
maintenance of life. From his results obtained from synthesized
food substances, he drew the conclusion that c a natural food
such as milk must therefore contain besides these known prin-
cipal ingredients small quantities of other and unknown sub-
stances essential to life 5 . Several other investigators found that
dietary deficiencies persisted in the presence of an adequate
caloric intake. The quest led to a new field of research in the
science of nutrition and resulted in establishing a causative
relation between a number of widespread diseases and the
deficiency in the diet of small amounts of substances playing
an indispensable role in nutrition.

Vitamins

We now turn to the discovery and function of vitamins. The
work of Eijkman to which we shall refer in the course of our
discussion on beri-beri had demonstrated (1897) the existence
of a ' certain something 5 in unmilled rice and rice polishings
the lack of which produced disease. The indication that there
existed some essential dietary constituents apart from those
already known to the science of nutrition encouraged a group
of investigators to probe into the problem. Experimenting on
synthetic diets consisting of protein, fat, carbohydrates, in-
organic salts, and milk, a Dutch physiologist, Pekelharing,
confirmed Lunin 3 s conclusion and found that milk contained
an unknown substance which even in very small quantities
was of paramount importance to the maintenance of health.
He published his results in 1905, thus lending further proof
of the findings of Grips (1901), and drew the conclusion that

5

VITAMINS

'undoubtedly this substance not only occurs in milk but in
various foodstuffs both of vegetable and animal origin 5 .

'No animal can live upon a mixture of pure protein, fat, and
carbohydrate; even when the inorganic material is carefully
supplied, the animal still cannot flourish, 5 wrote Hopkins in
1906. He further said: The animal body is adjusted to live
either upon plant tissues or upon other animals, and these
contain countless substances other than the proteins, carbo-
hydrates, and fats. Physiological evolution, I believe, has made
some of these wellnigh as essential as are the basal constituents
of the diet. . . . The field is almost unexplored, only it is certain
that there are many minor factors in all diets of which the
body takes account. . . . 5 He foresaw c that developments of
the science of dietetics will deal with factors highly complex
and at present unknown 5 . His own experiments with young
animals showed that a diet adequate in the normal constituents
was unable to maintain growth without the addition of small
quantities of milk, and that some alcohol-soluble organic sub-
stance in milk would supply the missing factor found necessary
for growth. By plotting the results of a series of these experi-
ments he showed how the inclusion of milk in the diet con-
ditioned the well-being of the animals the curve of the milk-
fed group rose steadily until the supply of milk was withheld,
when there was a sharp decline. On the other hand, the curve
of the non-milk group sprang upwards on the introduction of
milk and crossed the peak of the curve of the other group. It
was obvious that some unrecognized substance possessing
extraordinary potency must needs be present in milk. This
food factor later received the name of Vitamin A.*

According to present knowledge, there are five distinct
classes of vitamins designated by the letters A, B, G, D, and
E; and they are defined as being 'definite tangible substances
wholly necessary for the maintenance of life 5 . Aykroyd says of

* The word 'Vitamin' was coined in 19 n by a Polish scientist, Dr.
Gasimir Funk, while working in the Lister Institute, London. He spelled
the word 'vitamine', the terminal syllables being an indication of chemical
composition; but later Professor Drummond suggested that, since none of
the vitamines then known really belonged to the e amine' group of chemical
substances, the terminal 'e 3 should be omitted. Vita because the substance
discovered in rice polishings 3 which prevented beri-beri, was essential for
life.

51

THE SCIENCE OF NUTRITION

them that they are 'food substances of no fuel value, but which
are necessary to life in the higher animals and which they can-
not themselves manufacture 5 . McCarrison observes: 'Vitamins
do not themselves contribute to the energy supply of the body,
but they facilitate the utilization by it of proteins, carbo-
hydrates, fats, and salts.' And elsewhere the same authority
writes: c Vitamins are not foods in the sense of tissue builders
or producers of energy, they have not been isolated, and their
nature and composition are unknown. What is known of them
has been learned from feeding experiments on animals. Two
are essential to growth and maintenance; the third is necessary
for normal nutrition and the prevention of scurvy. Without
vitamins . . . food is dead. . . . They are obtained from the
vegetable kingdom; plants appear to have the power of syn-
thesizing them, while the animal does not.'

This passage is interesting not only as giving a clear summary
of the functions of vitamins, but as showing what rapid advances
in this part of the science of nutrition are being made. Since
McCarrison wrote (1921) two more vitamins, D and E, have
been discovered, most of them have been isolated in pure
form, and one, C, has been made synthetically in the labora-
tory.

The fact that vitamins are present in foodstuffs in very
small quantities and that it has proved extremely difficult to
isolate them, has placed very great obstacles in the way of
their discovery and has retarded it until recently. But the
investigations in regard to these five vitamins have come to a
stage where we may draw certain definite conclusions from a
large number of experimental data. Each of these substances,
even in an extremely small quantity, is known to have specific
relations to certain structures and functions of the body.
McCarrison 7 sums up these relations as follows : 'Vitamin A to
epithelium and nerve; vitamin B to the gastro-intestinal tract,
nervous system and skin; vitamin C to the cement substance
that binds the cells of the body together; vitamin D to the
bones and teeth; and vitamin E to the reproductive system.'
By ensuring the functional efficiency of these different struc-
tures, each of these vitamins tends to afford protection against
disease. The vitamins are links in a chain of essential food
substances necessary for normal metabolic processes. In other

52

VITAMINS

words, the vitamins are not only mutually related but their
efficacy is dependent upon the adequate supply and utilization
of other food components. The aim and purpose of a 'balanced
diet' are to bring about and maintain nutritional harmony so
that it may contribute to the development of normal health.
In the following chapter we shall describe some of the diseases
caused by nutritional disturbances. We now attempt to sum-
marize our present knowledge in regard to the availability of
each of the five classes of vitamins.

Vitamin A

This is known as the fat-soluble vitamin, because it can be
dissolved by fat, and by ether and other substances in which fat
itself is soluble. Vitamin A and carotene have the same physio-
logical action and carotene has been called the 'precursor' of
vitamin A. The action of the sun upon green plants produces
the substance known as carotene, and this in turn is converted
into vitamin A in the liver. For this reason liver is one of the
most important of the foodstuffs containing vitamin A. One of
the richest sources of this substance is cod-liver oil but a study
of various other liver oils has shown that other fish oils, such as
salmon and halibut, may be more than one hundred times as
rich in the vitamin as a good Newfoundland oil. The liver fats
of the sheep, calf, and ox are also rich sources of vitamin A.
Vegetable oils are very poor in this substance. Other foods rich
in vitamin A are whole-milk and it is much more abundant
in the milk of pasture-fed than stable-fed cattle; fat-containing
milk products such as butter; tissue fats, kidneys, and eggs.
Ghee., i.e. clarified butter prepared from goat's milk, is also a
source of this vitamin. Fresh green vegetables and carrots, and
certain fruits (e.g. tomatoes, bananas, dates, mangoes) contain
carotene which can be transformed into vitamin A in the
human body. Germinated cereals and pulses contain it in
moderate amount.

Vitamin B

The water-soluble vitamin B is of a highly complex chemical
structure and six or seven fractions of it have been identified.
Two of these, Bi and B2, which have certain well-marked
differences in physical and chemical properties, are of great

*> 53

THE SCIENCE OF NUTRITION

importance in dietetics. Bi and Bs frequently occur together
as, for example, in dried brewer's yeast; but they may also
occur separately. Thus the white of egg contains Bs without
Bi, while wheat-embryo is rich in Bi and poor in Bs.

Vitamin B i is widely distributed in nature, being particularly
abundant in the germ and pericarp of cereal grains and in
legume seeds. It is also present in yolk pf egg, liver, nuts,
certain fruits (especially bananas, oranges, lemons, grapefruit,
apples, pears, prunes), and in various vegetables (such as
tomatoes, spinach, cabbage, lettuce, carrots, and potatoes).
The -leafy portion of green vegetables contains it in fair amount
but the richest source of this vitamin is brewer's yeast. Milk,
fruits, and muscle meats are relatively poor in it. Vitamin Bi is
relatively resistant to heat but is destroyed by prolonged cook-
ing above the boiling-point of water. Since it is readily soluble
in the water there is risk of losing a great deal of it if foods
containing it are boiled at the higher temperatures and the
water thrown away. The water used in cooking unpolished
rice should not therefore be thrown away, as it contains the
vitamin. Vitamin Bs is less sensitive to heat than vitamin Bi.
It is particularly important to notice that, while whole cereal
grains and pulses are rich in vitamin Bi, their content is con-
siderably reduced by milling. All milled cereals, such as
polished rice, are therefore poor in this substance.

The richest sources of vitamin Bs are dried brewer's yeast,
lean meat, fish, milk, cheese, eggs, peas, peanut meal, green
leafy vegetables, and tomatoes. It is not abundant in whole
cereal grains and root vegetables.

Vitamin C

This is abundant in fresh fruits and vegetables, particularly
the citrous fruits. Among vegetables, parsley, tomatoes, green
chillies, cabbage, young leaves of radish, other green leafy
vegetables, and green plantain contain fair amounts. Legumes,
otherwise poor in vitamin C, develop this substance when
sprouted. To a lesser extent it is present in unpasteurized milk,
at least during the summer when the cows are on pasture; and
very small quantities are also found in meat.

Vitamin C and ascorbic acid are the same, and since paprika
is a very fruitful source of ascorbic acid, it has been used for

54

VITAMINS

making concentrates of vitamin C. Meantime the chemical
structure of this vitamin has been discovered by Zsent-Gyorgyi,
and it is now possible to produce it synthetically in the
laboratory.

Vitamin C is the most unstable of the vitamins; although
acidity seems to increase its stability. It is easily destroyed by
cooking and especially by methods of tinning or preserving;
hence stress must be laid on the value of fresh fruits and
vegetables. Processes of tinning are, however, beginning to be
devised which do not injure the vitamin C content of food-
stuffs. Burnet and Aykroyd recommend that 'public health
authorities, in drawing up regulations about food preservation
and sterilization, should bear the problem of vitamin C des-
truction in mind'. Fruits and vegetables in storage under
ordinary circumstances lose a considerable portion of their
vitamin C content.

Vitamin D

Discovered by McCollum, who was also responsible for the
discovery of vitamin A, it was the first of all the vitamins to be
isolated in a pure form. For a long time, however, it was
confused with the fat-soluble vitamin A, partly because its
most plentiful source, cod-liver oil, was known to contain
vitamin A and to be at the same time one of the cures for
rickets. It is not very widely distributed in nature, its chief
source being liver and yolk of egg; summer milk and butter
contain it in small quantities; and it is especially abundant in
fish liver and fish oils. It is absent from vegetable fats. It is the
only vitamin which, as far as is known, can be formed in the
body by the action of the ultra-violet rays of the sun. Food
substances may also be activated in the same way or by
artificial ultra-violet irradiation.

Vitamin E

This is fat-soluble and fairly widely distributed in natural
foods such as cereals, green leafy vegetables, and in various
kinds of vegetable oils. Wheat-germ oil is the richest source of
this substance. It is heat-resistant and retains its potency under
acid or alkali treatment.

There are as yet no exact quantitative data as regards the

55

THE SCIENCE OF NUTRITION
human need for these vitamins, but Nature is not niggardly in
their supply. An adequate intake of a reasonably varied diet
that includes fresh vegetables, fruits, milk, and milk-products
would satisfy the normal requirements of vitamins in health.
The Advisory Committee on Nutrition, appointed by the
British Ministry of Health, considers that the supply of vitamins
and also of inorganic substances would be Assured if the daily
diet contains one pint of milk, one orange or tomato, or a
helping of raw salad, one ounce of butter or vitaminized mar-
garine; if a moderate amount of cheese were included in the
diet, or if some sort of fish, such as herring, appeared in the
winter menu once a week, or in default of fish if half a tea-
spoonful of cod-liver oil were taken once a day.

In therapeutic diets vitamin adequacy is estimated in accor-
dance with the circumstances of the patient. In the treatment
of chronic gastro-intestinal disorders, or of chronic infections,
or in the case of expectant mothers, the intake of vitamin Bi
should be, for example, higher than its normal requirement.
The nursing mother requires from two to five times the normal
amount for her own needs of vitamin Bi if she is to supply
enough in the milk to provide the offspring with this substance.

Inorganic Substances

In addition to the proteins, carbohydrates, and fats which
are needed for tissue repair and for energy, and the vitamins
that are equally necessary for normal growth and maintenance
and for protection from disease, the body requires certain
inorganic substances which, though they are only needed in
small quantities, are no less essential than vitamins. The tissues
of the body contain no less than fifteen chemical elements
which are constantly being thrown off and must be replaced.
The most common chemical elements entering into the com-
position of tissues in addition to carbon, hydrogen, nitrogen,
and oxygen, are calcium, phosphorus, iron, iodine, potassium,
sodium, magnesium, sulphur, and chlorine. These salts make
the ash which is left after the combustion of food. Animal foods
supply acid ash, such as sulphates, phosphates, and chlorides;
and vegetable foods and fruits alkaline ash, such as carbonates.
In the next chapter we shall refer to the deleterious effects

56

INORGANIC SUBSTANCES

upon the organism resulting from the deficiencies of these
inorganic substances.

The energy-producing foods do not in general contain all
these inorganic substances and they must therefore be supplied
in leafy green vegetables and fresh fruits. From a dietetic point
of view, the first four of the elements mentioned above are of
chief importance, the rest being supplied in sufficient quantities
in most ordinary diets. Calcium, phosphorus, iron, and iodine,
however, are often present in inadequate amounts. We must
therefore briefly consider the function of each of them and
enumerate the foodstuffs in which they are to be found.

Calcium is necessary for the proper formation of the bones
and teeth; the promotion of bone-calcification is closely asso-
ciated with the presence of both calcium and vitamin D.
Calcium is equally required for the clotting of the blood and
the maintenance of the heart-beat. There is a constant supply
of calcium in the blood, estimated at 8 to n mg. per 100 c.c.;
thus, the body contains more calcium than any other of the
inorganic elements, and 99 per cent of it is to be found in the
bones. The chief sources of calcium are milk, egg-yolk, cheese,
black treacle, green vegetables of various kinds, watercress,
dried figs, and almonds. The calcium intake is particularly
important during pregnancy and lactation, and in infancy and
childhood when the bones are still being formed.

Phosphorus is also necessary for the formation of the bones,
and for the brain and nerves. This element is the chief partner
of calcium. It has been shown that the anti-calcifying effect of
many cereals is due to their deficiency in available phosphorus.
Milk, cheese, egg-yolk, lean meat, liver, fish of all kinds, whole
wheat, spinach, nuts, almonds, are some of the foodstuffs
which contain phosphorus. An absolute deficiency of it is not
common among human beings, but it is a problem of great
importance in the feeding of livestock, for large areas of land
are lacking in it; and in these areas human diet may also be
deficient.

In 1838 a Swedish chemist named Berzelius showed that
the red colouring matter of blood was capable of absorbing
much oxygen and concluded that this was due to the iron in
this pigment. His conclusion has been confirmed by physiolo-
gists, who find that this element is essential for the formation of

57

THE SCIENCE OF NUTRITION

haemoglobin, which carries oxygen through the blood stream
to the tissues. The richest sources of iron are lentils, egg-yolk,
whole wheat, spinach, prunes, dates, and raisins.

TABLE I*
'Energy-bearing 5 and 'Protective'. Foods

Food

c Good'

Min-

Vitantins

protein

erals

A B C D

Milk

-f +

j r + +

4- + +0 +0 "1

Cheese

+ +

_!__[_

i- _i_

EEggs

-+_]_

+ +

_l_ _|_-|_ _j__|.

E Liver

+ +

+ +

+ ++ +

E Fat fish (herrings,

etc.)

+

+ + + +

Highly

Green vegetables,
salads
Raw fruit, fruit

+

+++

+ _[_ J I
~r "1 T

i pro-
*" tective
foods

juices

+ + +

+ t + ++ -

E Butter

__

_

4. _ +0

Cod- liver oil

Yeast

+

+

++

Meat (muscle)

4-

_L

-f JL "|

Root vegetables,

tubers

+ * + +

Legumes (dry

Less

peas, lentils)
E Cereals, bread
(wholemeal)
E Cereals, bread

+

JL

i

pro-
tective
and
?

(white)
E Cereals, rice
(polished)

ENuts

J-.

J I

pro-
tective
foods

E Sugar, jam, honey

E Margarine, olive

oil and other

vegetable oils

E = foods of high energy or caloric value.
+ + + signifies very rich.
+ + signifies rich.

+ signifies present.

J_ signifies present in small amount or traces.
signifies absent.

signifies in summer, when the cows are on pasture,
f signifies, if yellow in colour.

* Taken from Interim Report of the Mixed Committee on the Problem of
Nutrition, League of Nations, June 1936.

58

TWO MAIN GROUPS OF FOOD SUBSTANCES
Investigations have shown that for mineral metabolism it is
necessary to maintain a ratio between the essential mineral
constituents. One example of the importance of this ratio may
be cited here. Diamard 8 was able to produce rickets in young
rats by adding iron to their diets to such an extent as to reduce
their phosphoruSoretention. An addition of phosphate, on the
other hand, diminished the utilization of ingested iron.

Iodine is an important constituent of thyroxine the chief
internal secretion of the thyroid gland and therefore its supply
is necessary for ensuring the proper functioning of the meta-
bolic process which is largely controlled by the gland. The
iodine content of foods varies with the locality as well as with
the season. Sea salt and sea foods are rich in iodine; shrimp,
crab, lobster, salmon, oysters, contain a high percentage. The
richest source is cod-liver oil. Milk, especially goat's milk,
contains a small quantity of iodine. Among condiments, gin-
ger, black pepper, coriander, and cloves are comparatively
rich in iodine.

Two Main Groups of Food Substances

These are then the essential food-constituents. Before we
discuss the principles of practical nutrition work it is useful to
emphasize that these food-constituents may be divided into
two main groups, one consisting of those which are known to
supply energy; the other providing the materials necessary for
the maintenance of the functions of the body as a whole and of
its constituent parts. In the first group are included the foods
rich in fats and carbohydrates and in the second those rich in
'good' proteins, inorganic substances, and vitamins. Because
the foodstuffs in the first contain nutrients which yield muscu-
lar energy, heat (calorics), they are classed as 'Energy-bearing 3 ;
and those in the second which provide nutrients lack or insuffi-
ciency of which results in poor health or disease are known as
'Protective 5 . This classification of foodstuffs, though not pre-
cise, may help us to understand the principles of modern die-
tetics. The relative food values of both the groups are shown in
Table I, and from this we may form an idea how it is possible to
obtain in practice a correct balance between them. A large
variety of different combinations of the two groups can be sug-

59

D

C/3

W

u

D

CO

Q
O
O

ffi

O

DIETARY STANDARDS

gested in order to satisfy the dietary requirements of normal
individuals. It should be borne in mind that a diet containing
too high a proportion of energy-bearing foods is as harmful as a
diet providing excessive proteins; protein starvation on the
other hand results in stunted growth and reduced vitality. Or,
a diet deficient in> vitamins and inorganic constituents offers no
protection against, ill-health and disease. Indeed, the correla-
tion between the two groups is of great importance since a diet
must be judged as a whole. A familiar illustration of the exis-
tence of such a correlation in nature is found in the composition
of human and cow's milk; in human milk energy-bearing sub-
stances total 88 per cent and those required for structure 12;
in cow's milk energy-bearing substances form only 67 per cent,
leaving 33 per cent for structure.

In Table II we have the structural formula of food constitu-
ents. In our discussion on protein we have mentioned that the
'biological value' of various proteins in human nutrition de-
pends largely upon the amino-acid constitution. Proteins exist
in colloidal form and are broken down into simpler compounds
which are known as ammo-acids. While fatty acids and carbo-
hydrates are effective sources of energy, amino-acids are able
to fulfil the dual function of supplying energy to the body as
well as building-materials for its structure. The chemical
radicals of fatty acids and carbohydrates show a marked simi-
larity in their structure, but those of amino-acids are compli-
cated and varied. All these radicals are dispersed and utilized
by the body during the processes of digestion and assimilation.

Dietary Standards

The question of dietary standards, that is the problem of
answering the questions: What constitutes an adequate diet?
What are human requirements as regards calories, fat, protein,
vitamins, etc., and in what proportion should the various food
factors be combined? is of great difficulty and no conclusive
answer, universally agreed to, can as yet be given. The science
of nutrition has, however, advanced to a stage where we may
have an objective standard derived from a large number of
experimental data, and certain recommendations can be made
at least as regards the energy-producing foods,

61

THE SCIENCE OF NUTRITION

There are two ways of assessing the individual's calorie re-
quirements: what may be called the direct and the indirect
methods. The direct method is by the use of the calorimeter
described above. It has been well established by this method
that the basal metabolism rate of an average individual is
from 65 to 75 calories per hour, or about 1,700-1,800 per day.
Any sort of physical exertion adds a certain number of calories
to this basal rate. Thus eating adds about 10 per cent; sitting
up in a chair about 8 per cent; ordinary movements may
add as much as 29 per cent. All these bring the total calories
up to about 2,200 per day. More violent exercise, such as
walking, adds still more, and Lusk., from whom these figures
are taken, concludes that an individual pursuing a sedentary
occupation consumes about 2,500 calories per day. These
must be supplied to him in his food if he is. to be properly
nourished and not to use up his own reserves of energy.

These figures may be checked and confirmed by the indirect
or statistical method of investigation. This consists in ascertain-
ing how many calories are in fact consumed by average persons
in ordinary circumstances when their choice is in no way
restricted. A great deal of such material has been collected,
and it has been found to be in substantial agreement with the
conclusions drawn from calorimeter tests. A standard some-
what higher than that proposed by Lusk has in the past been
generally accepted, and the figure of 3,000 calories per day has
become famous in nutritional investigations because it was the
one adopted by several of the early investigators in this field
such as Voit, Atwater, and Rubner. The modern tendency is
toward a slightly lower standard in the neighbourhood of that
suggested by Lusk. Thus the Conference on Standards of the
Health Organization of the League of Nations, while adopting
the 3,000 standard for reasons of convenience of comparison,
remarked that it was definitely high and that e a figure of 2,700
or 2,800 would be nearer the mark'. The recent Report of the
Technical Commission of the Health Organization lays it
down that An adult, male or female, living an ordinary every-
day life in a temperate climate and not engaged in manual
work, is taken as the basis on which the needs of other age
groups are reckoned. An allowance of 2,400 calories net per
day is considered adequate to meet the needs of such an

62

DIETARY STANDARDS

individual. 5 The Report continues: 'The following supplements
for muscular activity should be added to the basic require-
ments:

Light work up to 50 calories per hour of work.

Moderate work up to 50-100 calories per hour of work.

Hard work up to 100-200 calories per hour of work.

Very hard work up to 200 calories and upward per hour of
work. 5

The Report then gives the following table of coefficients and
calories for other ages. The figure 2,400 is taken as the basis
(unity) and the requirements of other ages are expressed in
terms of it:

Age (years) Coefficient Calories

1-2 0-3 720

2-3 0-4 960

3-5 0-5 1,200

5-7 0.6 1,440

7-9 0-7 i, 680

9-11 0*8 1,920

11-12 0-9 2,160

12 and upwards i-o 2,400

(male and female)

Women: Pregnant i-o 2,400

Nursing 1-25 3,ooo

The Report further comments: c The muscular activities
characteristic of every healthy child and adolescent necessitate
additions to the basic requirements shown above. It is suggested
that the activities of children of both sexes from 7 to 1 1 years
be considered as equivalent to light work, of boys from 1 1 to 15
years as moderate work, and of girls from 1 1 to 15 upwards as
light work. Allowance must also be made for women engaged
in household duties, whether pregnant or not; these have to be
reckoned as equivalent to light work for eight hours daily.'

We should refer here to an interesting computation made by
Aykroyd of daily energy requirements of a carpenter, 1 1 stone
in weight. It is as follows:

Calories

8 hours' sleep at 65 calories per hour 520

2 hours' light exercise at 170 calories per hour 340
8 hours' carpentry at 240 calories per hour 1,920
6 hours' sitting at rest at 100 calories per hour 600

The total requirements for the day 3,380

THE SCIENCE OF NUTRITION

In the chapter where we discuss some of the main features
of Indian dietaries, we shall refer to what little information
there is about the scale of energy requirements of average
individuals of different age and sex in India. It is necessary
to bear in mind that a diet may be adequate in its caloric
values but it may be still deficient from the point of view of
maintaining a proper nutritional balance. Many of the sophis-
ticated foods may be actually high in caloric value but
deficient in protective food constituents. The calorie is not
the only criterion by which food should be valued. No one
will of course seriously maintain' , observes Cathart, 9 'that
nutrition can ultimately be reduced to the satisfying of the
energy demands: the calorie factor may be regarded as
strictly secondary to the supply material We do not live on
calories, yet all our general estimates of food requirements
are quite properly for the most part made in terms of calorics.
Calorie value is simply a very convenient physical standard
for the assessment of diets, but merely because such a stan-
dard has proved of great utilitarian value there is no real
justification for placing this standard as the foundation stone
of hypotheses framed to offer an explanation of cellular
activity. Many writers are obsessed with the idea of the calorie,
forgetting that the organism is certainly not a heat engine.
It is perfectly true that calories are a measure of heat, but
it must not be forgotten that we do not consume actual heat
units but only potential heat-giving' substances which can
eventually be degraded to the form of heat and be measured
as such. The thermal aspect of nutrition is unduly stressed, for,
while heat may be a necessary product of tissue activity, it is,
after all, a by-product,'

In determining dietary standards, the emphasis should be
laid on the qualitative aspects of food, providing an optimum
diet required for the individual, and the efficacy of these stan-
dards has to be judged by their relation to health and power
of resistance to disease.

The question of the amount of protein to be consumed is
more difficult. Burnet and Aykroyd remark: There is no
existing "standard of protein intake" which rests on the sure
ground of experimental evidence, and the question, What is
the optimum protein intake? hotly debated by physiologists.

DIETARY STANDARDS

physicians, economists, and dietary faddists, cannot be
answered. 3 Some authorities recommend a low protein
intake, others a high one; and the evidence seems to be
conflicting.

On the one hand it is alleged that a high protein intake may
cause renal hypertrophy and other injury to the kidneys. New-
burgh, McCollura, and other investigators have carried out
extensive experiments on rats whose diets contained from 30
to 40 per cent of protein, and have found evidence of renal
lesions. Others, on the contrary, having fed rats on a diet
containing 70 per cent of protein have observed no adverse
effects. On the other hand, it is pointed out that races whose
diet is rich in protein are superior in physique and energy to
those whose diet contains little. As an example of this two East
African tribes have become famous, the Masai and their
neighbours the Akikuyu. The former live on a diet composed
largely of 'meat, milk, and blood', the latter on one composed
of cereals, tubers, plantains, legumes, and green leaves. The
Masai are taller, stronger, and in general physically superior
to the Akikuyu. 'But the diet of the Akikuyu', remark Burnet
and Aykroyd, c as compared with that of the Masai, is deficient
not only in protein, but also in fat, and certain vitamins and
mineral salts.' And in general it is the case that few conclusions
can be drawn from the superiority of the races whose protein
intake is high, for their diet differs also in other vital respects
from that of races subsisting on a low protein intake.

The result of M. Terroine's researches, which approach the
problem from the physiological point of view, is the formula-
tion of a more definite and precise answer to the question of
the standard of protein intake than any that has yet been
given. We have explained above how it is possible to arrive at
a fairly exact measurement of protein requirements at any
period of life once the coefficient of digestive utilization and
the biological value of the protein foods are known. As we saw,
the requirement is a variable dependent upon the biological
value of the different proteins, and therefore the amount varies
for each protein or combination of proteins. Tor a man of 70
kilogrammes', says Terroine, 'the requirement will be ex-
pressed by the formula 3j j^ 00 , where N is the biological value
of the food concerned' and the number 3 is the specific

65

THE SCIENCE OF NUTRITION

endogenous nitrogen expenditure for a man of 70 kilogrammes.
With this formula it is possible to determine accurately for
every protein food the quantity that is required, as soon as its
biological value is known.

Terroine insists that a consumption appreciably above this
amount is not to be recommended. The extra protein beyond
that needed to supply nitrogen is, of course, used by the
organism for the creation of energy; but on general physio-
logical grounds it may be said that the consumption of protein
to supply energy is undesirable. Terroine speaks strongly on
this subject: The problem which arises at this point ... is
that of the comparative value of the proteins on the one hand
and the ternary foods on the other. Now, on every ground,
whether physiological or economic, the former prove to be
markedly inferior. Whether the needs to be satisfied are merely
those of energy expenditure on function, or whether they com-
prise expenditure both on function and on the performance of
mechanical work, what the system demands is glucose; the
administration of protein involves straightway a loss of 35 per
cent of the potential energy supplied, owing to the operation
of the specific dynamic action. Whenever, during the cold
season or in cold climates, the need is for heat production,
because the current conditions of life (clothing, heating, hous-
ing, work) leave a deficit to be made up in this respect, a
greater proportion of protein in the diet is admissible, since the
heat output entailed by the specific dynamic action is then
turned to account. But even in such a case, fats will be much
more favourable, for they contain twice the energy per unit of
volume. If to these considerations there is added the fact that
proteins leave waste products which make extra demands upon
the kidney functions, it will be realized that the use of such
foods to supply energy is not only pointless but completely
irrational.'

Furthermore, at least in the case of growth, the consumption
of too large a quantity of protein actually impedes the meta-
bolism of nitrogen. c lt must not be forgotten', says Terroine,
c that there is absolutely no advantage to be gained by increas-
ing the protein intake above the amount necessary to meet
total specific endogenous expenditure, and the needs of protein
production for growth. The results of observations made in this

66

DIETARY STANDARDS

connection, whether upon the rat or the sheep or the pig, are
in complete concordance; as soon as a certain level is exceeded,
which may obviously vary according to the quality of the pro-
tein administered, the nitrogen gain not only ceases to rise but
it decreases and, as a first consequence, the gain in weight
becomes smaller. .A still further rise of protein intake would
greatly retard development.'

Finally., on economic grounds, the use of protein to supply
energy needs is to be deprecated. With very few exceptions the
foods rich in protein are very much more expensive than those
composed largely of carbohydrates. And to the actual cost of
the foods, moreover, one has to add one-third to allow for the
loss of energy entailed by the specific dynamic action. M.
Terroine concludes that: 'An abundance of protein in the diet
for the purpose of meeting energy requirements is thus nonsense
twice over i.e. physiologically and economically.'

As in the case of calories, so in that of proteins, the modern
tendency is to a smaller rather than a greater consumption.
Thus Rubner's standard of 127 grammes, Attwater's of 125,
and Voit's of 1 18 have given place to the standard of 100 pro-
posed by the Advisory Committee, the 80-100 of Tyszka, and
Burnet and Aykroyd's suggestion of 70-100. Finally, the Report
of the Technical Commission says: c ln practice, the protein
intake for all adults should not fall below one gramme of
protein per kilogramme of body weight.' For a person weighing
150 pounds, this works out at about 68 grammes per day.

So great a change in the standards recommended a de-
crease of very nearly half, from 127 to 68 may cause surprise,
and even doubt as to the precision of any of these standards.
There is much truth in the remark of Burnet and Aykroyd that
'physiologists, in drawing up dietary standards, are largely
influenced by the dietary habits of their time and country 3 . It
must be admitted that up to the present time the recommended
standards are at best only approximate, and cannot claim
absolute validity. With the work of Professor Terroine, a stan-
dard of protein intake resting on a more scientific and experi-
mentally verified basis appears to be in sight. We have seen
that Terroine insists that protein intake should be strictly
limited to that required for the building up or replacing of
nitrogenous materials. Commenting on the standard proposed

THE SCIENCE OF NUTRITION

by the Technical Commission, he says: 'When we go back to
the old rule of one gramme of food protein per kilogramme of
body-weight, we may say that the margin we are thereby
allowing is extremely generous if the diet is varied; for a person
of 70 kilogrammes body-weight, it will have the effect of sup-
plying the organism with at least three times tne amount of
protein needed to meet specific nitrogenous requirements, if
the food given is of high quality; even with the poorest foods,
requirements will be met nearly twice over. 3

In the ordinary diets of Western countries carbohydrates
supply from one-half to two-thirds of the fuel or energy require-
ments of man; while fat provides from one-fifth to one-third.
In poorer communities less fat and more carbohydrates are
used, while among the richer classes the reverse is the case. The
Advisory Committee of the British Ministry of Health recom-
mends a fat intake of 100 grammes and a carbohydrate intake
of 400 per day. With this recommendation Burnet and Aykroyd
appear to be in general agreement, but they remark: c We have
no knowledge as to the optimum proportions of these food
factors in the diet.' The Technical Commission says laconically:
Tat must be a constituent of the normal diet, but the data at
present available do not suffice to permit a precise statement
of the quantity required.' And about carbohydrate require-
ments it is silent.

We may sum up these remarks on standards of intake by
reproducing from the Burnet-Aykroyd Report a Table of
dietary standards put forward by various authorities as suit-
able for average men:

TABLE III
Dietary Standards

Fat

Carbo-

Protein

(in grmms.}

hydrate

Calories

n8

56

500

3.055

127

52

509

3^92

125

'25

450

3.520

Voit

Rubner

Atwater

Advisory Committee

(Min. of Health) 100 100 400 3 ? ooo

Playfair 119 51 531 3^40

Tyszka 80-100 60-80 500 3,000

N.B. The Advisory Committee recommends 37 grammes, Tyszka 40
grammes of animal protein.

68

DIETARY STANDARDS

It will be seen that in all these standards the larger proportion
of calories is supplied by carbohydrate, though in the more
recent ones fat also supplies a high proportion, indeed more so
than appears at first sight because fat has a much higher caloric
value per gramme than protein or carbohydrate. Thus pro-
tein and carbohydrate produce 4-1 calories per gramme, while
fat produces 9-3 calories. On the basis of the Standard of the
Advisory Committee the proportions of calories supplied by
the three energy-producing food substances would be approxi-
mately: protein 14 per cent, fat 30 per cent, and carbohydrate
57 per cent. In this connection we would refer to an interesting
suggestion made by Lusk. He said that it would be advisable
to sell foodstuffs by the 100 calories as a means of promoting
economy so that the consumer may get some idea of the actual
food value he obtains for his money.

A reference may here be made to various standards sug-
gested for India. McCarrison's estimate of a dietary standard
for the southern part of India is as follows: protein 90-100,
fat 80-90, and carbohydrate 360-450 grammes intake per day.
According to Aykroyd, a well-balanced diet should consist of
73 grammes of protein, 74 grammes of fat and 408 grammes of
carbohydrate supplying total calories of 2590.

It is at present impossible to deal satisfactorily with the
problem of vitamin requirements from a quantitative stand-
point.' And much the same situation exists as regards the
inorganic substances.

We have, however, abundant evidence of the importance of
calcium for the growing child and of the form in which this
requirement may be adequately satisfied. The main conclu-
sion, supported by numerous and varied experiments, is, to
quote Sherman, 10 that Tor children of all ages from 3 to 13
years, inclusive, an average intake of not less than one gram
of calcium per day (about twice as much as the maintenance
requirement of an average man) is needed to support an opti-
mum rate of storage in the normally growing child'. But it has
also been demonstrated that better storage results when this
substance is furnished mainly in the form of milk, than when
one-half of the milk is replaced by vegetables of equal calcium
content, even though the vegetables be selected and prepared
with the greatest care to make them as acceptable to the children.

E 69

THE SCIENCE OF NUTRITION

According to Orr and Leitch 11 the minimum requirement
of iodine is 457 for adults and 1507 for children of school
age. It is estimated that 5 mg. of absorbed iodine per year
would be sufficient for an adult. It is important to note
that considerable heat is lost through sweat. Now, sweat con-
tains various mineral substances. The loss of these substances
by perspiration must be replaced; and it w.ould seem that the
quantities required in a warm climate like that of India are
greater than in the cooler climate of Europe. Thus in Europe
the loss of heat by evaporation is 25 per cent, while in the tropics
it is as much as 40 per cent.

Burnet and Aykroyd give estimates for vitamins and inor-
ganic substances which have been made by various authorities
on the basis of what information exists. These are summarized
below in the form of a table:

TABLE IV

Estimates of Daily Requirements of Certain Vitamins and
Inorganic Substances

Vitamin A 4,200 international units* (Rose)

Vitamin Bi 300 (Cowgill)

Vitamin C 600 (Rose)

Vitamin D 50-250 (Hess & Lewis)

Phosphorus 1-32 grammes (Sherman)

Calcium -68 grammes (i gr. for children, 1-6 gr.

for pregnant women) (Sherman)

Iron 15 milligrammes (Sherman)

Iodine 147 (Von Fellenberg)

* With the manufacture of numerous kinds of vitamin preparations and
their extensive use both in prophylactic and therapeutic treatments,, it
became necessary to adopt certain standards and units of vitamin potency.
The methods of estimating vitamin potency are still rather cumbrous and
the second conference on vitamin standardization held in London in 1 934
under the auspices of the Permanent Commission on Biological Standardi-
zation of the League of Nations Health Organization considered the
possibility of adopting standards based on accurate tests. The conference
recommended the adoption of pure fl-carolene (C 10 H W ) as the Inter-
national Standard for vitamin A, defining the unit as e thc Vitamin A
activity of o'6 microgram (o-6y)' of pure /J-carotene. For vitamin Bi
the unit should be 10 milligrammes of the International Standard adsorp-
tion product. The Unit of Vitamin C activity should be 0-05 milli-
gramme ^-ascorbic acid (C 6 H 8 O fi ) which is regarded as the International
Standard, and of vitamin Di milligramme of the International Standard
solution of irradiated ergosterol (may be replaced by an equivalent solution

70

PRACTICAL DEDUCTIONS

The names in the right-hand column are those of the authori-
ties responsible for the suggested standard. Burnet and Ayk-
royd sum up the situation with regard to vitamin standards as
follows: 'Satisfactory quantitative data being absent, we must
emphasize the necessity of a very abundant supply of the
known vitamins. There is no evidence that any diet composed
of natural foodstuffs contains vitamins in such excess as to
produce harmful effects, and, on the other hand, we know
that vitamin deficiency produces the most serious conse-
quences.'

Practical Deductions from Nutritional Research

We may now ask what practical conclusions can be drawn
from the wealth of well-established and newly discovered facts
in the science of nutrition, a brief resume of which we have
attempted to set forth in this chapter. Let us glance back over
our results, summarize them, and show how they may, and
should, affect our actual diet.

One of the most outstanding facts that emerges from our
study is that the science of nutrition has two branches. One
branch deals with the theory of calories, and treats the body
as a thermo-dynamic machine for the production of energy;
the other branch considers the body as a living and growing
organism whose cells and tissues require constant replacement
and are subject to the attacks of various diseases and ailments
from which they must be protected. Neither of these views of
the body is adequate by itself, for the body is both an organism
and a machine; and it has been found that the science of
nutrition can only progress if both aspects and functions of the
body are constantly borne in mind.

We have seen that historically the theory of calories was dis-
covered first, although logically and physiologically it should
come second, for without the organism there would be no
machine. The historical priority of this aspect of nutrition is
probably partly due to the fact that the science was first

of pure crystalline vitamin D in olive oil) which has been found equal to
that of 0'025 micrograms (0*0257) of crystalline vitamin D (C^H^Otl) .
As regards vitamins B2 and E, the present knowledge of their nature and
possible complexity did not justify the adoption of standards and units for
them.

71

THE SCIENCE OF NUTRITION

approached, as we have shown, from the point of view of
chemistry and physics rather than from that of medicine or
biology. However this may be, the energy-producing function
of the body was well established by the end of the nineteenth
century. The quantity of energy daily expended by the body
and hence the quantity that must be furnished to it by way of
food had been determined with considerable accuracy. It
remained for later investigations merely to give precision to
principles already clearly defined. The exact function of the
food substances known as carbohydrates, fats, and proteins as
producers of energy has now been fully established. In short,
the theory of calories provides us with an instrument of
measurement which is invaluable in determining the amounts
of the energy-bearing foods which are required by the organ-
ism. The practical result of this branch of nutrition is to show
that energy is chiefly derived from the carbohydrates, particu-
larly flour of various kinds, sugar and glucose, and from the
fats. It should be especially noted that the caloric value of fats
is twice that of either carbohydrates or proteins (9-3 calories
per gramme against 4-1) and that fats therefore provide a con-
centrated and palatable source of energy. Finally, the proteins,
while they may be used to supply energy if the need arises, are
not to be recommended for this purpose both because they are
physiologically wasteful may even be detrimental if taken in
large quantities and economically extravagant. The theory
of calories, then, and the caloric value of the various foodstuffs
have been firmly established on scientific principles, and it
seems probable that little more remains to be discovered con-
cerning this branch of nutrition.

The other branch of nutrition that which deals with the
body as an organism though only lately discovered, has
made great progress within recent years, and important new
facts are constantly being brought to light. The body is a
complicated matrix of cells and tissues. For a long period both
before and after birth these tissues are in a process of continual
growth, and even after growth has ceased the tissues arc being
constantly worn out or used up and must be replaced if the
organism is to continue in a healthy state. It has been shown
that the tissue-builder of the body is protein, or rather the
animo-acids of which the proteins are composed. When the

72

PRACTICAL DEDUCTIONS

proteins enter the body they are decomposed in the digestive
system into their constituent acids, which in turn are absorbed
into tissue. Much progress has been made in the investigation
of the constitution of the various proteins and in determining
the kinds and amounts of amino-acids that the organism
requires. The time is in sight when it will be possible to express
exactly the quantity of protein to be consumed and the com-
binations which provide the most useful constituents for tissue-
building.

Proteins alone, however, are not sufficient to ensure good
health. Vitamins and minerals are also required. These sub-
stances are neither tissue-builders nor energy-producers, but
vitamins are essential for the proper metabolism of other food-
stuffs and for the protection of the body from disease, while
minerals are required in order to replace all those mineral
elements in the tissues which are being used up in the processes
of life. The discovery of vitamins was one of the most important
steps forward in the science of nutrition. Not only did it
suddenly provide a solution to the hitherto mysterious problem
of the aetiology of certain diseases, such as beri-beri, kerato-
malacia, and rickets; it showed, and this was if possible more
important, that the old theory that all dietary necessities could
be adequately covered by a sufficient supply of calories was
radically faulty. It became apparent that, quite apart from
the specific diseases caused by lack of vitamins, a very large
amount of general ill-health, reduced power of resistance, and
susceptibility to infection could be ascribed to the same cause.
The emphasis in dietetic standards was thus shifted from the
problem of quantity, which according to the old caloric view
was what chiefly mattered, to the problem of quality. The
question changed from, what is the optimum quantity of food
to consume, to, what, given an adequate supply of calories, is
the optimum proportion of the various foodstuffs in the diet?
The former question was comparatively easy, and had been
answered with a fair degree of accuracy by the end of the last
century. The new question has not yet been fully answered.
Much still remains to be discovered about vitamins; the stan-
dards of vitamin measurement are still in a rudimentary stage,
and it is impossible to solve the problem of intake until the
difficulty of precise measurement has been overcome.

73

THE SCIENCE OF NUTRITION

This does not mean, however, that no recommendations can
be made. The British Advisory Committee on Nutrition in
their memorandum to the Ministry of Health put forward five
criteria which in their judgement should be considered in
assessing a diet. They are: (a) the caloric supply per person;
(V) the quantity of 'good' protein; (c] the supply of inorganic
substances; (d) the vitamin content; and (&} the absolute and
relative amounts of protein, fat, and carbohydrate. Enough is
already known to indicate accurately certain principles of
reasonable and 'balanced' diet.

First, an adequate supply of energy must be assured. This
should be derived largely from carbohydrates and fats, in pro-
portions that may vary within wide limits according to taste.
Although, as we have been emphasizing, the problem of the
supply of energy is not the all-inclusive one it was long thought
to be, yet it is highly important, in view of the fact that there
are still, even in England, many millions of people whose diets
are inadequate in caloric value. Thus energy requirements
must remain the foundation on which the superstructure of
nutrition may be erected.

Secondly, enough proteins must be consumed to supply,
during growth, the amount required to build new tissue, and
during adult life, to make good the wear and tear that is
continually going on. The amount of protein required will
vary according to the kind of protein used and to the com-
binations in which it is consumed.

Thirdly, care must be taken to include in the diet a suffi-
ciency of vitamins and minerals. Except in the case of expec-
tant mothers and of infants, the average diet of the well-to-do
classes of the West generally contains an adequate supply of
these substances. Almost universally, however, there exist
striking deficiencies in the diet of the poor. The foodstuffs
which contain an assured supplysuch as fresh fruit and
vegetables, milk, eggs, and liver oils are almost everywhere
so needlessly expensive that they cannot be purchased by the
poor in quantities sufficient to ensure an adequate provision
of protective foods. This is one of the major social problems
exposed by the recent advances in the science of nutrition.

These three principles constitute the basis of the theory of
balanced diet. How can they be translated into practice, how

74

PRACTICAL DEDUCTIONS

can they be expressed in more concrete terms? We cannot do
better than quote the words of Burnet and Aykroyd: 'One of
the principles which emerges is the desirability of a mixed diet;
the many fopd factors which are necessary for life and health
are more likely to be supplied by a varied diet than by a
monotonous one. -A second important principle is the value of
a large intake of the "protective foods" milk and green vege-
tables, to which may be added fruit. Milk and cheese are rich
in calcium and supply proteins of high biological value, and
vitamin Bs. Milk fat in its various forms is an important source
of vitamin A. On account of its high content of valuable food
factors, milk is a necessary food for children and for pregnant
and nursing mothers, making good the deficiencies of meat,
root vegetables, tubers, and cereals. ... In general, green
vegetables resemble milk as regards protective food value; they
are moderately rich in calcium, vitamin A, and the water-
soluble vitamins, notably vitamin C. As a source of iron they
are superior to milk; fruits are valuable in that they supply
vitamin C, and for other reasons. The encouragement of the
production and consumption of these "protective 5 ' foods is a
valuable public health activity.

c Once the consumption of "protective" foods is assured,
elasticity in the remainder of the diet is permissible and choice
may be allowed free range. Meat, which some class among the
"protective" foods, in moderation, is a useful and palatable
article of diet, supplying first-class protein and vitamin Bs;
glandular organs and blood are, however, richer in vitamins
and mineral salts. Unmilled cereals are richer than milled
cereals in proteins, mineral salts and vitamins, and, for this
reason, American workers have recommended that one-third
of the cereal should be in unmilled form; the same opinion is
also being advocated in France. This, applied to the moder-
ately varied diets of Western civilization, seems a reasonable
idea, to which may be added the suggestion that children and
pregnant women should consume wholemeal bread. The
greater the quantity of cereal in the diet, the more important
it becomes that the more nutritive parts of the grain should be
consumed. . . . Dietary requirements, thus stated, seem re-
markably simple; there is nothing here that could not be
readily grasped by an uneducated peasant or manual labourer.

75

THE SCIENCE OF NUTRITION

The real problem lies in the fact that in all countries the great
mass of the people, mainly because of ignorance and poverty,
do not reach the simple standard of dietary excellence de-
manded by modern nutritional science.'

In the following chapter, where we discuss some, of the conse-
quences of dietary deficiences, we shall see -what happens to
the state of health in the event of a serious reduction in the
consumption of the essential constituents which go to form the
optimum standard of human diet.

CHAPTER THREE

Some Consequences of Dietary Deficiencies

*

Diet and Disease

'Life is impossible without food; food is the source of the
growth, strength, and healthful glow of our body; but, it is
irregularity of diet which brings about ill-health 3 ; such is the
comment of Susruta,* a Hindu medical writer of ancient
India, upon the relation of food and health. What he meant
by 'irregularity' is not clear from the text; but, according to
Charaka, another exponent of the Hindu science of medicine,
health (sukka) is described as that condition of the self when
all the elements (i.e. humours) work together in harmony.
Disease is a disharmony caused by the dissociation of the
functional unity of the organism.

In our survey of the development of the science of nutrition
we have observed that nutrition is the sum of the physiological
processes concerned in the growth, maintenance,' and repair of
the living body. It is, as McCarrison observes, a function of the
body on which condition of body that is, health depends.

Recent advances in the study of the relation of diet to health
have shown how dietetic deficiency gives rise not only to cer-
tain specific diseases but to the conditions favourable to the
prevalence of a wide range of illness. It is held that barring
infectious diseases and accidents nearly 75 per cent of human
ailments may be traced to food deficiency. Gastro-intestinal
disturbances, various forms of anaemia, beri-beri, scurvy,
rickets, pellagra, osteomalacia, keratomalacia, night blindness,
and dental caries all these have been found to arise from
* Probably he belongs to the tenth or ninth century B.a

77

CONSEQUENCES OF DIETARY DEFICIENCIES
nutritional maladjustments. The relationship between the diet
and sickness is indeed a matter of lowered vitality and reduced
resistance to disease. It has been demonstrated that a direct
relationship exists between the price of essential foodstuffs and
the epidemic malaria. Finally there are symptoms of indirect
effects of dietary deficiencies, the examples -of which arc well
known to trained observers. Retarded growth, loss of nervous
energy, restlessness, feeble-mindedness, loss of memory, and
various eccentric abnormalities may be regarded as indirect
effects of undernutrition or malnutrition.

The function of preventive medicine, as so admirably put by
Sir George Newman, is c the building of a better tabernacle for
the soul of man to inhabit 3 . Owing to the discoveries of bac-
teriology, disease which fouled that tabernacle was thought of
as being necessarily associated with positive agents such as
parasites, bacteria, toxic substances, etc. The means of control-
ling infectious diseases have proved to be a boon to mankind,
but degenerative diseases persist. To-day the science of nutri-
tion has widened our conception of the relationship between
diet and disease and we have evidence to show that if the
physical stamina of an individual is not allowed to be under-
mined by dietary deficiencies, he does not easily crumble
under adverse circumstances^' Long ago Francis Bacon main-
tained that the cure of diseases requires temporary medicines,
but longevity is to be procured by diets 5 . It is now established
that a liberal allowance of food rich in protective constituents
(e.g. vitamins and inorganic substances) provides positive
health and prolongs life.

McCarrison 12 found no macroscopical evidence of disease in
1189 rats fed on a well-balanced diet composed of whole
wheat, pulse, raw milk, butter, fresh vegetables and fresh meat
with fat and bones occasionally. On the other hand 2,243 rats
fed on an ill-balanced diet composed mainly of cereals, little
or no milk, inadequate fresh vegetables, and fats derived from
vegetable sources showed very diverse pathological condi-
tions'. He was thus able to induce optimal health in his animals
fed with a balanced diet and reared under hygienic conditions.

Clinical observations have established the fact that sus-
ceptibility to various forms of infection is closely related to the
state of nutrition of the people and that undernutrition, or

78

DIET AND DISEASE

malnutrition due to imbalance of the proper dietary constitu-
ents, does seriously interfere with the normal functions of the
body. It is common knowledge that famines are usually
accompanie4 or followed by pestilences and that food supply
plays an impgrtant role in warfare when methods are adopted
to cut it off with the object of reducing the physical .endurance
of the enemy's troops.

But the intimate correlation of diet and disease in day-to-day
life is not adequately realized. As public opinion on matters
relating to the problems of nutrition and health becomes
increasingly enlightened and as researches broaden some of
the fundamental conceptions of the incidence of disease, a
great step will be taken toward human welfare. Indeed, to
quote McCarrison, 'the newer knowledge of nutrition is the
greatest advance in medical science since the days of Lister.
When physicians, medical officers of health, and the lay public
learn to apply the principles which this newer knowledge has
to impart . . . then will this knowledge do for medicine what
asepsis has done for surgery.'

Dietetics, which is concerned with the practical application
of the c newer knowledge of nutrition', now forms an integral
part in clinical practice aiming at the maintenance of nutritive
equilibrium in the patient. It will be a great advance in clinical
medicine when disease is diagnosed not on the basis of local
pathological condition alone but on the general physiology of
the patient as well as on the state of his nutrition /Diet therapy
is coming to be recognized as an important factor in the treat-
ment of many common ailments. Scourges like scurvy, rickets,
beri-beri, pellagra, and other diseases related to dietary defici-
encies have been brought under control; but these achieve-
ments, great as they are, are not so significant for the human
race as a whole as the acquirement of knowledge which, by its
application to society, will improve the health of every man.

In this chapter we shall consider some of the consequences
of dietary deficiencies and note what are the characteristic
deficiency syndromes of the essential food-constituents. While
the causes of what is known as deficiency diseases may be
multiple, two main conditions, namely the accessory factor
(i.e. vitamins) and the factor to which it is accessory, are
essential for their prevention.

79

CONSEQUENCES OF DIETARY DEFICIENCIES

Concepts of Malnutrition

Health is dependent upon (i) adequate food, ,(2) quality of
food, and (3) approximately correct balance, in regard to
essential food constituents. In our discussion on the question
of 'balanced diet' we have explained that fin order to achieve
nutritional equilibrium a diet should contain the optimal
amounts of proteins, fats, carbohydrates, vitamins, inorganic
salts, water, etc., required to keep the body neither over- nor
under-nourished.. Such a diet aims at the restoration and
maintenance of health and of physical and mental efficiency
at the highest possible level. The problem of ideal nutrition is
a complex one, because a series of reactions involved in the
intricate processes of metabolic functions in the body is asso-
ciated with it. While underfeeding, overfeeding, and defective
diet may cause nutritional disturbances, there may be other
causative factors not directly related to actual foodstuffs. For
example, a constitutional defect in an individual or the pre-
sence of some forms of infection may seriously affect meta-
bolism. In other words, effective utilization of food by the
body is 'the denominator of the equation of nutrition'.

Investigations show that the state of nutrition may also be
dependent upon racial characteristics, climatic conditions,
social habits, age and sex; but broadly speaking, basal needs
may be regarded as being approximately the same in different
parts of the world.

Before we turn to the definition of such terms as under-
nourishment, malnourishment, and malnutrition, we should
refer to another important factor which determines the level
of nutrition. It is the method of cooking.* On it depends, to
a considerable extent, the absorbability of the essential food-
constituents in a diet.

I By under-nourishment is meant a dietary condition in which

there is an actual insufficiency both in quantity and in quality

of the nutritive substances the body needs for repair and

maintenance, and for keeping the body weight at the normal

level. It is usually indicated by the loss of body weight, though

under-weight is not necessarily an index of undernourishment.

* See p. 203.

80

CONCEPTS OF MALNUTRITION

It may exist without ocular evidence of waste; but if it is
prolonged for any length of time, we have the symptoms of
functional disturbances in the absence of an obvious patho-
logical lesion.. Thus, the slow deterioration of the physique of
a people, their diminished vitality, consequent lack of en-
durance and resistance and the lack of efficiency in work are,
indeed, some of the indications of undernourishment.

Malnourishment is related to any dietetic regime which is
deficient not in quantity but in quality. That is, if a diet fails
to provide all the essential nutritive substances in correct pro-
portions, it may cause malnourishment. A liberal supply, for
example, of energy-bearing foodstuffs without a proportion of
protective foods will not maintain normal health. The effects
of such partial deficiencies in essential food substances are
reflected in lowered resistance to disease and general depres-
sion of health.

Malnutrition, however, is in a different category. It is a term
not easy to define and c to be avoided as often as under feeding
will do the work' . While the causes of malnutrition are many,
inadequate or ill-constituted diet appears all too often as one
of the fundamental sources of mischief. 'The word malnutri-
tion', 13 writes the International Labour Office, c might be best
reserved to indicate the state of ill-health of a population or of
any group of a population in so far as that state is caused
either by undernourishment or malnourishment. 5 It is not
merely underfeeding, as McCarrison tells us, but disorder of the
function of nutrition brought about c by the prolonged use of
food in which certain essential constituents are either absent or
present in insufficient amounts'. While, for example, we have
sufficient evidence to conclude that vitamin deficiency per se is
the initiating factor in the causation of certain diseases, we
should remember that by mere inclusion of certain items of
food rich in vitamins, the diet is not made satisfactory. Not
only should a balance be maintained between the two groups
of food substances, namely, energy-producing and protective;
but also between the different constituents of each group.

Further, even when a dietis perfect from the nutritional point
of view, there may be various factors which interfere with its
proper utilization. Chronic infections may, for example, pro-
gressively affect nutrition; or Congenital anomalies' retard

81

CONSEQUENCES OF DIETARY DEFICIENCIES
proper assimilation of food, leading to malnutrition. Among
other aetiological factors, environmental conditions, such as
prevail in slums and in insanitary Indian villages, are very
important. Certain morbid physiological states may give rise
to conditions of malnutrition which may not .show definite
signs even to medical men until they have been exerting their
influence for some time. Many forms of dietary deficiencies are
insidious because, while their results in an advanced stage are
grave and obvious, in their earlier stages they are undiscernible.
The continuance of disturbed metabolism is, of course, indi-
cated in general appearance, muscular tone, the texture of the
skin and certain characteristics of veins of the individual. The
difficulties inherent in the problem of determining malnutri-
tion are clearly stated by Sir George Newman in his report to
the Board of Education of Great Britain. He writes: 14

'Sound nutrition is a general physiological condition which
connotes a healthy body in all respects and the good tone and
health of its various constituent parts, its brain and nervous
system, its muscular, digestive, circulatory, and lymphatic
systems. All this means that we must take a wide and compre-
hensive view of nutrition, which is a state revealing itself in a
variety of signs and symptoms. Thus, in endeavouring to esti-
mate a child's nutrition or its opposite (viz. malnutrition), we
must think not only of bulk and weight of body, but of ratio of
stature to weight; of the general balance and "substance" of the
body and of its carriage and bearing; of the firmness of the
tissues; of the presence of subcutaneous fat; of the condition
and process of the development of the muscular system; of the
condition of the skin and the redness of the mucous membranes;
of the nervous and muscular system as expressed in listlcssncss
or alertness, in apathy or keenness; of the condition of the
various systems of the body, and, speaking generally, of the
relative balance and co-ordination of the functions of digestion,
absorption, and assimilation of food as well as of the excretion
of waste products. It is obvious that these are data which arc
likely to lead to a much more reliable opinion than the con-
sideration of any one factor or ratio, however cxpcditiously
obtained or convenient in form or practice; and these data will
demand a wider as well as a more careful and accurate obser-
vation of the whole physique of the child. Nor can any ultimate

82

METHODS OF DETECTING MALNUTRITION

opinion always be formed at one inspection at any given
moment. For nutrition, like its reverse, malnutrition, is a
process and not an event.'

We make this long extract from a distinguished British
medical officer with a view to assisting the instructed Indian
public in realizing the extent of malnutrition among the various
strata of Indian communities. While research may yet yield
better methods of diagnosis and classification, a general con-
sideration of all the facts concerning the physical well-being of
the Indian population will show that malnutrition is more
prevalent than all estimates or statistics indicate.

Methods of Detecting Malnutrition

Since it is rather difficult to set up a definite standard by
which the degree of malnutrition may be measured, a number
of methods arc now employed in detecting the various grades
of malnutrition.

The exact determination of an individual's 'state of nutri-
tion 5 is not so easy a matter as might at first sight appear. The
first difficulty to be faced is the meaning of the phrase 'state of
nutrition'; how much should be included in this term, and
what should be its limits? There are some who would limit its
meaning to the very restricted idea of the amount of fleshy
covering which envelops the skeleton. But this criterion is not
in general satisfactory for judging a person's state of nutrition;
for it is by no means the case that thin people are necessarily
malnourished, while excesses of fat are no less a sign of defec-
tive nutrition than is excessive thinness.
' Most authorities in England and America give the phrase
^state of nutrition' a wider meaning. Thus Sir George New-
man, Chief Medical Officer of the Ministry of Health, defines
it as c the total well-being and right functioning of the whole
body', and declares, as we have already quoted, that height,
weight, substance, colour, elasticity, balance, and carriage of
body, the effective functioning of the nervous system, heart,
lungs, and alimentary tract, the readiness and relative strength
of the muscular system, arc all relevant to the determination
of an individual's state of nutrition. This is of course a very

83

CONSEQUENCES OF DIETARY DEFICIENCIES

comprehensive definition, but it is one which has gained wide
support and has much to recommend it. Naturally other fac-
tors besides diet, for example, lack of sleep, overwork, and
chronic infective disease, may influence an individual's 'state
of nutrition' when understood in this wide sense; but diet still
remains one of the most important influencing "factors.
/ The specific methods for assessing the state of nutrition may
be divided into three groups: (i) the comparison of certain
measurements with a chosen standard; (2) the formation of a
general clinical impression of the state of health and develop-
ment; (3) tests to assess physiological efficiency and to detect
incipient deficiency disease. None of these tests is absolutely
reliable, but they are the only methods yet available, and when
used in combination as, in practice, they frequently are, they
furnish a fairly accurate indication of the general state of
nutrition.

(i) The first method, often called the c anthropometric
measure', includes measurements of height, sitting height and
weight, and the comparison of these with a chosen standard
for the age. This standard may be either an 'average' or an
'optimum 3 standard; average if it is arrived at by measure-
ments of a large unselected group, optimum if the group upon
which it is based is selected on account of its superior physical
characteristics. These measurements are then combined in
various ways to give a more accurate indication of the exact
state of nutrition. One of the simplest classifications, which has
been widely and successfully used in the United States, is that
suggested by Emerson: 15

1 . Ten per cent or more below average weight for height =
'malnutrition'.

2. Under average, but less than 10 per cent = 'borderline 5 .

3. Average to 20 per cent above = 'normal' (about 10 per
cent above is considered ideal) .

4. Twenty per cent above average = overweight.

The Berlin Conference of 1932 on 'the most suitable method
for detecting malnutrition due to the "economic depression" '
recommended the rather more elaborate Telidisi' method.
This method was devised by Pirquet and widely used in Vienna
after the War, with considerable success. The fundamental
formula is as follows:

METHODS OF DETECTING MALNUTRITION

10 wt. in grammes __ ^ 100

sitting height in cm. 100

In other words, the basal unit, represented by 100, is the cube
root of ten times the weight divided by the sitting height.
When the sitting height and net weight have been determined,
the index figure can be obtained from the Pelidisi table. School-
children whose index exceeds 100 are over-nourished; those
whose index ranges from 95 to 100 are normal, and those below
95 are under-nourished. The Pelidisi method has been criti-
cized, however, on the ground that a very small inaccuracy in
the measurement of the sitting height greatly affects the result.

Another system of measurement, recently adopted by the
American Child Health Association, is known as the A.G.H.
index. It is based upon measurement of arm, chest, and hip
girth. For routine work the method is advantageous but ex-
perience shows that certain adjustments of the index are
necessary in order to make it suitable for conditions other
than those obtaining in America.

(2) Clinical impression. c lt is generally agreed', 16 write
Burnet and Aykroyd, c that the most satisfactory method of
assessing nutritional status is clinical examination by an ex-
perienced physician. The disadvantage of this method for
public health purposes lies in the fact that no two observers
employ the same criteria as the basis of judgment.' The
diagnosis of malnutrition in schools in Great Britain is usually
based on clinical examination. Various methods have been
devised in order to give this clinical impression a more objec-
tive character and to make the results comparable. The c Sac-
ramata 3 method, also invented by Pirquet, is among the best
known and is recommended by the Berlin Conference. The
report of this conference thus describes the method: 'The state
of nutrition of the human body is clearly evidenced by the
blood content of the skin, the condition of the subcutaneous fat
layer, the skin tension determined by the water content of the
subcutaneous tissues, and the condition of the muscles.

These various points are appraised according to a scale of
values represented by the five vowels of the alphabet arranged
in descending order of pitch. The meanings attached to these
vowels areas follows: "i" 3 particularly high; "e", increased; "a",

F 85

CONSEQUENCES OF DIETARY DEFICIENCIES

normal; "o", reduced; u u", lacking. The combination of these
vowels with the initial letters of the Latin equivalents for the
four characteristics, Sanguis, Crassitudo, Turgor, Musculus,
yields a descriptive word which expresses, in clinical terms the
state of nutrition of the person examined. Thus, "SOCRE-
TAMP' signifies a low blood content of the skin, an amount
of subcutaneous fat above the normal, a norfnal water content,
and great muscular development. 3

(3) Tests to assess physiological efficiency and to detect
incipient deficiency disease. This method of determining the
state of nutrition consists of various technical devices to measure
physical efficiency and Tatigability' (ergographic tests); and
well-established scientific tests to discover symptoms of specific
deficiency diseases (tests for nitrogenous equilibrium, radio-
logical examination, X-ray photographs, and so forth) .

Consequences of Underfeeding

A diet must be quantitatively sufficient to yield a reasonable
amount of calories to meet the energy requirements of an
individual. A condition generally characterized by the lack of
this requirement is inanition both chronic and partial. It is
produced by a negative balance between the income and out-
put of energy. In the circumstances of famines we have enough
examples of the mass suffering and of the pictures so charac-
teristic of inanition.

In the first place, growth is interfered with and retarded
through starvation. The consequence of enforced under-
feeding in Germany during and after the War was about 20
per cent reduction of the body-weight of the people. Sup-
pression of growth is, of course, conspicuous in children. In
adults the arrested growth possibly brings about a state of
equilibrium; that is, there may be neither a gain nor a loss in
weight.

We have seen that the minimum demand for energy is the
amount which is required for basal metabolism. Modern
research has thrown much light on the individual components
of a diet; and while their importance is rightly stressed, the
quantitative assessment of nutritional requirements must re-
main a matter of primary consideration. Inadequate diet

86

CONSEQUENCES OF UNDERFEEDING

results in a distinct lowering of metabolic activity which leads
to both physical and mental disturbances. It is estimated that
under-nutrition as a factor by itself may reduce basal meta-
bolism one-third. Fasting per se depresses metabolism, and it
has been experimentally demonstrated 17 that men on a
reduced diet for long periods undergo profound metabolic
changes which are indicated not only by certain physiological
reactions such as disturbance of blood composition, neuro-
muscular efficiency, and changes in the gaseous metabolism,
etc., but also by the development of a number of psychological
traits and abnormalities! From the psychiatric point of view,
the effects of prolonged underfeeding have not yet been ade-
quately investigated; but various traits in the behaviour of
those who practice fasting over a long period may be regarded
as the possible consequences of disturbed metabolism due to a
low nutritional level. Religious mania, crude forms of psychic
exhibitionism, egoism" of a rather childish character, vanity,
and certain types of sexual perversions are noticeable among
peoples subject to chronic under-nourishment. It develops
morbid nervous conditions and fosters inertia. It is certain that
millions of children and adults in India are under-nourished,
and if the truth of the old saying - c a hungry man is an angry
man' is not epitomized there in actual life, the reason may
also be traced to psychological aberrations which give birth
to and nurse the twin evils of fatalism and pessimism in the
outlook on life. Aykroyd 17a rightly observes that 'hungry men
make no revolutions; if they break windows it is not as a pro-
test against the greed of the rich but in order to be taken to
gaol and given something to eat. Hunger takes a man's courage
and self-respect and leaves him a whining cadger of crusts and
half-pence. 5 No Indian can read Knut Hamsun's autobio-
graphical book entitled Hunger., in which one finds a vivid
expression of his gruesome individual experience, without
bringing to mind a poignant picture of the suffering of some
of his own countrymen. The fact that they subsist on inade-
quate food is not a proof that they do not remain hungry: it
only suggests that under the circumstances of long continued
under-nutrition there may be an adjustment of the body to the
lower food intake. But the adjustment does not arrest the pro-
gressive undermining of the stamina of the underfed peoples

8?

CONSEQUENCES OF DIETARY DEFICIENCIES

and they remain susceptible to infectious diseases. And with
lowered vitality their capacity as producers also remains low.

The most serious effect of underfeeding is left upon children, j
Early physical development is a concomitant of the well-being
of an individual. What hope is there for children whose
growth process has been interfered with by inadequate nutri-
tion? Medical authorities tell us that from ^the age of two to
the period of school-going age underfeeding or even partial
deficiency in essential food substances may cause serious dam-
age to the child. Grave deterioration of health and efficiency
as caused by underfeeding is rare in most of the Western
countries. But partial deficiencies of food substances exist, and
'the influences of such partial deficiencies even when relatively
slight' observe the Medical Research Council of Great Britain
'may be extremely serious when they occur in very early life,
and, if we may judge from the results of experiments on
animals,, an adequate supply of these indispensable dietary
components later in life may fail to make good the damage
caused by a deficiency in youth. There is also danger that the
effect of such a partial or latent deficiency may persist as a
chronic condition throughout adult life. 5

The truth is that continued under-nourishment not only
becomes a predisposing factor in tuberculosis and other infec-
tious diseases but creates a vicious circle by weakening the
entire mechanism of digestion. Starvation diarrhoea is of
common occurrence in famine areas.

Consequences of Overfeeding

It is not the amount of food we consume but what we arc
able to digest and absorb that nourishes the body. One may
partake of abundant food but may not enjoy good health.
Apart from the consideration that overfeeding is economically
unsound, it is important to bear in mind that disturbed meta-
bolic process interferes with proper and adequate utilization
of the essential food constituents of the diet, and consequently
reduces its value. Continued overfeeding may lead to mal-
nutrition.

Overfeeding is harmful to health and exposes the body to
several ailments. The excess of nitrogenous foods leads to

DEFICIENCIES IN 'ENERGY-BEARING 5 FOODS

gastro-intestinal putrefaction which not merely disturbs nor-
mal metabolic processes but may seriously impair the functions
of the internal secretary glands (e.g. thyroid, pituitary,
adrenal, etc ; ) . The excess of carbohydrates results in fermen-
tation which.may lead to diseases of the intestines. Consump-
tion of food in excess of the need of the body is one of the
contributary causes of diseases of the heart, circulatory system,
and kidneys.

Among the well-to-do classes in India, overfeeding is one of
the chief dietary faults. While a study of the psycho-physiologi-
cal effects of hunger upon a man might elucidate certain
peculiar characteristics of the Indian masses, a similar investi-
gation on those who habitually consume more food than is
needed would probably throw some light upon their reduced
vitality and lessened chances of life.

Deficiencies in c Energy-bearing' Foods
(a) Proteins

In our last chapter we have dealt with the specific dynamic
action of the protein component and have outlined the nature
of the controversy over the quantitative aspects of its require-
ments for normal health. While the view in regard to the
liberal need of proteinous foods may have been modified, there
is no disagreement on their value both as 'energy-bearing' and
'protective' foods; but as a body-builder the protein component
is even more important. It is the noblest of the food constitu-
ents', as Liebig called it. If we had not protein in our foods,
there would result tissue-starvation even though the supply of
carbohydrates and fat were assured.

Deficiency in proteins may result either from the low protein
content of a diet or from factors affecting the level of protein
metabolism. We have already stated that proteins must be of
high biological value and that their quality is more important
than their quantity. Nigerian natives, as is shown in the study
by McCulloch, have a dietary containing approximately the
same amount of proteinous foods as the Scotch families of
St. Andrews, but mainly composed of foodstuffs lacking in
essential amino-acids.

CONSEQUENCES OF DIETARY DEFICIENCIES

(b) Carbohydrates

Deficiency in carbohydrates is unusual, for they are abun-
dantly supplied through some of the cheapest foods available.
More energy can be derived from them per unit. of cost than
from any other source of nourishment and they_are generally
more palatable than any other foods. Thus the functional dis-
turbances caused by them are not the consequence of their
deficiency but the source of the trouble lies in an excessive
consumption. Since a diet made up largely of carbohydrates is
likely to be deficient in protein, fat, and other food constituents
and inay therefore be faulty, we shall consider some of the
effects of the dietetic error involved in the consumption of
excessive amounts of fermentable sweet and starchy foods.

The objection to the excessive use of cereal foodstuffs and
other sources of carbohydrates in a diet is that the amount of
carbohydrates which has to be oxidized in the body becomes
disproportionately large in relation to the amount of protein
present. This is liable to lead to intestinal disturbances, par-
ticularly among children. 'Even if the large excess of carbo-
hydrates can be successfully passed on', writes Gray 18 in his
monogram on the Food ofjapan, Trom the intestine to the blood
stream without undergoing fermentation of an undesirable
kind, there remains the difficulty of the tissues of the body to
deal with more fuel than they require. . . . The consumption of
quantity without quality is in some respects more dangerous
than starvation, for the latter is obvious and a remedy is sought;
the former may remain a hidden source of evil, gradually
reducing the vitality of the people. 3

Several human ailments, such as periodical headaches,
dyspepsia, constipation, gastric and duodenal ulcers, high
blood pressure, certain forms of skin disease, and nervous
irritability, are caused by the absorption of putrefactive and
toxic products, derived from a disproportionate supply of carbo-
hydrates in the diet. The dietary history of patients suffering
from functional disorders in gall-bladders, bile ducts, and
urinary tracts records invariably an excessive consumption of
carbohydrates. The role of carbohydrates in diabetes is well
known, and it is suspected that the incidence of cirrhosis of the
liver may be related to prolonged adherence to consumption
of foods which are largely carbohydrate in character and

9

DEFICIENCY IN 'PROTECTIVE 5 FOODS

deficient in many essential food substances. At any rate there
is general agreement in the view that a diet excessive in
carbohydrates produces a 'favourable nidus' for the develop-
ment of chronic ill-health.

(c) Fats

Fats are c the rlighest condensed energy-producers'. That
is, they furnish weight for weight more than twice the amount
of heat and energy obtained from carbohydrates. Deficiency
in fats is usually detected clinically by signs of deficiency in
corresponding fat-soluble vitamins. Fats may be of either
animal or vegetable origin, and it is only those of animal
origin which contain vitamins A and D. Butter, cream, eggs,
cod-liver oil, are some of the sources of 'high grade 5 fats; lard,
almond oil, olive oil, cottonseed oil, are classified as low grade.
Vitamins are absent from hydrogenated oils.

Most of the Indian dietaries are deficient in e high grade 5 fats
and produce symptoms almost comparable to deficiencies in
fat-soluble vitamins. Lack of fats in the maternal diet produces
children oflow birth- weight, and on this point Balfour's inves-
tigation 39 in India, is of considerable interest. She found that
the death rate in the first three months of life was very much
higher when the birth-weight was low, being 62 per thousand
for babies with birth-weight of 5 to 5^ pounds, 333 for those
with birth-weight of 4 to 5 pounds, and 840 for those with
birth-weight below 4 pounds.

Deficiency in 'Protective 3 Foods
(a) Proteins

It has been established beyond doubt that diet poor in
protein tends to lower vital activity, and that an adequate
intake of c good' protein is one of the 'factors of safety 5 in human
life. The consequences of protein starvation or excessively low
protein supply are discernible in the poor physique and low
power of resistance to disease among all poverty-stricken
peoples. Protein starvation is regarded as one of the contribu-
tory causes of epidemic oedema? Individuals maintained on a
low protein diet arc liable to functional nervous diseases and
attain earlier senility.

91

CONSEQUENCES OF DIETARY DEFICIENCIES

The effects of a diet defective in the supply of proteins are
more apparent in children than in adults.

(b] Vitamins

We have stated in the preceding chapter that man and most
other animals cannot synthesize those food substances known
as vitamins (except vitamin D) and that tKiey must be taken
in the food, either from animal or vegetable sources. From
evidence obtained from experimental feeding of animals, it is
known that they are sensitive to vitamin deficiency. Although
the exact functions of these active substances are not known, it
is abundantly clear that their deficiency in food leads to
specific metabolic disturbances in the digestive, nervous, glan-
dular, and other systems of the body. The symptoms of such
disturbances medical authorities have agreed to call deficiency
diseases. Even when the specific symptoms are not pronounced,
there are positive indications of the impairment of health; and
deranged functions of the body tend to lower resistance to
bacterial infection.

It should be borne in mind that the importance of these
vitamins lies not only in the prevention of certain specific
diseases, due to their lack in diet, but also in preventing many
states of sub-normal health. It has been demonstrated that an
adequate supply of 'energy-producing 5 foods will not sustain
growth activity when vitamins are absent. Generally speaking
vitamin deficiencies affect growth with the consequence of
diminished nervous energy and even mental agility.

Certain facts about the cure of disease by the use of certain
definite foodstuffs, which are to-day explained by the existence
of vitamins, have long been known. Thus there is in existence
an Egyptian papyrus* dating from about 1500 B.C. which
prescribes liver as a cure for hemeralopia or night-blindness.
This cure was known also to Hippocrates, who recommended
raw ox-liver dipped in honey. Many primitive peoples, e.g.
the Newfoundland fishermen, know the efficacy of liver in the
treatment of eye-disease. But it is only recently that an expla-
nation of the cure has been given: namely, the existence of

* The following passage in Ebers Papyrus is interesting: 'Because the
unknown disease was cured by the roast liver of an ox, the disease was
supposed to be night-blindness. Also the patients were recommended to
hold their heads over the steam rising from the roasting liver. . . .'

92

DEFICIENCY IN 'PROTECTIVE' FOODS

vitamin A in liver. Again the cure of scurvy by acid fruits and
green vegetables was discovered in the eighteenth century, and
it seems probable that it had more than once before been dis-
covered and^lost again. It is now known that these foods are
able to cure scurvy by virtue of the vitamin C which they
contain.

The first real experiment which tended to show the existence
of some substance in food theretofore unknown was carried out
in 1820 by Magendie, to whom we have already had occasion
to refer as the discoverer of the important fact that foods differ
in chemical content. Magenclic found that a dog fed on white
bread and water died within two months, while a dog fed on
coarse brown bread and water lived. Magendie did not himself
carry his experiments further, but it has since been found that
vitamin Bi, which is contained in the germ and pericarp of
cereals, is lacking in highly milled white bread.

Eijkman, at the end of the nineteenth century, was the first
actually to produce and cure a deficiency disease. He was a
prison doctor in Java with a hospital full of patients suffering
from beri-beri* (Polyneuritis endemica). The relation of the
disease with lack of a c certain something' in unmilled rice and
rice polishings was first observed by him and subsequently
studied by British medical men in India. Paralysis of the legs
was one of the conspicuous indications of beri-beri and Eijk-
man observed one day that the hens in the yard showed the'
same disability. His experiments showed that one of the princi-
pal aetiological factors was related to a diet of polished rice. He
was able to induce paralysis in his hens at will by restricting
them to a diet of rice from which the entire pericarp and germ
had been removed by overarilling. On the other hand, the hens
fed on whole unmilled rice remained healthy. Eijkman's inves-
tigations were pursued by Grijns, who discovered (1901) that
rice bran possessed anti-ncuritic properties. Further research
showed that these properties are due to the presence of vitamin
Bi in rice bran.

We shall now turn to each of the known vitamins and sum
up our present knowledge of some consequences of their
deficiency in the diet.

* Beri-beri is a Singhalese expression meaning C I cannot'; that is, the
person affected by it is too ill to do anything.

93

CONSEQUENCES OF DIETARY DEFICIENCIES

VITAMIN A. ,It has been demonstrated that without vitamin A
the growth of young animals is arrested and they become easily
susceptible to infection. Numerous experimental data are now
available in support of the conclusion that it is p an essential
food factor for growing children and without it they show
definite signs of malnutrition. Mellanby and Green 20 found
that 91 out of 93 rats soon developed definite symptoms of
lowered vitality when fed with a vitamin A free diet, while not
a single case occurred among the 50 rats used as controls. A
distinguished Danish physician, Bloch, drew the attention of
the Danish Government to the high incidence of kcratomalacia
and other forms of eye diseases, especially among poor children,
as a consequence of selling butter and other animal fats to
Germany during the War.

But the need of vitamin A is not confined to the young. Since
it promotes vigour and stamina and also maintains the mucous
membrane in a healthy condition, vitamin A is necessary for
nutritional well-being at all ages. Its adequate supply for
pregnant and nursing women is of great importance. I One of
the underlying factors in many cases of premature birth and
foetal and neo-natal death is the deficiency of vitamin A,
which is known to affect the quality of mother's milk if it is
inadequately supplied in her diet. The infant receives a very
limited amount of vitamin A in utero and therefore the need for
its ample provision, especially at weaning, is urgent. The food
of the nursing mother should contain a liberal supply of
vitamins,

As early as 1913 Osborne and Mendel showed 21 that ani-
mals malnourished from lack of vitamin A exhibited c a peculiar
opthalmia 5 . Without its presence in diet, the epithelial tissue
becomes keratonized, that is, hard and horny; and in this
condition it cannot repel those infections which come from
micro-organisms. So long as the epithelium is kept intact, there
is little chance of such infections. But with the deficiency of
vitamin A, the membranes of the eye are affected and the
trouble begins in the lacrimal field. Eventually dryness of
the conjunctiva sets in, which is often a precursor of a more
serious affection. The ulceration of the cornea then exposes the
eye to any kind of bacterial invasion. Kcratomalacia, which is
a destructive form of eye disease, is produced by ulceration of

94

DEFICIENCY IN 'PROTECTIVE' FOODS

the eye.* While the subnormal condition may at the initial
stages be rectified by a proper diet plus cod-liver oil, advanced
keratomalacia nearly always leads to impairment of vision or
to blindness.. The prevalence of the disease among the negro
slaves on the coffee plantations of San Paulo in Brazil led to a
close investigation and its cure was found in a liberal supply of
cod-liver oil, which is a rich source of vitamin A or
carotene.

Another common eye disease, associated with vitamin A
deficiency, is night-blindness or hcmeralopia. In the retina of
the eye there is a colouring substance, known as visual purple,
the formation of which is affected by the deficiency of vitamin
A, in some way not understood. Consequently the patient is
unable to see in dim lights. Night-blindness is one of the earliest
symptoms of keratomalacia. In this connection we should
mention Jean and Zcntmire's visual test by which they were
able to detect partial degrees of vitamin A deficiency 'by
testing photometrically the ability of the retina to adapt itself
to diminished illumination'. 22

There is evidence to show that deficiency of vitamin A
increases the liability to acute infections affecting the lungs.
Prolonged deficiency of vitamin A alters the condition of the
mucous membranes, especially of the respiratory and urinary
tracts and weakens the defence mechanism of the body. Thus,
the lack of vitamin A may play an important role as a predis-
posing factor in pneumonia, tuberculosis, and other diseases
associated with the lungs, through lowering of the body-resis-
tance.

McCarrisoir''* came to the conclusion from his experimental
feeding of rats that stones in their bladder were produced by
faulty diet composed mainly of cereals and deficient in vitamin
A. He found that an adequate supply of this food substance
afforded protection against stone-formation. Fujimakr 4 in
Japan found that a vitamin A free diet has a definite relation-
ship with the formation of carcinoma, but his results have not
as yet been confirmed. Disordered liver function may indicate
the onset of vitamin A deficiency. Some of the skin diseases are
associated with diets persistently deficient in vitamin A. The
type of unhealthy cutaneous manifestations, such as dry papu-
* For the symptoms of keratomalacia, sec chap, iv, p. 141 f.
95

CONSEQUENCES OF DIETARY DEFICIENCIES

lar skin eruption so common in India,, is regarded as the result
of long-continued vitamin A deficiency.

In Western countries an absolute deficiency of vitamin A
appears to be rare, though there is evidence to, show that a
partial lack is not uncommon and is very probably responsible
for much subnormal health and development.

The results of diet-surveys so far carried o'ut in India and the
prevalence of respiratory diseases and the lowered resistance of
the people show that their diet is generally poor in vitamin A.
And yet this substance occurs abundantly in nature. c lts
bountiful supply 5 , to quote Sherman, 'is a bulwark against
disease of many kinds. 5 An adequate intake of milk and milk
products, leafy vegetables, carrots, tomatoes, egg-yolk, liver,
and fish would satisfy the normal requirement of vitamin A.

VITAMIN B (Bi and Bs). It is known that endocrine glands
exercise a considerable influence upon various functions of the
body. At present it is impossible to say how the physiology of
the endocrine system is disturbed by vitamin deficiencies; but
that it is involved in some way appears to be established.
McCarrison and others have accumulated experimental data
which show that the presence of vitamin B complex in the
animal body is essential for the health and activity of the gastro-
intestinal tract. In its absence or owing to partial deficiency
over a long period, the intestinal epithelium is damaged. Long
continued deficiency also affects the nervous system; and beri-
beri, as already stated, is one of the outspoken symptoms of
the extent of damage caused by the lack of vitamin Bi.

Several forms of physical ailments, such as gastric ulcer,
chronic constipation, defective gastric secretion, deficient lac-
tation, and nervousness and irritability in children may be
traced to partial but chronic deficiencies in vitamin Bi.
Maurer and Loh Seng Tasi 25 thought that it resulted in
'dimunition in learning ability'. Wills and Talpade 26 found in
their clinical observations in Bombay that lack of vitamin B
in the maternal diet was one of the causes of premature births.
It is held that the tissue stores of vitamin B become depicted
during pregnancy because of its accumulation in the mam-
mary glands and in the embryo.

The physiological role of vitamin B, however, is not well

96

DEFICIENCY IN 'PROTECTIVE' FOODS

understood, but the importance of its relation to carbohydrate
metabolism has been confirmed by several investigators. It is
maintained that physiological disturbance involving carbo-
hydrate metabolism may well be a contributory cause in
producing symptoms of beri-beri.

Since vitamin Bi is found in so many foodstuffs, deficiency of
it is comparatively' rare in the West, where the average diet
generally contains a sufficient quantity to prevent, at any rate,
the more striking and fatal results of a lack of it. In order,
however, to ensure enough of it, it is well, especially when the
diet is at all restricted or monotonous, to use wholemeal bread
rather than white, for the milling of flour takes away the
vitamin. In this connection it is interesting to note that a
partial deficiency of this substance may be corrected by in-
creasing the protein and fat contents of the diet. 27

In the East, where the usual diet of the poor consists largely
of milled rice, deficiency of vitamin Bi is very common and
outbreaks of beri-beri occur from time to time in consequence.
An endemic form of polyneuritis is prevalent chiefly in Eastern
India, China, Japan, the Philippines, and other rice-growing
countries. The symptoms of beri-beri are marked by c spas-'
modic rigidity of the lower limbs, with muscular atrophy,
paralysis, anaemia, and neuralgic pains'. Adults from about 15
to 30 years of age are more liable to the attack of beri-beri than'
children. Japanese investigators found that the number of
cases, especially in youths and adults, is enormously in excess
of the number of deaths directly due to this disease and that it
leads, as is the case in parts of India, to widespread sickness
and incapacitation. Infantile beri-beri can be cured with ex-
tract of rice-polishing, which is a rich source of vitamin Bi.

But every outbreak of beri-beri cannot be wholly attributed
to the deficiency of vitamin Bi in the overmilled rice. It occurs,
as is the case with other scourges of the tropics, among the
poorly fed population. General under-nourishment, insanitary
conditions under which the masses live, and ignorance are
indeed some of the predisposing factors which make them
liable to suffer from beri-beri. But experience has shown that
this disease which takes yearly toll of thousands of lives is easily
preventable. In 1878 the incidence of beri-beri in the Japanese
navy was about 38 per cent. Baron Takaki, a distinguished

97

CONSEQUENCES OF DIETARY DEFICIENCIES

naval physician, brought about a remarkable improvement by
a radical change in the dietary of the crew, reducing the inci-
dence of the disease to 0-03 per cent within ten years. And this
he accomplished by a practical demonstration of the immediate
effect of his dietary reforms. He persuaded the Government to
plan an experiment by sending out two warships on a voyage
to New Zealand and South America with 350 persons on
board. The crew of one were provided with the usual diet then
rationed in the navy and the other with a new diet scale which
included a liberal supply of nitrogenous food and a consider-
able quantity of wheat and barley. Both the warships were sent
along the same route with almost identical conditions. While
there was no case of beri-beri on. board the ship whose crew
were fed with this new diet, the other ship reported as many as
100 cases.

Since deficiency in vitamin Bi impairs the ncuro-muscular
activity of the gastro-intestinal tract, several other complaints
are associated with it. Pronounced deficiency of this substance
in the dietary of pregnant women exposes them to the risk of
haemorrhage, abortion, still-birth, and dropsy. It has been
observed that in South India, where milled rice is a staple
food, 'premature expulsion of foetus 5 and still-birth are more
common than in northern parts of India, where wheat enters
into the usual dietary.

Owing to its wide distribution in common foodstuffs and its
resistance to heat, vitamin Bs is usually present in a normal
well-balanced diet* However, it seems to be generally admitted
that a diet deficient in vitamin Bs leads to the development of
a form of dermatitis, known as pellagra, though it is still
obscure whether this is the only cause or merely a contributory-
factor . The first description of pellagra was given by a Spanish
physician, Casale, in 1707, who observed its symptoms in the
Asturias and ascribed it to an insufficient diet. In 1771 Frapoli
gave it its name, which means 'rough skin'. It is a skin disease
which is particularly common among people whose staple
article of diet is maize, a cereal which lacks vitamin B2 and
whose protein is also deficient in an important ammo-acid. In
addition to the cutaneous lesions, the nervous system of the
victim is affected, resulting in progressive weakness. It is held
that the disease is five times more common in women than in

DEFICIENCY IN 'PROTECTIVE 5 FOODS

men, and that the advanced stage of the disease is often accom-
panied by gasfrro-intestinal, nervous, and mental disorders. It >
is common in the southern districts in the United States of
America, where maize is the staple food. In 1913 Dr. Golden-
berger was appointed by the United States Bureau of Public
Health, to investigate the causes of the outbreak of pellagra.
From his observations he concluded that the disease was not
infectious and that it victimized chiefly those who lived in an
unhealthy environment and were under-nourished. After con-
ducting preliminary investigations in an orphanage where he
was able to control the recurrence of the disease by the intro-
duction of milk and a more varied diet, he sought to induce the
disease by feeding men upon a series of restricted diets. Twelve
convicts were persuaded by the offer of a free pardon to place
themselves under Dr. Goldenberger's dietary treatment, and
in six months seven out of the twelve showed all the symptoms
of pellagra. Further observations on a series of feeding experi-
ments gave sufficient indications as regards the relation of
pellagra to deficiency of vitamin Bs, although its symptoms
cannot be attributed to a single dietary factor.

Maize is also the diet of the very poor in many Central
Eur9pean countries, especially Roumania, Yugoslavia, and
south Russia; it used to be the staple diet of the Italian peasant,
but a campaign against pellagra undertaken before the War
has materially reduced its incidence, so that now it is a rare
disease in Italy. As many as 120,000 cases were reported in the
United States in 1927, the mortality rate being over 40 per
cent. It is particularly common among negroes and poor whites
in the Southern States, the death rate per 100,000 inhabitants
in the six most stricken States being, in 1930 29-4. In Rou-
mania in 1933 the death rate from pellagra was 15 per
100,000. It is difficult to cope with the recrudescence of the
disease because the populations among which it is common are
especially poor and especially ignorant. Still, the success
achieved by the pre-War Italian Government shows what can
be done with perseverance, though the general rise in the
Italian standard of living between 1900 and 1914 doubtless
had much to do with stamping out the disease.

VITAMIN G. The pronounced deficiency of vitamin C affects

99

CONSEQUENCES OF DIETARY DEFICIENCIES

primarily the intercellular tissue substance in the animal body,
and the most serious result is scurvy. Scurvy is for the most
part a disease of seafaring men, soldiers, and explorers who
may have to subsist for considerable periods on ajdiet of tinned
or preserved foods. The disease seems first to have been des-
cribed by Hippocrates; it was common in the wars of the
Middle Ages and in the great voyages <3f discovery in the
sixteenth and seventeenth centuries. Hawkins, for example,
saw 10,000 deaths from scurvy in twenty years. Vasco da Gama
in his voyage round the Cape of Good Hope is reported to have
lost 100 out of 1 60 men who accompanied him. The early
voyagers dreaded scurvy. Captain Cook was, however, for-
tunate in arresting the recrudescence of the disease in his
second voyage by the provision of germinated barley and cab-
bage preserved in vinegar. According to Hoist, Cartier in
1535, on his second voyage to Newfoundland, cured scurvy
by the use of a fresh decoction of pine needles. Lind (1716-94),
a British naval surgeon, was one of the earliest investigators
who attempted to discover both cause and cure of the disease.
In 1 752 he published a treatise on scurvy in which he suggested
the use of oranges and lemons as an effective cure for the
malady; but he did not consider it to be essentially a disease
due to a dietetic deficiency, and held the view that, to quote
his own words, a most powerful and principal cause of scurvy
is the moisture of the air, and consequently the dampness of
the sailors' lodging'. Thus we see that although the scurvy
preventing properties of certain foods were recognized, the
dietary cause of the disease was not acceptable to the medical
men of the eighteenth century, although in 1720 an Austrian
army physician, Kramer, asserted that c three or four ounces of
orange or lime juice will cure this dreadful disease without
other help 5 . It had, however, become established that fresh
lemon juice was an effective preventive and it was therefore
introduced as a compulsory item in the diet of the British
Navy in 1795. During the first decade of the twentieth century,
Hoist and his associates demonstrated that the lack of some
factor associated with the metabolic process was the cause of
the disease. Hoist and Frolich produced scurvy in guinea-pigs
by feeding them on bran and rolled oats. It is interesting to
note here that the disease was induced in monkeys by feeding

100

DEFICIENCY IN 'PROTECTIVE 5 FOODS

with vitamin C free diets, such as condensed milk. There is
also ,on record the case of spontaneous scurvy in monkeys
which broke out in a shipment from India to San Francisco.
A diet rich in vitamin C was supplied to the animals and
marked improvements took place within a short time. Many
of the 39 monkeys were completely cured.

Its main symptoms are a swollen gum and leakages of blood
from the vessels into the surrounding tissues. The disease
appears in an epidemic form. There were many outbreaks of
scurvy during the last War, particularly on the eastern fronts
where it was difficult to ensure a diet of fresh foods. It is re-
corded that in 1916 over 7,500 British soldiers and a large
number of Indian troops suffered from scurvy in Meso-
potamia.

While acute vitamin C deficiency is not very common, recent
observations show that partial deficiency may be far more
frequent than is suspected. Its symptoms are often observed
among the inmates of public institutions (e.g. prison, asylum,
orphanage, and boarding-school, etc.) if the supply of fresh
vegetables and fruits is inadequate.

Scurvy is not an uncommon disease among infants, because
milk is not rich in vitamin C. There is particular danger of it
with bottle-fed infants. Hence the importance, now generally
recognized in the West, of giving babies a daily dose of orange
juice or some other fruit juice rich in vitamin C. With the
discovery by Szent-Gyorgyi of the chemical nature of vitamin
C and the possibility of its* synthetic production in the labora-
tory, it should shortly be possible to eradicate for ever a disease
which has long been the bane of mankind.

VITAMIN D. Vitamin D is one of the factors directly concerned
in the prevention of rickets. Its deficiency in diet affects the
normal bone formation. Defective bone formation giving rise
to such deformities as spinal curvature, bow legs, beaded ribs,
knock-knee, etc.; muscular relaxation, gastric disturbances,
and nervous irritability are some of the symptoms of rickets.
Children suffering from this disease often develop a tendency

* Vitamin C has been isolated in large quantities in crystalline form from
paprika or Hungarian pepper. Professor Szent-Gyorgyi was awarded
the Nobel Prize for Chemistry.

G 101

CONSEQUENCES OF DIETARY DEFICIENCIES

to nasal., bronchial, and intestinal catarrh. Since some of the
characteristics of rickets are similar to those of hypoplasia of
the bony tissue, medical opinion used to be divided on the
question of the aetiology of the disease. In i84O.Chossat des-
cribed softening of the bones in pigeons fed on a calcium-free
diet, and in 1860 Friedleben demonstrated by chemical analy-
sis that rachitic bone contained less calcium than normal. In
1880 Voit was able to induce some of the symptoms of the
disease in puppies fed on a diet consisting of meat and lard;
but in 1888 Cheadle held that a diet deficient particularly in
animal fat was responsible for rickets. McGollum's extensive
experiments with the rat yielded much valuable information
regarding some of the factors associated with ossification. He
was able to produce in the rat a condition histologically
identical with human rickets.

The discovery of vitamin D was made more difficult and
perplexing because of the mystery in which the aetiology of
rickets was for long enshrouded. On the one hand it was
observed that diets which were deficient in certain substances.,
especially liver and eggs, produced rickets which could, how-
ever, be cured by adding cod-liver oil to the diet. This seemed
to indicate a fat-soluble anti-rachitic vitamin. It was demon-
strated that the most potently calcifying diet was rich in fat-
soluble vitamin and that its absence resulted in some functional
disturbances leading to rickets. On the other hand, at the same
time that experiments were being made along these lines by
Mellanby (1919) Huldchinsky succeeded in curing rickets with
ultra-violet rays, and Hess with direct sunlight. This confirmed
an ancient theory, mentioned by Pliny the Elder, that sun was
a specific against rickets; and also the observation that the
disease was rare in hot and sunny climates but very common
in northern, comparatively sunless lands. Huntly, a medical
missionary working in Rajputana, Central India, reported in
1885 tnat although the diet of the poor folk in India was
markedly deficient in fat, rickets was not very conspicuous
among them; and this he thought was due to some beneficial
effects of abundant sunshine. Thus there were two seemingly
contradictory explanations of rickets; one ascribing it to
climatic conditions, and the other to dietary deficiency.

The clue was found at length when it was shown, first, that

102

DEFICIENCY IN 'PROTECTIVE' FOODS

certain foods previously inefficacious against rickets became
anti-rachitic when irradiated by ultra-violet rays a discovery
due to Steenbock in 1924; secondly when, soon afterwards,
'ergosteroF, die parent substance of vitamin D, was discovered.
Ergosterol, when irradiated, turns into vitamin D. It is present
in a large number of foodstuffs, especially in yeast, from which
an extract is made; and also in the human body. It is by means
of the ergosterol in the body, therefore, that the sun, playing
upon the skin, is able to cure rickets by turning the ergosterol
into vitamin D. Thus the deficiency theory of rickets was
vindicated and the conflicting evidence harmonized. Shortly
afterwards vitamin D was isolated in a pure form.

Vitamin D acts as a catalytic agent in the presence of which
the blood is able to absorb calcium and phosphorus. In other
words, the function of vitamin D is to regulate the metabolism
of calcium and phosphorus in the body. The exact mode of the
process is a subject of further investigation. In rickets the
amount of calcium and phosphorus metabolized or assimilated
is below normal. This has the effect of keeping the bones weak
and unformed. The deficiency of calcium and phosphorus may
be due either to the diet's lacking these chemicals, or, if the
diet is not lacking in them, to a deficiency in vitamin D. For it
has been shown that the body cannot retain calcium and
phosphorus when given directly; they are eliminated without
reaching the blood stream. When vitamin D is supplied, how-
ever, it assists in the metabolism of the minerals and calcium
phosphate is deposited in the bones. This is confirmed by Pro-
fessor Pirquets's painstaking investigations into the prevalence
of rickets in Vienna during and after the War. He thought that
fat-soluble vitamins functioned as an activator for calcium
metabolism and recorded a number of cases where the disease
was produced in normal healthy subjects by withholding fat-
soluble vitamins in their diet. 28

Mellanby was able to induce rickets in puppies by feeding
them on a diet adequate in regard to calcium and phosphorus
content but defective in vitamin D. There is also evidence
that excessive use of cereals, such as oatmeal and maize, is
likely to produce rickets, partly because they contain an and-
calcifying substance which interferes with calcium and phos-
phorus absorption and partly because they lead to increased

103

CONSEQUENCES OF DIETARY DEFICIENCIES

growth without supplying to the bones a sufficiency of calcium,
phosphorus, and vitamin D.

It is now clear that there are not less than five distinct
preventives and cures for rickets; (i) cod-liver oil; (ii) irradia-
tion of the body by ultra-violet rays or by the sun; (iii) irradi-
ated food, especially milk activated by exposure to ultra-violet
radiations; (iv) irradiated basic substance, ergosterol, extracted
from yeast; and (v) yeast milk, a biologic product endowed
with anti-rachitic potency as a result of feeding irradiated
yeast to the cow (or by irradiating the cow directly).

Although the aetiology and cure of rickets have been so
triumphantly elucidated, the disease still remains one of the
major problems of public health authorities. It is true that
since the War the incidence of rickets has fallen considerably,
but over large areas of Europe and America, and in northern
India and China, it is still rampant. In the poorer districts of
most of the great towns in these countries rickets has been
found among anywhere from 50 to 90 per cent of the children.

Wilson's investigations 29 in the city of Lahore, Punjab, re-
vealed 607; cases of rifkets among 1,482 girls attending the
schools. In v|tomljg\^t is prevalent among the women and
children Iivf5g*m me slum area and it exists in other industrial
centres. The problem is one both of poverty and ignorance, but
in the face of our present knowledge there can be no excuse for
continued failure to solve it. Let us remind ourselves of the
established dietary fact that milk is one of the best sources of
vitamin D as well as of calcium and phosphorus.

Another effect of deficiency in vitamin D is osteomalacia,
the adult form of rickets, in which the bones, particularly the
pelvis, are softened and deformed through lack of enough
vitamin D to metabolize the available calcium and phos-
phorus. Recently Wilson and Surie 30 gave a review of 265
cases of osteomalacia in India and they consider that in most
of these cases the diet was probably not deficient in calcium or
phosphorus, but in vitamin D. The disease generally attacks
women and is particularly common in pregnancy, when un-
usual strain is put upon the bones. Owing to pelvic deformities
of child-bearing women, it may in many instances result in
still-birth and neo-natal death. It is not very common in
Europe, though a milder form appeared in both sexes in post-
104

I. Ostomalacia: It is with great difficulty
that the patient is able to stand as straight

as this.
By kind permission of Miss A. Edgar.

II. Ostomalacia victim, showing chest

deformity.
By kind permission of Miss A, Edgar.

DEFICIENCY IN 'PROTECTIVE' FOODS

War Vienna as a result of the semi-starvation caused by the
economic collapse after the War.

In the cities of India and China, however, osteomalacia is of
very frequent occurrence among women who practice 'pur-
dah'. It is prevalent in the more crowded parts of the cities.
Scott, 31 who has made a study of osteomalacia in India, finds
that it is worst among the Mohammedans, who, although their
diet is on the whole better, practice stricter purdah; it is less
common among the Hindus and does not exist among the
Parsi community. Women who work in the fields generally
escape it, owing to the vitamin D producing action of the sun.
It is unknown among the non-purdah Afghan women.

Osteomalacia can be successfully treated in its early stages
by any of the methods mentioned above for rickets; though of
course the bones, once bent, cannot be straightened. This
horrible disease, which is due not so much to poverty as to
ignorance and superstition, could be wiped out by purely
educational means. Aykroyd's remark that c every step toward
the abolition of purdah is a step toward the abolition of osteo-
malacia' is endorsed by those who have studied the circum-
stances of this disease. It is, however, recognized that plentiful
sunlight cannot compensate for a diet quantitatively and
qualitatively deficient in essential food components.

Burnet and Aykroyd describe dental caries as c one of the
major scourges of modern civilizatfoR'^E^efeayed teeth are a
very malignant 'septic focus 3 and poison the whole system. A
flood of new light has recently been shed on the problem of
dental caries by Mellanby and her associates who suggest that
at any rate its chief cause is deficiency of vitamin D. Com-
menting upon the relationship between dietary deficiency and
teeth, she says: 32 c The supply of calcium and phosphorus must
be adequate. The presence of the anti-rachitic vitamin which
diet should contain seems to control the actual process of
calcification and is necessary. Cereals act in the opposite way
and specifically interfere with calcification. 5

The structure of teeth resembles that of long bones, and
teeth, like bones, need calcium phosphate. As we know, vita-
min D assists in the metabolism of calcium and phosphorus,
and Mellanby therefore argues that a deficiency of it must, as it
causes rickets in the bones, so produce dental caries. She has

105

CONSEQUENCES OF DIETARY DEFICIENCIES

carried out extensive experiments which support her theory;
thus the examination of a large number of deciduous human
teeth shows that defective calcification does lead to caries.
Further she has conducted an important experiment upon four
groups of children. Over a period of two years and on the
basis of a similar diet in other respects., one group was given in
addition treacle, the second olive oil, the third cod-liver oil,
and the fourth radiostol (a preparation from Vitamin D).
At the end of the experiment all the groups had increased
caries, but the last two very considerably less than the others.
It is suggested as a result of this and other experiments that if
pregnant and lactating mothers and infants were given suffi-
cient vitamin D the children would have strong, white, regular
teeth which would be immune from decay. Mellanby's con-
clusions are not yet universally accepted, but it seems to be
generally agreed, among those who are qualified to judge, that
lack of vitamin D, though it may not indeed be the sole cause
of dental caries, is at least an important contributory factor.

In this connection it is interesting to note that Wilson and
Surie 33 in their study of 100 Indian children suffering from
rickets found that the more severe the hold of the disease, the
greater was the tendency to gross hypoplasia of the teeth.

The occurrence of pyorrhoea is also attributed to dietary
errors involving either deficiency in calcium, phosphorus, and
vitamins G and D, or excess of carbohydrates and proteins.
Further investigations into the increased incidence of dental
diseases and their relation to diet are in progress. Meanwhile
anthropologists report from their observations that immunity
to dental caries and allied troubles disappears among the
primitive races as soon as some forms of processed foods are
introduced into their dietary.

VITAMIN E. There is little or no evidence that the deficiency
in vitamin E ever produces pronounced symptoms of any
disease; but its lack in diet appears to be one of the contribu-
tory factors in human sterility. A diet rich in this substance is
helpful in the case of sexual neurasthenia.

It has also been observed that deficiency in vitamin E pro-
duces pathological changes in the placenta of rats and even-
tually leads to abortion. It is reported that cases of habitual

1 06

DEFICIENCY IN 'PROTECTIVE' FOODS

abortion in cattle 3 and also in human beings, were cured by a
liberal supply of feeding-stuffs containing this vitamin.

(c) Inorganic Substances

Inorganic substances are known to control largely the func-
tions of the physical-chemical mechanism of the body. They
are essential for the maintenance of physiological equilibrium
and fulfil an important role in nutrition. Consequently their
deficiency may produce serious nutritional disharmony. The
tissues are particularly sensitive to mineral deficiency; 'without
the proper balance' , observes Bridges, c of mineral material,
there is an immediate alteration in surface tension phenomena
as well as osmosis.' 31

In our discussion on 'balanced diet' we have noted that an
adequate supply of inorganic substances is one of the criteria
for the evaluation of a diet. They play an important part in
maintaining acid-base equilibrium in the body. Here we shall
briefly refer to four main inorganic substances and note the
consequences of their deficiency in human nutrition.

i. CALCIUM. Experiments with young animals have shown that
the deficiency in calcium and phosphates is characterized by a
poor deposit of calcium phosphate in the ossifying cartilage.
Since calcium metabolism is related to vitamin D, a low level
of calcium in the diet is associated with osteomalacia. Diets of
patients suffering from this disease show a negative calcium
balance, but this deficiency may arise from a disordered meta-
bolic condition even if the diet contains adequate calcium. To
ensure a normal relationship between calcium and phosphorus
in the metabolic process both elements should be supplied in
optimal ratio. Sherman 35 has pointed out that calcium shor-
tage greatly influences the process of iron metabolism.

It should thus be clear that an adequate supply of calcium
is singularly important on account of its conspicuous role in
metabolic processes. The results of its deficiency in diet are
summed up by the chief medical officer of the Ministry of
Health, Great Britain, 36 in the following terms:

A deficiency of calcium during the growth period when the
effects of inadequate diets arc particularly liable to become
manifest, would result in defective development of the bony

107

CONSEQUENCES OF DIETARY DEFICIENCIES

skeleton. This is the most obvious effect of such a deficiency,
but others less striking, though just as important, would occur.
The proper functioning of contractile tissues depends on the
presence of a certain concentration of calcium jons in their
environment, and as the calcium in the blood is lowered by
calcium-poor diets, the contractile elements in the body, e.g.
the musculature of the circulatory and alimentary systems,
would not play their requisite parts in a proper fashion. There
is also evidence for believing that absorption of carbohydrates
would be reduced by deficiency of calcium in the blood. Fur-
ther, the metabolism of calcium is intimately bound up with
that of phosphorus and with the function of the parathyroid
gland, so that any disturbance of the former is bound to lead
to disturbances in the metabolism of phosphorus and in para-
thyroid function. In addition, since calcium plays a dominant
role in maintaining the selective permeability which is an
essential characteristic of all living cells, there is probably not
a function in the body which would not be adversely affected
by continued ingestion of diets low in calcium.'

2. PHOSPHORUS. For the maintenance of healthy tissues of the
body, phosphorus is an essential substance. It is needed for all
cellular activities and supplies a protective constituent to the
nervous tissues. Its deficiency leads to several ailments especi-
ally related to depression of vital processes. In those parts of
the world where soil is poor in phosphorus, the effects of its
deficiency both in human and animal diets may be pronounced.

3. IRON. The amount of iron in foodstuffs is not fully available
to the body, and the process of its absorption and utilization is
probably dependent upon complex physiological factors not
fully understood. But it is known that lack of iron supply is one
of the causes of anaemia.

Various types of anaemia are included in the category of
deficiency diseases. Recent evidence shows that this disease is
very common among infants and in adult women in the child-
bearing period. While a diet deficient in essential food sub-
stances is likely to affect, in this period, the normal gastric
secretion and thereby become a causative factor in anaemia,
the iron deficiency plays a decisive part in the development of

1 08

DEFICIENCY IN 'PROTECTIVE' FOODS

the disease. The demand for iron by the foetus during preg-
nancy has to be met and it must obviously come from a mater-
nal source. Physiologists tell us that the liver of a newly born
animal contains weight for weight six times as much iron as
the liver of an adult animal and that this iron-content decreases
during the milk-feeding period. Hence the necessity for an
adequate supply of foodstuffs containing iron to nursing
mothers. It is common knowledge that artificially fed infants
suffer from nutritional anaemia.

Burnet and Aykroyd quote Mackay as having shown c that
50 per cent of infants in the East End of London develop some
degree of nutritional anaemia from the fourth month onward'.
And from some recent observations in Aberdeen it appears
that 'of i ,000 women belonging to the poorer classes 50 per
cent showed some degree of anaemia, 1 5 per cent being severely
anaemic. . . . Many of these women considered their condition
of chronic ill-health and wretchedness as normal and accepted
it with resignation. 3

There is a very high incidence of anaemia throughout India
a fact which must be taken into consideration in an investigation
of infant mortality. Nearly 36 per cent of maternal mortality
in India may be due to pernicious anaemia developing during
pregnancy. Strauss and Castle 37 came to the conclusion that an
infant might be born with a normal supply of haemoglobin
even if the mother were anaemic; but this 'inheritance 3 did not
fail after a few months to produce anaemic conditions in
the infant. This is, they asserted, the result of maternal iron
deficiency.

4. IODINE. Since the discovery by Baumann in 1895 of iodine
as an essential constituent of the thyroid gland, the attention
of physiologists has been directed to determine the influence
of this mineral in the regulation of the metabolic process. It is
found that the metabolic disturbances caused by a deficiency
of iodine produce goitre. Peoples living near the sea rarely
suffer* from the disease because sea salt and sea foods are rich
in iodine. In Japan the incidence of goitre is as low as one per
million and its absence is due to the consumption of sea-weed,
which contains about i ,000 times as much iodine as any other
* But it is common in Danzig.
log

CONSEQUENCES OF DIETARY DEFICIENCIES

food. Mountain or inland inhabitants are often afflicted with
endemic goitre. It is, for example, a common disease in certain
Himalaya regions, where the rate of incidence frequently rises
to 50 per cent. Von Fcllenberg, of the Swiss Goitre.Commission,
studied the distribution of iodine in nature and found thai
foodstuffs grown in a goitrous region contained less iodine than
those from a non-goitrous tract.

Much attention has been paid to the problem of goitre in
various countries of late years, and in Switzerland and America
steps have been taken to make good the deficiencies of iodine
wherever they occur. Thus the water supply of the towns has
sometimes been iodinized, iodine compounds have been given
to school children, and salt containing sodium iodine has been
encouraged.

It should not, however, be concluded that goitre is due to
iodine deficiency alone. Stott finds 38 a remarkable connection
between endemic goitre and calcium in water in the Hima-
layan regions of the United Provinces and suggests that an
excessive intake of calcium through the drinking water may be
an important causative factor. Others hold the view that a diet
which is ill-balanced and provides a very low supply of calcium
tends to cause goitre. The truth is that the incidence of thyroid
disease cannot be ascribed to a single factor: it is related not
only to imbalance between calcium, phosphorus, and iodine
but also to vitamin deficiency. According to McCarrison, 38 ' 1
faulty diet is one of the goitrogcnic agents. He enumerates Llic
imperfect constitution of such diet as follows: '(a) Excesses of
certain substances fats, fatty acids, and lime, (b) Deficiency
of certain substances iodine, vitamin A, vitamin C, protein
(in association with vitamin A deficiency), and phosphates
(relative to an excess of lime), (c) Goitre-producing substances
-cyanogen compounds in certain foodstuffs such as cabbage.
(d) Insufficiency of certain anti-goitrogcnic substances, of
unknown nature but other than iodine, present in certain fresh
plants such as green grass, alfalfa, the expressed juice of steamed
cabbage, and in spouted legumes and carrots. 5

no

PROBLEM OF DEFICIENCY DISEASES

Problem of Deficiency Diseases

We may JJLOW sum up the problem of deficiency diseases.
Lombroso once observed that It was Impossible to cure these
obvious manifestations of ill-health because he might as well
advise his patients to be rich as to have adequate and proper
food which they could not afford; while if a patient were rich
he could easily be persuaded to correct the errors of his diet
and would not suffer from deficiency diseases. It seems almost
superfluous to comment on this penetrating remark, which
goes straight to the root of the problem. The question, "Can
deficiency diseases be wiped out? 3 is no longer medical but
social and economic. Doubtless much remains to be learnt
about the relation of diet to disease, but already medical science
is in a position not merely to cure but to prevent a whole series
of fatal or debilitating maladies which spring directly or in-
directly from malnutrition. Rickets and osteomalacia; scurvy;
beri-beri and pellagra; xerophthalmia and keratomalacia all
these could, so far as our scientific knowledge is concerned, be
banished from human society. Tuberculosis, dental caries, the
commoner forms of anaemia, could be radically reduced if
not stamped out. It is not medical knowledge that is lacking;
it is the economic system which tolerates widespread poverty
that is largely at fault.

Poverty, then, is a factor of fundamental importance in the
causation and the prevalence of the deficiency diseases, and in
the face of poverty medical science is rendered impotent, as
Lombroso points out. It is for this reason that a great deal of
emphasis is laid in the present book upon social and economic
questions, and our discussion is not confined merely to a sum-
mary of the new knowledge of nutrition. With this new know-
ledge as a sure foundation, the problem which confronts us at
the present time is the economic problem of how to apply this
knowledge in such a way as to ensure adequate nutrition to the
population as a whole. The enormous disparity in incomes
which creates a tiny caste of plutocrats and an immense group
of the very poor; the chronic maladjustments in agricultural
industry which is in perpetual disequilibrium with the eco-
nomic system as a whole; and the recurrent crises incident to

in

CONSEQUENCES OF DIETARY DEFICIENCIES

that system; these are the problems which must be faced if it
is hoped seriously to tackle the question of malnutrition and
the diseases which spring from it. The final Report of the
Mixed Committee of the League of Nations on- the problem
of nutrition rightly observes: The malnutrition which exists
in all countries is at once a challenge and an opportunity; a
challenge to men's consciences and an opportunity to eradicate
a social evil by methods which will increase economic pros-
perity,'

It may well be doubted whether in an economic organiza-
tion where commodities, including foodstuffs, arc produced for
profit rather than for use, it will ever be possible to ensure to
the working masses a really adequate diet. That this system, at
all events, does not in fact ensure such a diet even in the
advanced countries is now fairly widely admitted; and any one
who takes a serious interest in nutritional problems must
squarely face the possibility that they can only be solved by a
profound modification in the economic structure of society.

Meantime, there are palliative measures which can be taken.
Some of these we have already discussed; others will be treated
at length in Chapters Seven and Eight. The principle involved
in these measures has been well summed up by Sir John Orr
in his Chadwick lecture. c lt may be assumed', he says,
'that any government would accept as the first essential the
necessity for ensuring that every individual in the state shall be
able to get a diet sufficient to maintain health. If a system of
producing and marketing foodstuffs fails to do this, the State,
through its medical and social services, must pay for the treat-
ment for those suffering from an inadequate diet. 3 Since in
fact no state, except the Soviet Union, has yet recognized its
responsibility in the first respect, the second alternative to
cure or alleviate diseases or deficiencies which have already
appeared is the only one which remains open. To what extent
this has been done in the advanced countries in order to lessen
the gravity of deficiency diseases we shall sec at a later stage;
here we need only remark that the policy of palliating the effect
rather than eradicating the cause, which is typical of the pre-
sent form of society in many fields, is to say the least wasteful
and illogical.

112

CHAPTER FOUR
Public Health and Deficiency Diseases in India

General State of Public Health

The sound nutrition of the individual and the community is
the foundation of the public health/ writes Sir George New-
man. Indeed the points of contact between the Public Health
Service and the problems of nutrition are so intimate that in
some of the advanced countries the means and methods of
solving dietary deficiencies are made an integral part of the
activities of Public Health Administration. While the standard
of public health depends largely upon two governing factors
the habits and customs of man and the kind of environment
it is now widely recognized that the diet of a people is of
primary importance in making that standard both efficient
and progressive.

The state of the public health of a country has to be esti-
mated not merely by the incidence of diseases, but by the con-
ditions of life in which the bulk of its population lives. That the
standard of health of the people of India is low is common
knowledge; the average expectation of life is about 38 for males
and 36 for females, and the death rate is over 34 per mille; but
it is important to realize that there is an alarming sign of
physical deterioration due to under-nourishment and other
causes, which does not effect the mortality rate and yet gives
rise to a state of chronic ill-health of the people. Their low
vitality cannot altogether be explained away as being the
consequence of climatic conditions or other features of a tropi-
cal and semi-tropical zone. That the physique of the people
was once strong is suggested by the fresco and other paintings

113

PUBLIC HEALTH AND DEFICIENCY DISEASES
of the Buddhist periods; the monastic regulations show that
only those who were physically strong could fulfil them and
that the members of the Buddhist-Sangria were healthy and,
vigorous. In the pre-Buddhist era, the Aryan-speaking com-
munities selected for service as priests, warriors, and traders
only those 'who were not too young but of middle-age; who
were brave, self-controlled, and able-bodied 5 .

Records of the early days of the British advent in India
contain references to the excellent physique of the settled com-
munities. Speaking of the natives of Bengal, the province where
to-day the living millions of humanity present a ghastly picture
of a race on the verge of collapse, Lord Minto at the beginning
of the nineteenth century wrote: I never saw so handsome a
race. They are much superior to the Madras people, whose
forms I admired also. Those were slender; these arc tall,
muscular, athletic figures, perfectly shaped, and with the finest
possible cast of countenance and features.' They were even
enrolled in the British Army in India and fought well!

In the northern parts of India from where the Army recruits
are drawn to-day, signs of physical deterioration among the
fighting races cannot escape a discerning eye. 'There were
many fine soldiers, well built and with stalwart figures; it
seems to me that there has been a great change in the physique
of the Indian peoples since that day. 3 So remarked the Gack-
war of Baroda, the other day in London while describing his
impression of the Delhi Durbar of ist January 1877.

While it is not our purpose to traverse here the entire field
of public health in India, we feel justified in attempting a brief
survey with a view of impressing upon the new Legislatures of
India that if the task before them is of immense magnitude, the
efforts to grapple with it must be of a similar calibre. The
immensity of the task lies in the fact that the problem of public
health is no longer related only to medico-hygienic activities
by a group of specialists, but must take into consideration all
the factors affecting the economic and social life of the com-
munity. Those who are now concerned with the task in the
West realize that the problems of public health, of human and
animal nutrition, and of agriculture which still remains even
in the industrialized countries the basic industry, should
'vitally constitute the elements of a single great administrative

114

GENERAL STATE OF PUBLIC HEALTH

policy 5 . With us in India, on the advent of a new constitutional
era, the need of formulating a co-ordinated policy is of special
importance, not only within the sphere of each Provincial
Government but for India as a whole.

Perhaps the most striking feature of the general health of the
bulk of Indian peoples is their extremely low power of resis-
tance to infections of all kinds. Malaria takes a heavy annual
toll and incapacitates millions in India, and because of their
low vitality even milder forms of attack often prove fatal. It is
estimated that the number of deaths each year from malaria
alone is one million, and Tor one million deaths in adult males
between fifteen and fifty years of age there should be at least
two millions constantly sick and the equivalent of fifty million
admissions to hospitals'. The pandemic of influenza affected
over 125 million and destroyed nearly thirteen million persons
in 1918-19, and such an incredibly high death rate cannot be
ascribed only to the unhygienic environment of its victims.
Indian immigrants in Malaya, for example, were found to be
more susceptible to infectious diseases than their fellow workers
living practically under the same conditions.

Throughout India tuberculosis is on the increase. Year by
year the official reports of the Departments of Public Health
record an alarming increase in deaths from tuberculosis, in
every province. The figures for Bengal in 1933 show an increase
of 30-4 per cent; for Bombay over 35 per cent over the preced-
ing year. The death rate from tuberculosis in Delhi is over 3
per 1,000 population. The women between 15 and 40 years
are more readily susceptible to acute infection of tuberculosis
than the men of the same age-group owing among other causes
to early marriage and the purdah system. In all large centres of
population the disease accounts for a high death rate as well as
for the poor physique of those who have been 'uprooted' from
a rural environment. The police recruits and labourers, drawn
from villages, indeed, frequently become infected when they
are faced with urban conditions of existence. But although its
incidence particularly in its pulmonary form appears to be
higher in the cities and towns than in the villages, there is every
indication of its encroachment upon the rural areas. And once
infection is introduced into the villages, Colonel Russell in his
last Annual Report warns us, c it is almost certain to spread

115

PUBLIC HEALTH AND DEFICIENCY DISEASES
rapidly and to cause a heavy morbidity and mortality'. Accur-
ate statistics of deaths due to various forms of tuberculosis in
India are not available; nor can we, under the existing system
of collecting vital statistics, have recourse to factual studies of
any great significance. The death rate from tuberculosis is
very often confused with multiple fevers and is recorded as
such; and it was probably because of our defective system of
recording vital statistics* that one of the leading physicians of
Calcutta could declare at an International Congress in Berlin
(1892) that phthisis and other lung diseases were rare among
the natives of India!

In 1904 Sir Leonard Rogers, scrutinizing the death returns
from a malarious tract of Bengal, obtained 'clear evidence that
phthisis accounted for at least 9 per cent (90 per mille) of the
total deaths in villages 5 . Recent public health reports of the
province show an increase of over 30 per cent in the death rate
from phthisis. Similar alarming facts reported from a great part
of India confirm the view that the rapidity of the spread of this
deadly disease is largely due to the very low resisting powers of
its victims. And the root cause of low powers of resistance is, to
quote Sir Leonard Rogers, c that the stress of population is
increasing to such an extent that there is not enough nourish-
ment for the people 5 .

The mechanism of immunity to tuberculosis is not sufficiently
clear; but it is known that resistance to infection is definitely
influenced by proper nutrition and hygienic conditions of liv-
ing. Recent investigations have proved beyond doubt that the
spread of this fatal disease has a close relation to under-
nourishment and malnutrition. On examining the diet schedule
of families where the disease has obtained a footing, it is noticed
that their nutritional requirements are not being satisfied,
especially with reference to 'protective 3 foodstuffs. Although
the disease is not uncommon among the well-to-do classes, its
rich field of harvest lies in poverty-stricken families. Ewart's
study 39 on the relation between economics and tuberculosis
shows that the effects of poverty upon the incidence of the
disease are pronounced. Analysing conditions in England and

* Vital statistics are defined as e the Book-keeping of Public Health'; but
the task of collecting them in India is entrusted to the police administration,
which divides districts into Thanas under a sub-inspector of police!

116

GENERAL STATE OF PUBLIC HEALTH

Wales from 1851 to 1920, he found c a high inverse relationship
between the real value of wages, and the tuberculosis death
rate'. The potency of the economic factor in the incidence of
this disease is shown so clearly by its ravages wherever the
economic standard of life is low that the mortality from tuber-
culosis may be used 'almost as a mathematical function of a
measure of poverty 5 . The rate increases considerably as one
passes from the prosperous to the poor districts in any area.
While poverty is not the only aetiological factor, it is becoming
evident that there can be no other effective prophylaxis of this
disease than the increase of the economic level of the people
sunk to an abyss of misery. In other words, as Sir John Orr put
it, c the most effective line of attack on tuberculosis is by an
improvement in diet'.

The problem of controlling the incidence of tuberculosis
therefore requires not only an extensive organized campaign
and adequate facilities for treatment, but a liberal provision
of 'protective 3 foodstuffs, in order to increase the powers of
resistance to the infection. Preventive medicine alone cannot
solve the problem. It is a disease which spreads in a similar
manner under various unrecognizable cloaks without assuming
the proportion of an epidemic; and poverty and malnutrition
are the two main factors responsible for its persistence among
our ill-nourished population. c lt must be realized', writes the
Public Health Commissioner, c that the way to victory does
not lie, except in small part, in the provision of clinics, hospitals,
and sanatoria. Money spent on such institutions will be money
largely wasted unless the social factors involved are studied
and then attacked with vigour. In the practice of more hygienic
methods of living, in the provision of ample and nutritious food
supplies* and generally in a wider appreciation of the dangers
inherent in harmful social practices will be found the way to
a gradual decrease of this scourge of civilization. 3

As regards facilities for treatment, Major-General Bradfield,
Director- General of the Indian Medical Service, informed the
annual Conference of the National Association for the Pre-
vention of Tuberculosis, in London ( 1 938) , that according to one
authority there were about two million cases in India, but in
the entire country there were only 77 clinics and 39 sanatoria.
* Italics are mine.

H 117

PUBLIC HEALTH AND DEFICIENCY DISEASES

We have no organization for care of the convalescent or for
rehabilitation of his economic position. Consequently even if
he is cured of the disease, he is left in a wretched condition
only to die of poverty.

There are other infectious diseases which have been success-
fully domesticated in India and owing to the diminished
powers of resistance of her peoples they arc able to take a
heavy annual toll. Although sickness aggravates poverty and
a high mortality rate is a pregnant source of waste, the serious-
ness of the state of public health in India lies in the prevalence
of general debility among all classes of her population. In a
resolution passed by the All-India Conference of Medical
Research Workers, it is stated that 'the percentage loss of
efficiency of the average person in India from prevent! ble
malnutrition and sickness is not less than 20 per cent 3 . What
hope is there if the blessings of positive health are denied to
the growing generation? How is India going to cope with the
circumstances of the modern world if persistent ill-health ham-
pers the life and labour of those who arc called upon to share
the responsibilities of India's economic and social welfare? For
an adequate realization of the state of general health of all Indi an
communities, it is not altogether necessary to turn to statistical
studies; the facts are well drawn on the physique of the people.

If one cares to examine the 'health stratification' of all the
social groups in India, it would be evident that widespread
ill-health is not confined to the poor. It is true that the upper
social classes in India average a greater longevity and a lower
mortality than the lower classes, but their general health is,
with relatively few exceptions, poor and signs of their physical
degeneration are becoming conspicuous.

Diabetes is prevalent among the upper classes of the Indian
communities. It is observed that in some well-to-do Bengali
families of Calcutta, most of the males 'have alimentary giyco-
suria or diabetes before reaching the age of fifty'. Here is a
disease caused not by imdcr-nourishment but through mal-
nutrition leading to malassimilation of food. Probably a high
percentage of carbohydrate and fat in the diet is one of the
causative factors;* at any rate it is associated with certain
disturbances in the metabolic process. Sugar and starchy snb-

* The correlation between a high percentage of fat in the diet and the

118

GENERAL STATE OF PUBLIC HEALTH

stances are not normally metabolized and consequently there
is an excess of sugar in the blood constantly percolating through
the kidneys.

Hindus, whose diet consists of excessive carbohydrates and
fats but is p9or in proteins, are more suspectible to the
disease than other Indian communities. Perhaps over-eating,
one of the chief dietetic errors of the well-to-do Hindus, pro-
duces the metabolic disorders referred to above. Diabetes is
frequently preceded by an acute form of dyspepsia. The
diabetic symptoms usually occur between 40 and 50 years, and
it is a tragedy that at an age when their services to the nation
might be of immense value, a large percentage of the educated
classes should suffer from ill-health.

The middle-classes can show no better record, and at the
bottom of the 'health stratification 3 we have the agricultural
and the growing industrial proletarian classes. Those who
lament the rigidity of barriers between our various social
groups should realize that one of the factors which can facili-
tate social mobility is the physical well-being especially of
those belonging to the lowest social strata. The social promo-
tion, for instance, of the Harijans* cannot be attained merely by
removing certain social disabilities from which they suffer. The
temple-entry cannot arrest the tragedy of 'social sinking' if
their health, physical and mental, is allowed to be undermined
by poverty and defective nurture.

From our general description of the state of public health as

incidence of diabetes is worked out by a recent investigator as follows:
DIABETIC DEATH RATE PER 100,000 POPULATION

Percentage of Calories
Countries Death rate in the diet derived

fromfat

Japan 2-9 4.7

Italy 8-2 18-2

Scotland 10-1 28-3

England and Wales 14-5 32*0

Holland 17-6 35-5

United States 20-4 36-1

(Himsworth, H. P., 'Diet and the Incidence of Diabetes Mellitus', Clinical
Science, Vol. 2, 1935.)

* The Harijan refers to the so-called depressed classes. One of the social
disabilities from which they suffer is that they are not permitted to wor-
ship in the orthodox Hindu temples. In recent years Mahatma Gandhi
launched a movement for the removal of this restriction.

"9

PUBLIC HEALTH AND DEFICIENCY DISEASES

reflected in the prevalence of disease and ill-health of the
population, we now turn to the kind of environment which
surrounds the lives of the Indian people. The spread of tuber-
culosis and the frequent recrudescence of infectious diseases
point to an utter lack of essential sanitary amenities on which
the health of a community so largely depends. Of these the
supply of safe and ample water and the sanitary disposal of
excretal matter are the two main items relevant to the subject
of our discussion.

Water Supply

Water is an essential element of diet although it is neither an
'energy producer 3 nor a 'protective 3 food constituent. Among
other reasons its indispensable role in all metabolic activities
in the body makes water a prime necessity of life. The pro-
vision of water for drinking purposes as well as for domestic
uses is therefore one of the elementary needs of a community.

Only in a small number of our towns and cities are there
provisions for the supply of sufficient and safe water. In the
rural areas, its supply comes from rivers, tanks, canals, and
wells which owing to the ignorance and indifference of the
inhabitants in regard to the quality of the water they use, are
liable to both contamination and pollution. The habit of per-
forming their natural functions in water is common among the
bulk of our rural population and the conviction that the water
of the running stream cannot be defiled is deep-rooted. It is
not an uncommon sight to see persons drinking water from the
river only a few yards lower down while others are contaminat-
ing the same stream with human wastes. The habit of using
streams for the disposal of human excreta may have arisen
from the necessity of escaping from flies which inevitably
collect round the land-latrine; or, it may be due to the empiri-
cal knowledge in regard to the evil effects of soil-pollution upon
the health of the community.

We need not dwell here upon some of the extremely un-
pleasant details of the conditions of water-supply in rural areas
in India. Village tanks or canals or cess-pools generally have
the drainage waters of the village led into them; and the
villagers, indifferent to all the sources of contamination and
pollution, use the water for all' purposes.

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GENERAL STATE OF PUBLIC HEALTH

The provision of a safe water supply and the spread of
knowledge about the grave risks attending the use of water
rendered unwholesome by human or animal wastes is an
essential condition for the physical well-being of our people.
That contaminated water may well be a potent cause of mal-
nutrition because of the gastro-intestinal disturbances fre-
quently brought about by parasites introduced into the body
through the drinking water, that water carries micro-organisms
of certain infectious diseases which frequently break out in the
form of epidemics, and that it also carries parasites responsible
for diseases having their primary seat in the digestive tract
all these facts should be clearly elucidated before the public.
Dysentery, both bacillary and amoebic, is a rural disease closely
associated with the conditions of water supply in the village.
In Eastern Bengal, Cunningham 40 found as high as 86*5 per
cent of the dysentery cases under observation to be bacillary
and came to a conclusion which is of special interest to a
nutritionist. He believed that in a community where the infec-
tion is so widespread, one would discover several cases of latent
dysentery among groups of apparently healthy persons. Then
there is a host of water-borne diseases which year by year leave
marks of debility upon the physique of our rural masses.

Sanitation

Our consideration of the state of public health in India
would be incomplete without a reference to the problem of
sanitary disposal of excretal matter and other filth which is
closely related to the one we have just discussed. The dumping
of night soil on the outskirts of our cities and towns is a com-
mon practice but it becomes a source of contamination of the
sub-soil and consequently the use of water from wells is fraught
with grave risks. Most of the dairies from which we draw our
milk supply are situated near the sources of water into which
there is a constant inflow of human and animal excreta. Even
if the milk is not deliberately adulterated it becomes liable to
contamination because of utilizing the contaminated water for
washing the dairy vessels.

In most parts of our cities, the elementary form of conser-
vancy persists; and there is no excuse why the sanitation in
urban areas, where the demand for sanitary improvement has

121

PUBLIC HEALTH AND DEFICIENCY DISEASES

long been so insistent, should be of a very low standard. In
Bombay, the home of the Indian cotton industry, there arc
still, for example, over 15,000 basket privies and the features of
conservancy in other cities and towns are pretty much the
same.

Here we may pause to consider the environment of our
industrial workers. Within the last thirty years the extent of
employment in industries has increased approximately by 148
per cent, but the figures conceal the actual trend of employ-
ment in various establishments. It is estimated that there arc
some 25 million workers who depend for their livelihood upon
the total field of industries, but of these only 5 millions arc
employed in establishments of more than 10 employees; the
average attendance of workers at factories of more than 20
workers employing power is about one and a half millions; and
over two millions are employed under conditions which would
normally be recognized in an industrialized Western country
as constituting modern large-scale industry.

Drawn within the orbit of the industrial system, the millions
of our workers find themselves in an environment worse than
their village. Over 95 per cent of the houses occupied by our
organized labour in industrial centres arc unfit, even by an
elementary standard of sanitation, for healthy human habita-
tion. Mr. Sorley tells us in a recent report that some of the
conditions of housing in Bombay city c must be more reminis-
cent of the Black Hole of historical memory than of any
modern city pretending to sanitary living conditions'. Tt is
estimated that one-third of the population of 1,116,383 lives
in rooms occupied by more than five persons at a time and
15,490 in rooms occupied by 20 or more persons. Here in the
paradise of Indian capitalists over 97 per cent of the workers
live in a single small room accommodating from 6 to 9 persons.
'The crowding on the floor space, the smoke and smells from
the cooking; the food eaten amid a chaos of pots and pans; old
clothes, bedding and crawling children; the heavy fetid air;
the utter absence of privacy for ordinary needs as well as for
birth, death, and sickness; the publicity of the common stair-
case, the common washing place, the common latrine, . . .'
these are the constituent elements of housing in industrial
India which, as Miss Margaret Read declares, 41 revealed to

122

GENERAL STATE OF PUBLIC HEALTH

the Royal Commission on Indian labour an abominable state
of affairs. In the crowded quarters the water supply is defective
and so is the drainage, and it is not surprising that living in
such an environment our working class is constantly afflicted
with ill-health and disease.

Ten years have elapsed since the report of the Labour
Commission was published; but no determined efforts have
yet been made to cope with the appalling sanitary conditions
in our industrial centres. There hovels multiply, overcrowding
persists, tuberculosis and other allied diseases show an upward
curve, the rate of infant mortality increases, and the physique
of the working class drawn into the industrial centres for the
meagrest livelihood deteriorates; but neither the city corpora-
tions nor municipalities nor the industrial enterprises have taken
measures to improve the situation. In this respect Local Gov-
ernment authorities have indeed failed to discharge their
duties, and in instances where industries have provided tene-
ments for the worker, the lower income groups can have no
access to them.

The environment of our labourers working in the mining
areas is worse than that of industrial workers. Here a large
proportion of the mining coolies are recruited from the aborigi-
nal and backward tribes, who are obliged to resign themselves
to whatever conditions of service are offered to them because
they have no other means of livelihood. Their health and well-
being must engage our immediate attention; for, to quote from
those memorable words of Gandhi, c if India is not to perish,
we had better begin with the lowest rung of the ladder. If that
was rotten, all work done at the top or at the intermediate
rungs is bound ultimately to fail 5 .

As regards the sanitary conditions in rural areas, it is not an
exaggeration to say that they bear no evidence of the adminis-
tration of an advanced State claiming to be Enlightened
custodians of the health of the natives/

Ten years ago the Government were persuaded to appoint
a Royal Commission to inquire, for the first time, into the
environment of over 300,000,000 living in rural India. Evi-
dence of British medical men and public health officers before
the commission was characterized by that sense of duty and
devotion to their profession which no critics of the British

123

PUBLIC HEALTH AND DEFICIENCY DISEASES

administration could deny. They were keenly interested in
every aspect of the problem of rural India that appertains to
the health of the people and regretted, as Ross once observed,
that for the purposes of sanitation and public health they
received 'only the crumbs which remained at the bottom of the
public pocket 3 .* And the Report of the Linlithgow Commis-
sion observed: 'Sanitation, in any accepted sense of the word,
is practically non-existent. The public latrine is too often the
bank of the river or the margin of a tank. This predisposes to
hookworm infestation and to the spread of the diseases caused
by a polluted water supply, for the same water is in many
places used both for drinking and bathing purposes. Unpro-
tected wells and tanks, unswept village streets, close pent-up
windows excluding all ventilation; it is in such conditions that
the average villager lives. . . .'

The lack of provision for public water supply and the un-
hygienic ways of disposing of human excreta are the main
factors which have made our rural areas a veritable slum; and
not only the application of the principles of preventive medi-
cine but the maintenance of an effective standard of health
and physique has become an impossibility in that environment.

Widespread pollution of the soil is responsible for helminthic
diseases and for the frequent outbreak of epidemics. The hook-
worm, a parasite (Ankylostoma duodenale] which causes so
many depressing symptoms of ill-health, still continues to
infect the greater part of India. Nearly 80 per cent of our rural
population suffer from hookworm discasef (Ankylostomiasis) ,
which is perhaps one of the most common tropical diseases.
The prevalence of anaemia among tea-garden coolies and
agricultural labourers is partly clue to hookworm infection.
Add to this malaria and chronic undernourishment, and you
have the picture of the state of health of our labouring class.

Although hookworm disease has existed for centuries, the
discovery of the causative factor by Dubini in 1883 has shown
that its incidence can be prevented by taking adequate mea-
sures to stop the pollution of the soil. And in some of the

* The expenditure on Public Health in British India, taking both Central
and Provincial estimates, was only o-oi per cent of the total in 1928-9.

f The disease is believed to have been known to ancient Egyptians under
the expression heltu, which is mentioned in the famous Ebers Papyrus, written
about 1550 B.C.

124

INFANT MORTALITY

advanced countries its incidence has been greatly reduced by
the proper disposal of human excreta. So long as the hookworm
disease retains its grip upon the masses of India no substantial
improvement in their physique can be possible even through
adequate nutrition; for, as Dr. Bentley, Director of Public
Health in Bengal, says, it c bequeathes a pernicious legacy to
the infected community, its work being done in a subtle
insidious manner, weakening the race generation after genera-
tion, always tending to produce a condition of physical, intel-
lectual, economic, and moral degeneracy 5 .

As regards the direct relation between soil-pollution and
purity of foodstuffs, one example may be cited here as an
illustration of the seriousness of the situation. Beef is a common
article of food of the Moslem community; but if the cattle are
raised in an environment where the safe disposal of excreta is
neglected and pollution of the soil with human faecal matter is
widespread, the helminthic infections* render beef unfit for
human consumption.

We trust that the emphasis which we have laid upon the
subject of the environment of the people may not be considered
irrelevant to the problem of nutrition; for physiologists have
adduced adequate evidence to show that environment exerts a
considerable influence upon the functioning of the mechanism
of digestion. From this general account of public health in
India, we now turn to specific instances of the conditions of
health of infants, mothers, and schoolchildren.

Infant Mortality

Infant mortality is usually a sensitive index of the economic
and sanitary conditions of a country. That it is extraordinarily
high in India is an indication not merely of the state of public
health but of a vast source of misery and waste. Apart from
other considerations, the high infant mortality puts a severe
strain upon the precarious economic life of the family; and its
tragic repercussions upon the health and mental outlook of the
child-mother cannot be estimated so long as she remains a
voiceless victim of both social and economic circumstances.

* In this instance the infection is caused by the cysticerci of a kind of
worm ( Taenia saginatd) found in human faecal matter.

125

PUBLIC HEALTH AND DEFICIENCY DISEASES

The rate of infant mortality is, of course, related to various
factors such as age of mother, her general health and nutrition,
adequate intervals between childbirths, income of the family,
and the kind of environment. In urban areas and industrial
centres, the lack of housing accommodation bears a direct
relation to infant mortality. The statistics of Bombay, for
example, show that the rate varies in direct proportion to the
number of rooms in the houses occupied by the labouring
classes. But the prevention of diseases in infancy depends more
upon diet than upon any other single factor. Medical authori-
ties consider that the pre-natal period is probably the most
important period in man's existence and that the development
of various diseases may be traced to a defective state of pre-
natal nutrition.

Two main diseases which are responsible for the loss of over
one-fifth of the Indian infants born in the first year of life, are
disorders of the alimentary system and respiratory diseases. We
have now ample evidence to show that one of the chief causa-
tive factors in the prevalence of these ailments may be traced
to defective nurture. It is estimated that over 75 per cent of
infants under two years develop anaemia and that the anaemic
infants are liable to fall victims to both gastrointestinal
troubles and respiratory diseases.

No serious attempts have been made to estimate the extent
of infant mortality in British India and the figures available
vary, for example, between 137-8 in Bihar and Orissa to 329 in
Lucknow. In Calcutta the average death rate is 278 per thou-
sand births in the first month of life; but in the Jute Mill areas
the figure is as high as 282. At any rate, no one can dispute the
fact that the infant mortality both in urban and rural areas
throughout India remains obstinately high and that its causa-
tive factors must be fully investigated.*

The unimaginable poverty of the people is of course one of
the main causes of this abnormally high rate of infant mortality
in India. It is higher among families belonging to the low
income groups and the rate decreases with a general improve-
ment in the standard of living. An investigation initiated by
the Director of Public Health in the Presidency of Madras in

* Infant mortality in New Zealand 34, Canada 94, Japan 140, and India
187 per 1,000 births.

126

INFANT MORTALITY

1929 in the fair cities of Madras, Madura, Coimbatore, and
Trichinopoly showed as follows:

Income per month (rupees) Death per mille
25 and under 120

.50 and under 102

Over 50 84

But, let us admit that the social custom which encourages
immature maternity is also responsible for this senseless slaugh-
ter of the innocent. Nearly 40 per cent of Indian girls are
married at about the age of 15 years. The conditions under
which they bear children, the environment under which they
live and their insufficient and defective diet are some of the
contributory factors not only to the progressive loss of their
vitality but to the short span of life of our population. An
estimate of survivors of 100,000 infants at the end of 50 years
shows that India has the lowest number in comparison with
England and Japan.

TABLE V*

Survivors of 100,000 Infants at the End of Fifty Years
Countries Male Female

England 59.9^3 64,742

Japan 5 2 > 6 29 5*>794

India 18,658 *9j7i4

Whatever may be the root cause of this low survival value of
our population, the outstanding factor is certainly the preva-
lence of under-nourishmcnt and malnutrition among infants
from the age of 2 to 5. No other age-groups of our population
suffer more from malnutrition. It is not surprising that the rate
of infant mortality should be so high when a large proportion
of babies receive nothing better than rice-water or other forms
of gruel. It is therefore imperative that special provision should
be made for the supply of fresh milk or milk-powder to infants.
The establishment of a number of dairy farms throughout the
country for this specific purpose would be a useful measure to
be undertaken by the State; and in factories and industrial
centres where women are employed the supply of milk to their
children should be compulsory.

* Taken from Child Marriage by Miss Eleanor Ralhbonc, M.P.
127

PUBLIC HEALTH AND DEFICIENCY DISEASES

Mothers of 'Mother India 5

All medical evidence tends to show that nutrition is at the
bottom of the problem of maternal mortality. -In pregnancy
there is an increased demand upon the supply .of essential food
constituents necessary for the growth of the foetus as well as for
the maintenance of strength of the expectant mother. In the
period of stress and strain, her health and nutrition are almost
synonymous. It is largely due to the pronounced deficiencies
in diet that the maternal mortality rate in British India ranges
as high as 55 per thousand live births. A statistical analysis
from the records of the Calcutta Eden Hospital for the period
1850-1901 shows that the death-rate at delivery was 66-5 per
mille 42 . It is not possible to obtain an accurate All-India esti-
mate of maternal deaths on account of the defective system of
collecting vital statistics but medical authorities believe that
deaths in childbirth exceed 200,000 per annum.* An exami-
nation of maternity statistics from the State of Mysore shows
that over 55 per cent of maternal deaths are associated with
still-births and that they are more frequent among the Hindu
communities.

It is a truism to say that irreparable damage is done to the
childbearing woman by undernourishment and malnutrition.
c After all, sound nutrition in a pregnant woman', writes Sir
George Newman in his report (1933) to the Ministry of Health
of the United Kingdom, e is obviously the only way of sustain-
ing her own health and strength and that of her forthcoming
child. She should become accustomed to a diet which includes
ample milk (two pints a day), cheese, butter, eggs, fish, liver,
and vegetables, which will supply her body with essential
elements, salts and vitamins, without overburdening the organs
of excretion.'

Figures, calculations, and neatly recorded tables, etc., are
not available to show the state of nutrition of Indian child-
mothers; but in support of the fact that it is inadequate and
faulty, we have only to look within our homes where for every
1,000 babies born over 350 mothers become disabled, and
about 24 die; nearly 2 per cent of all pregnant women in India
suffer from pernicious anaemia.

* For figures in some other countries of the world, see Appendix I.

128

MOTHERS OF 'MOTHER INDIA'

Wills and Mehta 43 conclude from their investigations that
the high maternal mortality in India may be ascribed to the
severity of pregnancy anaemia which is largely nutritional in
origin. Its incidence is particularly high among the working
class. In 31 tea-gardens in Assam, Balfour 44 found on examin-
ing 9,373 deliveries registered within a period of three years
that an average maternal mortality was 42 per 1,000 and that
in one garden the rate was as high as 1 30. Taking the data for
the year 1932 alone, the death-rate revealed the appalling
figure of 256 per 1,000. There is every reason to believe that
a great percentage of this heavy mortality is due to pregnancy
anaemia.

It should be noted that anaemia usually occurs in those
patients who have had for a considerable time a diet deficient
in such essential food constituents as proteins, calcium, iron,
and vitamins. And, since the foetus c is a parasite who robs the
mother' of these nutrients, their supply should be well assured
in the maternal diet. The diet should therefore contain an
adequate quantity of 'protective' food constituents supplied by
milk, milk-products, fresh green vegetables, eggs, and fish.

There are other grave symptoms of ill-health in this period
of woman's life which may be traced to undernourishment
and malnutrition. Eclampsia before or during labour, is some-
times due to chronic deficiencies of vitamins and inorganic
substances. Theobald 45 has recently suggested that all forms
of toxaemias of pregnancy may beregarded as the consequences
of dietetic deficiencies, especially if there be any disturbance
in calcium metabolism. Based upon his observations in India,
Green-Armytage found that tetany 'is much more common
than is realized and may be seen in women in all communities
during pregnancy, if their diet is defective and they are anae-
mic 5 .

It should be understood that the high maternal mortality in
India is not merely a question of poverty. Inadequate and
crude maternity service, ignorance in regard to proper and
adequate nutrition, adherence to harmful social customs and
depressing environmental conditions all these circumstances
combine to produce so much suffering in almost every home in
India. Twenty-five years experience of pregnancy conditions
in every community has convinced me', writes Green- Army-

129

PUBLIC HEALTH AND DEFICIENCY DISEASES
tage after his prolonged sojourn in India, c that diet and sun-
light deficiency are responsible for an ever-increasing number
of obstetrical difficulties. 3 In a country where the fate of every
girl, irrespective of her physical and mental condition, is
marriage, it is not surprising that only a small percentage of
Indian women are aware of the joy of good health.

A vast number of mothers survive the ordeal of childbirth
only to live a life of chronic invaiidism, the dire consequence
of which is reflected both upon the family and the community.
It is this depressing fact which is largely responsible for the
persistent gloom that overshadows the Indian home. Not only
does it involve individual suffering but is also a severe strain
upon domestic economy.

Then there is the custom of early marriage. How it affects
mother and child is shown in great detail in the Report of the
Age of Consent Committee appointed by the Indian Legisla-
tive Assembly in 1928. That a fairly large percentage of our
child-wives die of some form of respiratory disease or of some
ovarian complication within ten years of the consummation of
marriage, that the maternal mortality rate at ages from 1 5 to
19 is nearly 50 per cent lower than the rate below the age of
15, that still-births and neo-natal deaths arc frequent in the
case of mothers below 16 all this is emphasized in the report-
It says: 'Early maternity is an evil and an evil of great magni-
tude. It contributes very largely to maternal and infantile
mortality, in many cases wrecks the physical system of the girl
and generally leads to degeneracy in the physique of the race.
. . . The evil is so insidious in all its manifold aspects of social
life that people have ceased to think of its shocking effects on
the whole social fabric.' Sir John Mcgaw estimates that e onc
hundred out of every 1,000 girl-wives are doomed to die in
childbirth'. Indeed, the mothers of 'mother India' oscillate
between two conditions of existence, namely, gestation and
lactation, till merciful death comes to their rescue.

While the serious consequences of premature motherhood as
a dysgenic force should be brought home to the people, the
problem of nourishment during pregnancy and lactation is
urgent and measures of direct assistance, where necessary,
have to be adopted in order to protect mothers against the
risks of malnutrition. Those who arc loud in proclaiming the

130

HEALTH OF SCHOOLCHILDREN
much-vaunted glories of Indian motherhood should realize
that the failure to provide adequate and proper maternal diet
is one of the root causes of racial decay.

Health of Schoolchildren

Records of attendance of pupils both in primary and secon-
dary schools in India show that a large percentage of absence
is due to illness; but owing to haphazard and spasmodic
medical inspections it is difficult to ascertain the nature of the
illnesses or the extent to which they may be ascribed to under-
nourishment and malnutrition. Nevertheless, Sir Ronald Ross's
mordant picture of a class of Indian pupils, c all with enlarged
spleens, struggling to learn by rote the dates of accession of the
Plantagenet Kings 5 , is pathetic but true. Lack of muscular
tone, roughness of skin, tired eyes, slow gait all these are well
marked in most of our schoolchildren. Nervous restlessness,
poor comprehension, poor memory, and the habit of lisping
are the symptoms which indicate a certain retardation in the
processes of co-ordination of the nervous system.

A system of medical inspection in India other than seeing
the schoolchildren 'on parade' has revealed some of the com-
mon defects arising from prolonged suboptimal nutrition. A
closer examination, for example, of the pupils in secondary
schools in Bihar and Orissa in 1932 showed that 62 per cent
of the boys and 66 per cent of the girls examined had some
pronounced defects which could be ascribed to nutritional
deficiency. Among nearly 1,500 children in the primary schools
in Central Provinces, over 33 per cent suffered from rickets,
faulty dentition, dental caries, and various forms of gastro-
intestinal disorders. Nearly 30 per cent of the children exam-
ined in the North-West Frontier Province suffer from dental
diseases. Investigations recently conducted by Aytroyd and
his associates into the state of nutrition of schoolchildren in
South India show 46 the heavy incidence of angular stomatitis,
phrynoderma, and Bitot's spots among them, the frequency of
which is related to the insufficiency of 'protective 3 foods.

The prevalence of these specific symptoms associated with
undernourishment and malnutrition is coming more and more
under the close observation of the medical profession and Public

PUBLIC HEALTH AND DEFICIENCY DISEASES

Health authorities and the problem of defective nurture in
childhood has become a serious concern of every civilized
state.

The Mixed Committee on Nutrition of the League of Nations
found that a decline in physique was specially common among
undernourished children between the ages of 15 and 18
and that between those ages the risk of pulmonary diseases is
generally great. In the absence of an organized system of
medical inspection of schoolchildren in India, we do not realize
the extent of wastage involved in providing educational facili-
ties to those who are sadly handicapped with ill-health and
cannot benefit from education. There is, therefore, ample
justification for the resolution recently passed by the All-India
Women's Conference that 'Systematic medical inspection
should be made compulsory in all schools and colleges; and in
the case of girls, the inspection should be carried out by medical
women. Where possible school kitchens should be started and
arrangements made to deal with cases of malnutrition 3 . Re-
sults of such medical inspections, especially in regard to evi-
dence of undernourishment and malnutrition, should be widely
circulated both on the grounds of awakening social conscience
and in furtherance of the spread of the c new knowledge of
nutrition'.

In Chapter Seven we have attempted a short account of the
measures adopted by certain advanced countries for the super-
vision of the nutrition of schoolchildren. We now pass on to a
general survey of some of the common food-deficiency diseases
in India.

Prevalence of Diseases Caused by Nutritional
Deficiencies

In Chapter Three we have collated some general informa-
tion in regard to the consequences of multiple and partial
dietetic deficiencies. Here our purpose is to deal with certain
pronounced manifestations of diseases in India, apart from
several obscure illnesses, which are closely associated with a
lack of essential food constituents and food accessories. While
systematic investigations into the nature and extent of func-
tional disturbances caused by undernourishment or by mal-

132

PREVALENCE OF DISEASES

nutrition operating for long periods of time among all sections
of the population of India have not as yet been undertaken,
we hope to be able to adduce sufficient evidence from the
observations of medical officers in India to elucidate the fact
that there are several diseases prevalent in the country in
which the main aetiological factor is concerned with the con-
stitution of the dietary. It must, however, be remembered that
there exist a large number of border-line cases which do not
show clinically recognizable symptoms of deficiency disease;
nevertheless they are there to undermine the stamina of the
people. In Indian homes, rich or poor, the complaints of
suffering from undefinable illnesses are almost universal and
their occurrence may also be traced to the imperfect state of
metabolism, resulting chiefly from inadequate or improper
diets. Intestinal stasis, chronic constipation, dyspepsia, and
other forms of ailments arise mainly from disturbed metabol-
ism. Diabetes mellitus, as already mentioned, is another disease
caused by disharmony in the metabolic process, especially in
relation to carbohydrate and fat. Beri-beri, rickets, osteoma-
lacia, ophthalmic disease, and various forms of anaemia are
common in India.

Castro-Intestinal Disorders

There is a common saying with us that c rnan is an organism
built around a food tube'. Our unsophisticated folk regard
health of the body as mainly dependent upon the proper
functioning of the gastro-intestinal tract, which, they have
observed, suffers most from irregular diet. Gastric and duo-
denal ulcers, colitis and various types of gastro-intestinal dis-
turbances are due to faulty nutrition, or to dietetic errors.
That an important relation exists between food accessories and
the normal functions of the gastro-intestinal tract has been
clearly demonstrated by McCarrison. 47 He selected two kinds
of diets to feed albino rats, one resembling the usual diet taken
by the poorer class of population in Madras, and the other by
the indigent peoples of the State of Travancore. Both these
diets were grossly deficient in vitamin content as well as in
other essential food constituents. Among the first group of his
animals there was an incidence of gastric ulcer of 1 1 per cent
and in the second group 28 per cent.

* 133

PUBLIC HEALTH AND DEFICIENCY DISEASES

Medical authorities are agreed that when gastro-intestinal
disturbances become associated with nervous disorders, various
forms of neuritic symptoms soon manifest themselves and that
this association is also due to nutritional deficiencies.

Nervous Disorders

Inadequate diet with the total calories below 1,000 and pro-
nounced deficiency in 'good' proteins,, fats and vitamins gives
rise to some of the characteristic features of the disease known
as famine dropsy. Although its name suggests association with
famine conditions, it should not be concluded that the disease
breaks out only when the Government decide to declare
famine! It is strikingly a disease of poverty. Signs and symp-
toms such as weakness of the muscles, emaciated body are
noticeable among our indigent population throughout India;
but only when they are allowed to develop to a great extent
does oedema of the body set in and the victim become in-
capacitated. Infants fed largely on a starchy diet over a long
period are liable to the disease, and it is rather widespread
among schoolchildren. Sir John Megaw rightly says, 'Minor
degrees of this disease are common among people living on the
border-line of starvation. 3 A picture of famished India would
abundantly corroborate this statement.

There is another form of dropsy not strictly regarded as a
deficiency disease which breaks out as an epidemic, especially
among people whose staple diet consists chiefly of rice. Its
incidence appears to be related to the use of parboiled, highly
polished rice, especially if the cereal is stored for considerable
periods in damp places. Megaw, Acton, Chopra, and other
authorities consider that epidemic dropsy is caused by the
toxins produced in rice by micro-organisms* under improper
conditions of storage; and their observations in Calcutta are
confirmed by Burnet in his investigation of the incidence of
the disease in Sierra Leone. It is believed that rice toxin also
destroys vitamin B complex. The study of the epidemic in rice-
growing tracts in India shows that it usually breaks out among
the communities which depend for their supply of grain on

* An organism named Bacillus asthenogems is found in badly stored rice
and may be a causative factor in the production of a toxin in the digestive
tract.

PREVALENCE OF DISEASES

milled rice stored under conditions altogether unfavourable
for its protection against moisture and heat; and it disappears
with the harvest of the new rice crop. A liberal supply of
protein and.the substitution of wheat for rice are recommended
for the treatment of the disease.

Epidemic dropsy has certain symptoms which often confuse
the disease with beri-beri, but aetiologically they are not re-
lated; though c there is little doubt that rice dietary plays a
very important role in their aetiologies 5 . We have already stated
some of the characteristic features of beri-beri., which Is more
widespread in India than is usually supposed. It occurs in
Bengal, Bihar, Assam, Madras, and Malabar the areas where
rice is the staple diet of the people. Although its outbreak is
primarily associated with the consumption of milled rice be-
cause of the loss of vitamin B in the milling process, it is held
that a pronounced deficiency of vitamin A may have an
ancillary action. It may thus explain why Indian labourers,
whose diet consists of milled rice of inferior quality and is
almost devoid of the sources of vitamin A, suffer most from
beri-beri. It should be noted here that an ill-balanced diet
involving deficiencies of proteins and inorganic salts but con-
taining an excessive amount of carbohydrates often leads to the
development of symptoms somewhat similar to those of beri-
beri.

But the salient deficiency of vitamin Bi is the chief aetiologi-
cal factor in the incidence of this disease and therefore our
attention must be drawn to measures that can be taken to
control the production of over-milled rice. The husk of rice-
grains is removed by two processes. One is to soak it for some
time and then to steam or boil it. After drying the paddy thus
treated, either in the sun or in heated cylinders, it is pounded
or milled. The process is known as parboiling. The other pro-
cess is just milling without these preliminary treatments of
soaking or steaming.

The relation between various grades of milled rice and the
incidence of beri-beri may be seen from the following table
composed from data obtained by Vorderman in his examina-
tion of over 279,000 persons in the prisons of Java and Madura.

135

PUBLIC HEALTH AND DEFICIENCY DISEASES

TABLE VI*
Beri-Beri and Milled Rice

Type of Rice
Consumed

Number
of Prisons
Examined

Number
in which
Beri-beri
Occurred

Per

Cent

Proportion of
Cases of Beri-
beri Among
Total Number
of Inmates

Half-polished
One-third polished
Polished

37
13
51

i
6
36

2-7
46
7i

i in 10,000
i in 416
i in 39

In the provinces where rice is a staple food, steps should be
taken to adopt measures for proper storage of the cereal. In
India the medical authorities have drawn the attention of the
Government to the importance of stamping out both beri-beri
and epidemic dropsy but nothing has yet been done. 'These
diseases are so serious', writes the Indian Medical Gazette, c they
are responsible for such an immense amount of mortality and
morbidity, and their prevention appears to be such a simple
matter, that Governments of the countries affected might well
consider the advisability of formulating regulations for ensuring
the proper storing of rice, and for restricting the sale of diseased
grain. 5

The chief obstacles in the way of eradicating it are, as is
always the case with deficiency diseases, poverty, ignorance,
and deplorable economic conditions. The wretchedly penu-
rious populations of the East are as a whole too poor and too
ignorant to have a diet sufficiently varied to prevent beri-beri.
But the obstacle of poverty and ignorance might in this case be
easily overcome by prohibiting the manufacture of highly
milled rice and so forcing people to consume rice that contains
enough vitamin Bi. The Far Eastern Association of Tropical
Medicine did indeed propose such a prohibition as long ago as
1921, but the official representatives of the Governments con-
cerned refused in 1923 to take any action on grounds that one
might call frivolous if they did not conceal a turpitudinous
purpose. These persons declared that the aetiology of beri-beri
was still not fully elucidated, that unmilled rice has an un-

* Based on the table in the Medical Research Council's Report on the
Present State of Knowledge of Accessory Food Factors, 1924.

136

PREVALENCE OF DISEASES

pleasant taste and that it does not keep as long as milled rice,
that a reliable test for distinguishing rice that contains enough
vitamin Bi from rice that does not had not yet been found,
and, finally, that 'the prohibition of highly milled rice in Far
Eastern countries would meet with great resistance from the
rice trade,, which, in general, is organized to produce that
article 5 .

The speciousness of the first three of these 'reasons' is clear
when one remembers the official declaration of the Far Eastern
Association that, 'there is enormous annual loss of life, with
corresponding invalidism and disability, due to deficient diet
in the above countries (the Far Eastern countries) and this
deficiency is mainly due to the over-milling of rice, which
removes a vital part of the essential food factors . . . nothing
has been put forward in the last ten years which proves that
beri-beri cannot be controlled by substituting under-milled for
polished rice in countries in which rice is the staple article of
diet. 5

It therefore appears that the real reason for the Govern-
ments' refusing to take action is the opposition of the rice
manufacturers, who do not wish to be forced to reorganize
their industry. The anomalous situation thus created is well
illustrated in Siam where unmilled rice cannot be purchased
but where the Government buys the rice-polishings from the
manufacturers and makes vitamin Bi extract as a cure for the
beri-beri which is rife in the country. Thus the manufacturers
are both saved from having to reorganize their industry and
paid by the Government for their waste product out of the
taxes of those who suffer from beri-beri as a result of the manu-
facturers' recalcitrance. Aykroyd rightly stigmatizes this situa-
tion as 'roundabout, inefficient, insane'.

The provinces in India where beri-beri is increasing with the
use of milled rice should follow the example of the Govern-
ment of Federated Malay States by prohibiting the use of
polished rice in all institutions directly under the State control,
such as schools, hospitals, asylums, and jails. Ever since that
Government enforced the measure in Singapore, there has
been a steady decrease in the incidence of beri-beri, and the
people are beginning to realize that the substitution of under-
milled for milled rice is a step towards the maintenance of

137

PUBLIC HEALTH AND DEFICIENCY DISEASES

health. The need of proper rice-storage as an Insurance against
the outbreak of dropsy and allied disabilities Is equally urgent,
if the health of rice-eating peoples is to be protected. With the
introduction of rice-mills, the storage of rice in ihe form of
paddy and the practice of unhusking small quantities at a time
as required are not in favour, especially in the urban areas.
Public institutions, industrial communities, organized board-
ing-houses, and other bodies concerned in mass-feeding should
take adequate care for the storage of rice; and municipal
organizations should be empowered to supervise the methods
of storage adopted by grocers and rice-dealers. The period of
storage should be as short as possible. As regards the rural
areas, the encroachment of rice-mills should be discouraged,
and the indigenous organization known as c Dharma gola 3 can
be revived, through efforts of co-operative societies.

Lathyrism is a form of chronic nervous disease associated
with 'degenerative changes in the spinal cord similar to those
occurring in dogs fed on diets deficient in vitamin A'. But its
incidence appears to be closely related to the habitual use of
the seeds of certain species of vetches (e.g. Lathyms sativus,
Lathyms deem, Vicia satwa) although the precise nature of
the correlation between their consumption and the symptoms
of the disease is not as yet clearly elucidated; but since the
symptoms are somewhat similar to those of food intoxication
by a toxic alkaloid substance, it was suspected that the vetches
referred to above might contain poisonous substances capable
of causing the disease. But, c it is possible', writes Megaw, 'that
the absence of vitamin A and carotene from the diet allows a
neurotoxin in the peas to exert its harmful effects on the central
nervous system 3 .

Rickets and Osteomalacia

The causative factors of both these diseases are identical.
While a pronounced form of rickets is common in some parts
of south and western India, minor degrees of its symptoms
occur wherever the diet is deficient in vitamin D. Rickets is
common among infants and children, and osteomalacia occurs
chiefly among female adults. Infants who cannot obtain the
mother's milk and are ill-fed, develop symptoms of rickets; or
in consequence of an inadequate supply of calcium and phos-

138

III, Typical appearance of angular stoma-
titis in a girl aged 20,

IV, A closer view of rickets,
By Mjfffmm of Miss L EAgw.

PREVALENCE OF DISEASES

phoras in the food of the childbearing mother, predisposition
to rickets in infancy and childhood may be present, and should
the post-natal feeding be extremely deficient the infant may
develop the Disease. On the other hand, there is conclusive
experimental evidence to show that a predisposition to rickets
may be overcome by a period of proper diet. In the Kangra
districts among the peoples whose diets are quantitatively and
qualitatively deficient and contain an excess of cereals, Wilson
found 48 the greatest incidence of both rickets and osteomalacia;
but the Gurkhas, whose dietary includes milk, vegetables, and ? ^
fats of animal origin, are relatively free from these diseases, j

General weakness, restlessness, muscular spasms, pains in the
pelvic zone are some of the early symptoms of osteomalacia. If
they are overlooked softening of the pelvic bones sets in and
during pregnancy they become deformed. It is found that the
disease is frequently preceded by pregnancy anaemia.

As regards its geographical distribution, it is of frequent
occurrence in Northern India and in the province of Bombay,
but comparatively rare in Madras and in the Gangetic delta.
Both rickets and osteomalacia are fairly common among the
poor in the Central Provinces. Balfour 49 found that the average
incidence of osteomalacia in Indian hospitals was 24-4 per
1,000 maternity cases, while the ratio per community per 1,000
labours was as follows, for All-India excluding Bombay.

Ratio per 1,000 labours

Hindus 30.9

Mohammedans 62-0

Others (mainly Christians) 5-2

Since purdah is strictly observed among Mohammedan women
in Bombay, the ratio of the disease among them per 1,000
labours is as high as 38-0. The disease is prevalent in the State
of Kashmir. Dr. Kathleen Vaughan 50 reports that out of 29
caesarian sections performed by her during her first year as a
medical officer of the State Hospital, at least 25 were due to
pelvic deformity caused by this distressing disease.

Most, investigators are agreed that the development of osteo-
malacia is contingent upon at least one additional factor be-
sides deficiencies in diet, namely, unhygienic conditions

139

PUBLIC HEALTH AND DEFICIENCY DISEASES
of living, especially want of sunlight and fresh air. We have
already alluded to the custom of purdah which debars young
girls approaching the age of puberty from the blessings of the
open-air life. Where the evil of purdah and the di/re poverty of
the people conspire, the disease finds favourably circumstances
for tightening its grip, but the fact that the disease frequently
occurs among the wealthy communities such as the Banias 5
Marwaris, Bohras, and Khojas, who strictly adhere to purdah
precludes it from being associated with poverty alone. Here
unbalanced dietary is responsible, but the incidence of the
disease among the poverty-stricken peoples who do not
observe the custom shows that sunlight cannot prevent osteo-
malacia if the diet is grossly deficient in essential food acces-
sories. The main factor in the aetiology of the disease is a
consistent lack of vitamin D, together with excessive use of
cereals. Wilson's 51 observation in the village of Launa in the
Punjab confirms that the influence of diet in the incidence of
osteomalacia is predominant. All the inhabitants of the village
live freely in the open air, and sunshine is plentiful eight months
of the year; and yet, c of the three groups in the village, those
living on cereals and practically without milk, eggs, greens, or
meat showed a heavy incidence; those better off and having
a little milk and perhaps a slightly better diet, a milder inci-
dence; those having milk, occasionally fresh greens and fruit,
and more cooked vegetables and meat, showed no signs of the
disease 5 .

We have already mentioned that there is a general agree-
ment among medical authorities that certain forms of dental
diseases such as caries are primarily due to inadequate protec-
tive foods. Defective calcification of the enamel and dentine of
the teeth and consequently low resistance to caries are now
ascribed to marked and prolonged dietary deficiencies, especi-
ally in the supply of calcium and vitamin D. Pyorrhoea alvco-
laris is also associated with a diet deficient in vitamin A.
Megaw observes that 'Caries in young Indian adults is far less
common than in England or New Zealand. Pyorrhoea alveo-
laris on the other hand is almost universal after the age of 40.'
Clinical experience shows that well-balanced diets definitely
arrest the progress of tooth decay.

Statistics of the prevalence of dental diseases in India are not

140

V. Rickets, which cripples Indian children by the thousand.
By kind permission of Miss A. Edgar.

V* , .-.-iteW,"

VI. Xerophthalmia, an eye trouble caused by deficiency of vitamin A.

The cause of thousands of cases of blindness annually in India.

By kind permission of Professor C. E. Block.

PREVALENCE OF DISEASES

available but even the cursory medical inspections carried out
in schools reveal that they are common even in those parts of
the country where diets are comparatively satisfactory. In the
North- Western Frontier Province, for example, over 30 per
cent of the schoolchildren suffer from dental caries and other
forms of dental diseases. Among the population in the rice-
growing parts of India, the incidence of badly formed or decayed
teeth is widespread. Many children who may have an outward
appearance of good teeth are found on examination to need
dental treatment.

Eye Diseases

The association of dietary deficiencies with certain diseases
of the eye has long been suspected, and sufficient data are
being collected by medical investigators to correlate the rela-
tionship on an accurate basis. It is admitted that even where
the specific effect of vitamin deficiency may not be ascertained,
its indirect influence upon the health of tissues or of mem-
branes is often pronounced; and that malnutrition and conse-
quent low vitality may be one of the important causative
factors in retinal defects.

The inflammation of the eyes so common in India among
women and children is largely due to the inadequacy of vita-
min A, along with other co-existing deficiencies, in their usual
diet. In many cases there is an almost complete inhibition of
the activity of the lachrymal glands and the persistence of the
symptoms often leads to blindness. Defective vision, dryness of
the conjunctiva, and other signs of eye diseases are noticeable
among a large proportion of schoolchildren in India, the chief
cause of which is malnutrition. Those who are familiar with
our rural folk cannot but observe cases of keratomalacia among
the poor classes. It is common on the tea plantations of Assam
and elsewhere, and also among the industrial workers. Medical
authorities believe that keratomalacia is responsible for more
blindness among children in many parts of India than any
other eye disease. We are indebted to Lieut. -Colonel Wright
for his vivid description of the symptoms of this disease in
South India, where he observed the fatal consequences of pro-
longed vitamin A deficiency. He 52 says: 'When the early signs
and symptoms appear, if nothing is clone to augment the

141

PUBLIC HEALTH AND DEFICIENCY DISEASES

amount of essential food-factors in the diet, the case rapidly
progresses and marasmus sets in; the patient becomes wasted,
the skin harsh and earthy-looking, the hair appears dull,
brittle and thin, the mucous membranes also show a dimin-
ished secretion and the more accessible membranes of the nose,
throat and mouth are seen to be abnormally dry. It is generally
somewhere about this stage that babies are brought to the out-
patient department. Pari passu with the wasting of the mucous
membranes, there is an advance in the eye symptoms. As a
rule, the smoky conjunctiva becomes dry, wrinkled, and greasy-
looking, the cornea becomes dull and lustreless and eventually
opaque. . . . Later the cornea undergoes necrosis and ulcera-
tion, and if untreated, the ulcer perforates, and the eye is
ultimately lost.'

There are no statistics of the blind for India, but it is esti-
mated that there are about one and a half million totally and
over four million partially blind persons. Night-blindness is
common among our poverty-stricken adult population. The
incidence of eye diseases varies in different parts of India
according to the state of nutrition and to the acutcness of
poverty of the masses; consequently the estimated figures for
total blindness show a variation of from 450 to 900 per 100,000
persons.*

In recent years a number of institutions have come to be
established in India for social amelioration and training for the
blind; but a greater emphasis should be laid on the prevention
of the contributing causes of blindness one of which is under-
nourishment and malnutrition. The prevailing belief among
our peoples that blindness is a form of punishment for misdeeds
committed in a former existence has to be refuted by demon-
strating how defective vision and retinal defects are related to
the diet. When supplied with diets which include adequate
milk and butter or when treated with liberal doses of cod-liver
oil, retinal defects at their initial stage are remedied. Certain
types of conjunctivitis prevalent among Japanese school-
children were successfully treated by the use of various oils
containing vitamins. In Central Europe during the period
following the Great War, the prevalence of night-blindness was

* The figures for totally blind in Egypt are i ,2 1 9, England and Wales 119,
Japan 105, United States 49, and Belgium 36 per 100,000 of the population.

142

PREVALENCE OF DISEASES

successfully checked by ensuring adequate supplies of vitamins
A and D.

Skin Diseases

One of the conspicuous manifestations of dietary deficiencies
is to be found in the prevalence of skin diseases. We have
already mentioned pellagra, which is, according to Aykroyd,
'the most horrible of all food deficiency diseases'. The disease
is not uncommon among the indigent population of North
Bihar, Hyderabad (Deccan) , and certain parts of the Presi-
dency of Madras. It prevails mostly among agricultural
labourers whose diet is utterly deficient in proteins and vita-
mins.

In various other forms the symptoms of unhealthy skin pre-
vail to a great extent among our ill-nourished population.
According to a recent investigation by Aykroyd and Krish-
nan 53 a type of stomatitis (sore mouth) somewhat similar to
that found in pellagra patients is common among poor chil-
dren in the Presidency of Madras. What is described as toad-
skin (phrynoderma) is due to vitamin A deficiency, and the
subject whose skin is thus affected is often afflicted with sore
mouth. It has also been noted that pathological conditions of
the skin are frequently associated with keratomalacia.

The progressive wasting of the child suffering from mal-
nutrition is usually manifested in the condition of the skin.
Describing the clinical aspect of the cases of vitamin A defici-
ency, Wright observes that c by the time the average mother
brings the baby to hospital, the skin is hanging in baggy
wrinkles round the joints the so-called elephant skin the
mucuous membranes of the mouth, nose, and throat are wasted s
glazed and dry, the thin piping or hoarse croaking voice is
hardly recognizable as proceeding from a human being'.

Stone in the Bladder

The formation of stone in the bladder (urinary calculi) is a
common disease in the western part of the United Provinces,
the Punjab, Sind, and the North- Western Frontier Province.
McCarrison's researches show 54 that a pronounced deficiency
of fat-soluble vitamin A and an imperfect balance between the
supply of calcium and phosphates in the diet are the two fao

PUBLIC HEALTH AND DEFICIENCY DISEASES

tors conducive to the incidence of the disease. Megaw's enquiry
into the dietaries of the three chief communities of the Punjab,
namely the Hindus, the Sikhs, and the Muslims, indicates the
possible relationship between diet and stone formation. He
found 55 that the incidence of the disease was less among the
Sikhs, whose diet was well balanced and more nutritious than
that of either of the other two communities. The Sikh diet,
which we have described in Chapter Six, is varied and usually
includes a liberal supply of milk, fresh vegetables cooked in
ghee and meat. While the Hindu diet is predominantly vege-
tarian, the Moslems take a considerable quantity of meat but
less milk and vegetables.

These are, then, some of the prevalent diseases in India,
which may be ascribed to faulty nutrition. Since the problem
is related to public health, it is relevant for our purpose to turn
to the State organizations concerned with the health of the
people.

Public Health Services and Organizations in India

The British system of public health is unique and provides
a pattern to all countries concerned in the formation of their
public health policies. Its advancement in England was made
possible not merely by progressive stages of legislation which
served to spread knowledge of hygienic practices, but by the
growth of a wider concept of social service fostered by humani-
tarian ideals. The spiritual awakening ushered in by the
Wesleyan movement, the gradual shifting of philosophical
interest from metaphysics to sociology, the comparatively
homogeneous character of social organization and the develop-
ment of the sense of social responsibility these are some of
the potent factors which have helped to extend the benefits of
medical science and public health to the majority of the people
in Great Britain.

British medical men carried with them the spirit that pro-
moted the growth of their art to distant lands where they went
in various capacities and made sustained efforts to put their
art into practice. In India they found themselves faced with
obstacles arising from poverty in its most acute form. The
social habits of heterogeneous races, the ignorance and preju-

144

PUBLIC HEALTH SERVICES

dices of the general population and lack of initiative among
them to attaining a high standard of sanitation added to the
complexities of the problem. Nevertheless, imbued with the
spirit of science, they pursued their goal with zeal and enthu-
siasm. They were not sceptical of their success in overcoming
the initial difficulties which faced them; nor did they lay undue
stress upon the conservative forces within the Indian socio-
religious system as being hostile to the benefits of medical
science and hygienic practice. They knew that most of the
scourges which now afflict India had once upon a time existed
in Europe and bred among her peoples that fatalistic attitude
and superstitious bent of mind which to-day undoubtedly
darken the outlook of the Indian masses; they frankly acknow-
ledged that a satisfactory advance in matters relating to public
health and hygiene could be made possible if the Government
took adequate steps for providing facilities for medical educa-
tion; and they found the progressive elements in Indian com-
munities responsive to measures for the physical welfare of the
peoples.

In the third decade of the nineteenth century, they took the
initiative by establishing a medical college in Calcutta for
training the Indian youth in medical science and hygiene and
found in them promising material for acquiring the knowledge
of medical relief and sanitation. 'Difficulties will beset his pro-
gress, it is true/ wrote Dr. O'Shaughnessy, a teacher of chemistry
and pharmacology in the Calcutta Medical College in 1844,
'but to overcome them all, he requires only the qualities which
the Indian youth possesses in a most pre-eminent degree. He is
quick of perception, patient in reflection, adroit and delicate in
experimental manipulation, and with these endowments his
full success in this study may be confidently foretold. 3

While British medical and sanitary officers in India fully
realized that the provision of all that is implied in the mainte-
nance of health should be one of the chief concerns of an
enlightened government and admitted that a great many posi-
tive measures could be adopted in the interest of public health
in India, the policy of the Government of India was that of
non-interference with habits and customs of the peoples under
the plea that an awakening of the public health conscience was
a task for Indians themselves. For an alien government the

H5

PUBLIC HEALTH AND DEFICIENCY DISEASES

hesitation to interfere with the freedom of social life of diverse
communities, even when such freedom is proved to be contrary
to the recognized principles of public health, may not be
unnatural; but during a long period the responsibility of public
health remained entirely under their control, they could have
initiated a unified policy in the interest of India; and with their
prestige and power they could have influenced public opinion
in favour of activities leading to an awakening of the corporate
sense in regard to maintaining the health of communities. But
their achievement in this matter has been poor. What sub-
stantial progress can be made when the annual public health
budgets for the whole of British India do not exceed even at
their highest a penny or two per head of the population?

A brief reference to the history of the public health organiza-
tion in India at this stage may be of interest.

Two years after the Indian Mutiny, it became necessary for
the Government, then transferred to the Crown, to strengthen
the British garrison in India. The high mortality among the
troops and the general insanitary environment induced the
Government to examine the problem by a Royal Commission
which visited India in 1860 and reported in 1863. As a result
of their recommendations, three permanent sanitary commis-
sions were established in the three major provinces of Bengal,
Bombay, and Madras. The primary concern of these commis-
sions was to reduce the rate of sickness in the army but it
involved the proper administration of certain rules and regula-
tions applicable to the sanitary condition of the general
population. No attempt was made to introduce a comprehen-
sive sanitary reform 'owing to the financial and administrative
difficulties 5 . A quarter of a century later, with the passing of
Local Self-Government Legislation, the Government of India
issued a resolution laying down that 'the promotion of sanita-
tion should be regarded as one of the most important duties of
all local bodies and of village unions', but when they found that
the rate of sanitary progress was exceedingly disappointing,
their consolation was that e in the land of the ox-cart one must
not expect the pace of the motor-car 5 .

The arrival of a great plague epidemic in 1896 and the unrest
that followed that disaster stirred informed public opinion but
not until 1912 did the Government of India formulate any

146

PUBLIC HEALTH SERVICES

coherent policy for public health and sanitation. They intro-
duced a system of giving grants to Provinces for the purpose of
initiating sanitary measures both in districts and municipal
areas and allowed Provincial Governments to appoint sub-
ordinate staffs; but the administration of public health re-
mained highly centralized. Steps were taken towards the
provision of facilities for the study of problems of public health
and the Indian Research Fund Association was established to
widen the scope of investigations. But the question of trained
research workers in India became urgent and many expert
British hygienists in tropical fields emphasized the need for a
proper training of Indian personnel, without whose co-opera-
tion and experience practical application of sanitary know-
ledge to Indian conditions would be extremely difficult. For
subordinate positions, provincial governments offered, through
universities, specific courses but the obvious limitations of the
scope and outlook of such a training were largely responsible
for the failure to secure Indian personnel of the type necessary
to initiate sanitary measures in India; and for the superior staff
the Government of India insisted upon a British Diploma of
Public Health.

In 1914 a distinguished British medical officer, Sir Leonard
Rogers, definitely proposed that a School of Tropical Medicine
in Calcutta and an Institute of Hygiene in Bombay should be
established for the purposes of both research and training. It
was largely through his perseverance and enthusiasm that the
School of Tropical Medicine and Hygiene was opened in 1920
in Calcutta. However, for the evolution of an effective public
health policy which must provide special facilities for training
students to devise and apply measures for improving the health
and well-being of the masses, the scope of public health educa-
tion has to be widened and brought to a higher standard of
efficiency.

With the introduction of the constitutional reforms of 1919,
certain aspects of public health work were transferred to the
Provincial Legislatures; but the control of research was left in
the hands of the central Government. On its administrative
side the central public health organization of the whole of
British India now consists of a bureau with a Public Health
Commissioner, a Deputy Health Commissioner, two assistants,

147

PUBLIC HEALTH AND DEFICIENCY DISEASES

and a statistical officer. It is obvious that such a bureau can do
nothing more than see through the routine work involved in
keeping the Central Government in touch with public health
affairs in the provinces.

Owing to the deplorable state of finance, none of the pro-
vinces could initiate fresh developments or formulate sanitary
schemes; but faced with the primitive state of sanitation
throughout the country and with the consequent appalling
wastefulness of sickness, the ministers realized the special
urgency of training public health workers and urged upon the
Government the need of expanding facilities for a thorough
education of Indians in all matters concerning public health.
For ensuring a degree of success in public health measures,
they argued, the responsibility has to be left in the hands of
the Indians. At long last the hierarchy of the central Govern-
ment realized that corporate action necessary for ameliorating
the deplorable environment in which the masses of the people
live cannot be taken by them and, to quote the words of the
Public Health Commissioner with the Government of India,
'to be effective it must carry conviction and establish its posi-
tion against immemorial conservatism and tradition., it must
therefore be done by Indians'. While the Government were in
Tull sympathy' with proposals for establishing institutes or
schools devoted to specialized training in public health, they
could not offer the requisite financial support for their fruition.

The opportunity came when the Rockefeller Foundation
offered to provide the entire cost of building and equipping an
All-India Institute of Hygiene and Public Health on the con-
dition that the Government of India would meet the recurring
cost of staff and maintenance of the Institute. The Rockefeller
Foundation stipulated that the Institute should conduct its
work in such a manner as to serve the whole of India. The
Government of India accepted the offer and the building was
completed in 1932 on a site adjoining the Calcutta School of
Tropical Medicine. One section of the Institute, opened in
1933, is devoted to research and training in biochemistry and
nutrition. Two main lines of investigation are being followed
at present, namely, determination of nutrient values of the
common Indian foodstuffs, and surveys of dietary habits of the
various races and communities in India. The other institute

PUBLIC HEALTH SERVICES

which is concerned with the problems of nutrition in India is
situated at Coonoor (Madras) where Sir Robert McCarrison
initiated his pioneer work. We shall refer to these institutes in
the last chapter in connection with an account of nutritional
research in India.

To complete our account of the Public Health Service and
Organization we give here an outline of the Provincial Ad-
ministration so far as it touches public health. Each province
is divided into divisions which are again sub-divided into
districts. Each district has a number of local bodies a district
board for rural areas, and city corporations or town committees
for each town,. Since the passing of the Government of India
Act 1919, the responsibilities of the Provincial Public Health
Department have been transferred to a minister in each pro-
vince, and through a system of grants-in-aid from its meagre
budget, supplemented in some cases by local taxes, the local
bodies do the best they can to maintain the public health
service.

No substantial modification of the Public Health Organiza-
tion has taken place under the Government of India Act of
1935. In view of the importance of a unified public health
policy, the relation of the autonomous provinces with the
Federal Government must of necessity be more intimate if
public health and sanitary measures for the whole of India
are to be made efficient and effective. It is hoped that the
Central Advisory Board of Health constituted in 1937 may
serve the purpose of co-ordination of public health activities
throughout Federal India. In the sphere of administration the
process of decentralization should be given further impetus,
leading the local bodies to a stage of development when their
active co-operation in public health and sanitary measures
may be fully assured.

There are, of course, several statutory enactments in India
for the purpose of effecting sanitary reforms, and these provide
as usual elaborate regulations and precise definitions of ad-
ministrative duties. They are lacking in only two things:
namely (a) adequate funds to give effect to the aims of the
Acts and (b) the firm resolve of the responsible authorities to
enforce them. In a country where diverse religious faiths and
variegated social customs prevail, where no sustained efforts

K 149

PUBLIC HEALTH AND DEFICIENCY DISEASES

have been made for the education of the people, and where the
struggle for a bare existence usurps all strength, the problem is
not easy; but the history of public health abundantly corro-
borates the fact that the opposition from conservative elements
of society can be overcome by the pursuit of a deliberate policy.
When, for example, Sir James Simpson advocated the use of
chloroform in labour, the clergy of England were loud in
denunciation of the practice as being an 'unmitigated piece of
iniquity 3 . But this opposition has been overcome. Recently the
popular British Press chuckled when the Ministry of Health
appointed an Advisory Committee on Nutrition. To the bulk
of the people even in advanced Western countries, nutritional
problems do not exist; but their conservative attitude is not
offered as a plea for inaction in matters of health, physique,
and nutrition of the nation.

Pure Food Acts

Foodstuffs, though originating from healthy sources, may
become contaminated subsequently with pathogenic micro-
organisms; or they may be deliberately adulterated with sub-
stances prejudicial to health. The enforcement of pure food
regulations should, therefore, fall within the scope of Public
Health Administration. In a country like Great Britain where
supplies of food are drawn from many different sources, ad-
ministrative control of the purity of food must of necessity
become an integral part of Public Health Policy, but its need
in the circumstances of Indian conditions is equally urgent.
Lack of state surveillance, apathy of the informed public,
ignorance and poverty of the masses are the circumstances
under which unadulterated food has become almost a rare
commodity in the Indian market. Public Health Administra-
tion in India can no longer overlook the importance of mea-
sures for the purpose of evolving suitable systems of food control.

Although at present supplies of food available to us are
mostly home-grown and Indian dietaries do not usually include
articles of preserved food, there is every indication of a growing
demand for products of the food-preserving industry. With the
development of that industry, laws dealing with food hygiene
have to be enacted in order to safeguard the interests of the

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PURE FOOD ACTS

consumer. Besides, one must take into consideration the alarm-
ing fact that India is becoming a dumping ground for every
variety of manufactured infant food and adulterated drug.

But, of the many sanitary sins, the least excusable is the one
which allows some of the principal foods of the people to be
exposed to contamination and does not exercise adequate con-
trol of their purity. The conditions of milk supply in the Indian
cities and towns are still in a primitive state and there is no
end to the fraudulent practices. Milk is usually adulterated
with water, flour, rice-gruel, and in certain seasons with milk
expressed from shredded coconut. The chemical composition
of milk is not constant as it depends upon such factors as the
breed, the kind of fodder, and the facilities for grazing, and it
is held that owing to wide variations in the quality of milk in
different parts of India, it is not possible to formulate a statu-
tory standard of its purity for the country as a whole. But it is
certainly not impossible to introduce uniformity in the milk
regulations within each province. Milk is an ideal medium for
the growth of pathogenic and other forms of micro-organisms
and therefore its bacterial purity is of much greater hygienic
importance than its chemical composition. The health authori-
ties in India cannot overlook the fact that owing to the practice
of adulterating milk with water, its bacterial content may
have all the characters of a sewage effluent. It is, moreover, no
consolation to a nutritionist to be told that the universal prac-
tice of boiling the milk twice serves to assure the bacterial
purity of milk. For this indispensable article of food, India
must organize dairying upon a hygienic basis and adopt the
method of pasteurization by which the physical properties of
milk as well as its nutrient constituents remain unaffected.

We need not pause to consider the extent of the adulteration
of other common articles of food which, in a pure form, have
almost disappeared from the Indian market. The classes of the
population engaged as middlemen and vendors of foodstuffs
are usually poor and devoid of the sense of responsibility, but
they are shrewd enough to recognize that constancy in price
has a special appeal to the Indian consumer. Consequently the
practice of adulteration follows for the most part the trend of
the prices of foodstuffs, and with its upward tendency, various
methods of adulteration are adopted to keep prices as near as

PUBLIC HEALTH AND DEFICIENCY DISEASES

possible to a normal level. One possible measure for reconciling
the conflict of the various interests would be to organize
regulated markets throughout the country on a proper basis.

It is here, we believe, that there is room for real social service
activities through voluntary associations. The gross forms of
adulteration usually practised by oil-mill owners, dairymen,
and grain dealers and the consequences of using adulterated
foodstuffs upon health should be made known to the consumer
by every available means of propaganda. Once the consumer
is fully aware of the precise nature of adulteration and insani-
tary practices to which the foodstuffs are liable, he will make
a contribution towards the control of their purity by restricting
his consumption or by putting the pressure of collective opinion
upon the dealers.

But the State cannot remain indifferent to a matter of food
adulteration which has an important bearing on public health.
Where public opinion is not sufficiently alert, its duty is to take
the initiative by enforcing legislative enactments.

There is no Public Health Act for British India but in some
of the provinces some sort of legislation exists for dealing with
foods and drugs. Most of these Acts are not sufficiently com-
prehensive to prevent the sale of adulterated foodstuffs; nor
have they put a substantial check on those abuses which so
often affect the health of the community. Local authorities
which are concerned with the administration of these Acts
have not even succeeded in enforcing them within the limits
of their restricted scope.

'In towns of Bengal,' writes the Government of Bengal in
their review of the working of municipalities, 'where retail
trade is extensive, municipal executives are often reluctant to
antagonize influential tradesmen by insisting on a high stan-
dard of purity of foodstuffs' ! Fines imposed on those prosecuted
for food adulteration are usually inadequate and regulations
laid down by the Acts are not given reasonable publicity. The
difficulty of setting up a standard of purity and also of adminis-
tering such a standard where it is formulated is offered as an
excuse for the failure of legislation in exercising an effective
control over the purveyors of both fresh and manufactured
articles of food; but the truth is, even the best regulations
become ineffective unless they are properly enforced. There is

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MATERNITY AND CHILD WELFARE

no adequate co-ordination between Provincial Governments
and local government bodies, without whose concerted efforts
the whole system of inspection and supervision breaks down.
Of course, legislative measures by themselves cannot achieve
the object unless they are adequately supported by sustained
methods of educating the public. In the interest of the health
and welfare of communities. Provincial Ministries of Health
should now amend the existing Acts and explore all avenues
of approach for concerted action both in regard to the adminis-
tration of Pure Food Acts and to the spread of knowledge of
food hygiene.

Maternity and Child Welfare

The maternity and child-welfare movement is comparatively
new even in the advanced countries of the West. In England
the first Infant Welfare Centre was opened through a voluntary
agency in 1904 but since then the growth of the movement has
proceeded apace. There are at present over three thousand
maternity and child-welfare centres in England and Wales of
which nearly one thousand organizations are run by voluntary
agencies. Their programme of activities includes, in addition
to measures for temporary relief, an intensive educational
campaign and practical demonstrations of what can be
achieved by personal hygiene, and persistent efforts towards
the improvement of environment. The movement has to some
extent contributed to the decline in the infantile death-rate in
England and Wales. From 154 deaths per 1,000 children born
in 1900, the figure is brought down to 64 in 1933.

The maternity and child-welfare work in India is in its
initial stage and is chiefly confined to a few of the larger
towns. There are not more than 600 such organizations
throughout India and even these are irregularly distributed.
For example, the United Provinces with an area of 106,295
square miles have over 166 centres and the State of Hyderabad
(Deccan), with an area of 82,698 square miles, has none. Except
in certain model village settlements it has not touched the rural
areas although the need for its expansion is frequently urged
by those who are able to discern in the movement one of the
effective means of contact with the neglected masses. The

PUBLIC HEALTH AND DEFICIENCY DISEASES

trouble is that this form of social service has not as yet assumed
the character of a serious national concern. Its outlook is
narrow and activities restricted; its ideology springs from a
kind of pseudo-religious philanthropy; its organizations are
chiefly directed by untrained personnel and depend on patron-
age; and its funds are meagre. It has to be admitted that so
far the movement has not made any difference in the rate of
infant mortality or in the direction of health education.

Nevertheless, the movement does signify the awakening of
the social conscience in India, and we believe that if the
organizers of maternity and child-welfare work obtain accurate
figures of preventable deaths, both of mother and infant, and
initiate an educational campaign based not so much upon
temporary relief of the distressed as upon the urgent need of
attacking the problem at its roots; if their efforts are now
directed towards the training of personnel on whose efficiency
and foresight the future of the movement will depend; and if the
local self-governing bodies realize that an increased expendi-
ture to foster the movement would ultimately lead to economy,
we will then succeed in laying its foundation upon a more secure
basis. The first and foremost step towards better organization
of maternity and child-welfare work is to make proper pro-
vision for the training of personnel. It is only through trained
personnel that the results of medical research can be applied
to this work. We have now an All-India Institute of Hygiene
and Public Health in Calcutta where a section devoted to this
purpose has actually been operating for the past three or four
years and is likely to become permanent; but owing to the
financial circumstances of the Government of India, its activi-
ties have been restricted to a narrow scope. It now rests with
the various Provincial Governments to take the initiative in
providing a thorough course of training for a body of officers to
carry out the maternity and child-welfare work in a manner
warranted by the special circumstances of India.

Our legislators, publicists, social workers, and medical
authorities should realize that the problem of nutrition has a
very close connection with that of raising the standard of
health of the mother and the infant. There are over eight and
a half million annual childbirths in India and the diet of many
millions of those born is below even a minimum standard of

154

MATERNITY AND CHILD WELFARE

nutrition; and therefore, to quote McCarrison, they c are con-
demned from their mother's wombs to a subnormal or diseased
existence as certainly as is the engine of the best motor-car
when not provided with efficient lubrication or when supplied
with an improper fuel'.

The maternity and child-welfare organizations should there-
fore concentrate their efforts more upon the problem of nutri-
tion than on the treatment of the symptoms arising from
malnutrition and undernourishment. The problem of para-
mount importance is, of course, to ensure an adequate and safe
milk supply. What measures have been adopted in other
countries and how we in India should face the problem, will
be discussed in subsequent chapters. Here we would raise a
note of warning, that the growth of our import trade in
'infant foods' of all sorts and descriptions can no longer be
viewed with complacency. Grave nutritional disturbances in
the new-born child are due to the injudicious use of these foods
which are finding their way to Indian homes. Most of these
contain an excess of carbohydrates and are deficient in proteins
and vitamins. Even when babies grow temporarily fat on them
and look healthy they do not possess the stamina of an infant
fed with natural milk. The incidence of infantile liver com-
plaints and even rickets may often be traced to the use of
certain brands of these preparations containing an excess of fat.

The Provincial Health Services should therefore examine the
various claims of these infant foods and issue an authoritative
account for the guidance of the public. We would especially
appeal to the Indian Vernacular Press to take great care in the
matter of advertising these commodities. Through the channels
of the maternity and child-welfare organization and other
institutions, knowledge about the basis of infant feeding under
the specific conditions obtaining in India should be widely
disseminated, and in order to give some practical exactitude to
these considerations, our medical authorities in co-operation
with nutritional experts should be able to indicate how best the
nutrition of the new-born and the child can be made effective
without the risks inherent in the use of the glorified infant
foods.*

* For the import of milk foods for Infants and invalids, see Table VIII, p. r 67

PUBLIC HEALTH AND DEFICIENCY DISEASES

Health Education and Propaganda

It is obvious that an organized health service should include
effective propaganda in regard to the relation of dietary habits
and health. In some of the Western countries, as we shall see in
a subsequent chapter, popular education concerning nutrition
has to a considerable extent been successful. Specific instruc-
tions as to the ways and means of correcting the deficiencies in
diets form a part of the general education, and its inclusion in
the school health programme has perceptibly increased the
children's knowledge of the principles of dietetics. Simultane-
ously with teaching, the organizations for school feeding offered
a practical demonstration of the value of balanced diet.

In India matters relating to 'health education 3 are treated
with indifference or in an academic fashion. Propaganda
organized either by the Government or non-official bodies is
devoid of coherent plan and lacks vigour. Health lectures are
often delivered in terms wholly unsuitable for the comprehen-
sion of the audience; posters, diagrams, charts, and other
familiar accessories are assembled and exhibited in such a
manner that they give the impression to the masses that they
are being entertained with a 'tamasha 5 (amusement) . And sucla
'tamashas 5 springing as they often do from sporadic organiza-
tions cannot be fruitful of any positive results. The propaganda
carried out by official agencies is equally uninspiring, for their
health inspectors have no special training either in rural
problems, in relation to the subject of their propaganda or in
the technique of addressing an illiterate but shrewd audience.
It is not realized that health education is 'the sum of all efforts
to modify human conduct and attitudes so as to raise the health
levels of individuals and of the community 5 . It must embrace
the co-ordinated activities of all those concerned in education,
public health, and agriculture.

The task is not easy, especially in a country where the bulk
of the population is illiterate. Poverty, illiteracy, rigidity of
social customs, superstitions, prejudices, all combine to present
formidable obstacles to the development of what is known as
'health consciousness 5 . But it must also be admitted that the
measures so far adopted either by the Public Health Service or

156

HEALTH EDUCATION AND PROPAGANDA

voluntary agencies, are largely responsible for inadequate
results. An occasional visit of a health inspector or a propa-
gandist, followed by a discourse on the principles of health and
hygiene, will not modify people's mode of living. And yet,
through judicious adaptations of some of the modern technique
of propaganda, health instruction can be made really stimu-
lating and educative. The personnel entrusted with the task
should not merely recite formulae of health directions or per-
form routine work during their visits in rural areas. It is
necessary to explain in the simplest terms possible the under-
lying causes of persistent ill-health and incapacity which breed
misery and reduce human efficiency. If traditions are to be
replaced by a rational basis of knowledge, if inertia is to be
overcome by awakening of 'health consciousness 3 , the task
cannot be relegated to untrained propagandists or to sentimen-
talists. An effective propaganda would require training, tact,
local knowledge, and inspiration for genuine social service on
the part of those who undertake the task. Only through sus-
tained and co-ordinated efforts can we succeed in enlisting the
co-operation of our rural leaders in arresting the dysgenic
forces which are undermining the health of all races and
communities in India.

It is held that classroom instruction with the help of a mere
health primer would be useful. But any one familiar with the
staff, equipment, and environment of a village primary school
in India will agree that the conditions there are utterly un-
favourable for imparting any effective teaching of health and
hygiene. The school is usually just an ill-constructed mud hut
with no sanitary arrangements; the water supply is often bad.
The entire staff consists of one ill-paid teacher whose habits in
many instances are not illustrative of what personal hygiene
should be. It is no wonder that health propaganda has made
so little impression upon our conservative rural communities.

We are here concerned with one aspect of the health move-
ment the food habits of people. In our opinion the first step
should be directed to arousing the interest of the villagers in a
campaign for the improvement of nutrition of their children,
not by mere propaganda but by instituting physical examina-
tions of the pupils. This should be done by a competent medical
man in the presence of the villagers, and each parent should be

PUBLIC HEALTH AND DEFICIENCY DISEASES

provided with the result of the diagnosis. It will be explained to
them that there are certain indications of ill-health not dis-
cernible without the aid of a medical examination which are
due to nutritional defects and that they can be remedied by a
proper understanding of food values and by adjusting the
child's diet according to his needs. The cost of the medical
examination, which should be repeated at intervals of every
three months, must be borne by the District Boards, where a
complete record of diagnosis of the cases should be preserved.
An abstract report of medical examinations and periodic pro-
gress made in removing some of the causes of defective nutri-
tion will be made available to the Press and to the Ministry of
Education and also of Public Health. The medical men hold-
ing these examinations must have adequate knowledge of
nutrition and should be able to suggest dietary changes advan-
tageous from a physiological point of view as well as from the
consideration of availability and economy. Their aim must be
to create an atmosphere of confidence so that a sympathetic
response on the part of the rural community may be evoked in
starting a campaign for better nutrition and better health.
Such a step we believe would introduce a new element in the
conception of education generally held by the villager. That
the care of the body is also the concern of the school will im-
press our illiterate but unsophisticatedly intelligent rural folk,
and once their confidence is gained they will do their utmost
to follow the guidance of expert advice in regard to the much-
needed adjustment in their children's dietary. We must bear
in mind that our rural folk are peculiarly susceptible to the
human touch. Without it, no propaganda will ever succeed in
India.

Secondly, the children whose growth is found to have been
seriously impaired by nutritional defects will need special con-
sideration. Village elders may be persuaded to raise a fund for
the purpose of providing adequate nutrition to this group.
Small contributions on ceremonial occasions would provide a
nucleus of such a fund whose management should be entrusted
to the school committee. Arrangements for feeding the group
of ill-nourished children should be made in school. The ex-
pense of a school kitchen and a few cooking utensils is very
slight, and I believe it should not be difficult to obtain it from

158

HEALTH EDUCATION AND PROPAGANDA

the villagers themselves. What is important is that our public
bodies should realize that the improvement effected by such
measures is a matter of economy to the state and the society.

Thirdly, it should not be beyond the bounds of practical
politics to induce certain groups within the rural community
having special prestige to take a lead in this matter of adjusting
food habits to correct dietary deficiencies. The central question
here is the method of approach. We believe it should not be
difficult, to cite an example, to secure the active co-operation
of the authorities of our temples and mosques where during
festivities they organize mass-feeding. On such occasions a
temple priest or a moulovi may be trained to address the
guests. Suggestions in regard to proper diets based on foodstuffs
easily available should be followed by simple statements show-
ing the relation between health and nutrition. Here the impor-
tance of using germinated cereals and legumes, leafy vegetables,
unpolished rice, and gur instead of refined sugar, may be
stressed; here they may be told that an excess of sugar in their
dietaries is injurious and may even predispose to disease; and
here it may be explained that the outbreak of epidemic diseases
is not Kismet (Fate) or an inevitable curse of God and that we
fall an easy victim to them because of our low power of resis-
tance, the result of inadequate and improper dietaries.

Fourthly, in matters of elementary sanitation, dietary re-
forms, and education for positive health in a community,
organized propaganda through women may be of immense
service. Appeal for the infants and children of the next genera-
tion, coming from members of their own sex, would have a
special significance for the majority of our women. Within the
area of each Local Board it should therefore be made possible
to place a trained woman resident so that she may be in con-
stant touch with homes in a surrounding group of villages.
After all, the problem of malnutrition has to be tackled in the
home, and once we succeed in showing the village mother how
best she can improve the diet of her family within the restricted
means at her disposal, the way to a great advance will un-
doubtedly be made. The woman resident in co-operation with
district health officers will examine the undernourished within
her jurisdiction and will keep a register of each case. We believe
that if she gains the confidence of the villagers and once they

159

PUBLIC HEALTH AND DEFICIENCY DISEASES

are made to understand that it is diet not medicine which
ensures health, it may not be difficult to organize kitchen
gardens on a co-operative basis. In initiating the kitchen gar-
den movement, landlords should offer all facilities for evolving
a system of production and village elders for marketing the
produce within the community.

Lastly, one main cause of the failure of propaganda activities
in rural and semi-urban areas is the absence of any local or
regional organization through which the work may be followed
up. Most of our social service or welfare institutions favour a
city environment with occasional excursions into rural areas;
and they do not represent a corporate sense of the community
which they propose to serve. The true function of a 'welfare
movement' is to revive the esprit de corps of the rural communi-
ties. Therefore if a beginning of an intensive health propaganda
is to be made, the task must lie with the local self-governing
bodies. Instances of neglect by these bodies in matters of sani-
tation are unworthy of the responsibilities entrusted to them.
It is the growth of municipal governance and local self-
government in England that has paved the way for deriving
benefits from what the science of medicine and hygiene can
offer. It is through local organizations alone, whether volun-
tary or official, that the people and the state can co-operate
for the maintenance and improvement of public health. We in
India have overlooked the entire field of rural health and have
left our rural areas without any corporate institutions which
should have concerned themselves with the welfare of all sec-
tions and classes of the community.

A beginning might be made by the establishment of small
bodies in a number of typical areas, whose functions would
comprise survey, propaganda, assistance in enforcing public
health regulations and other activities related to the improve-
ment of nutrition and physique. Through such units of organi-
zation the task of public health authorities may be adjusted to
local needs; on the other hand, they may develop into effective
agencies for co-ordination of services that concern the welfare
of the people.

We venture to offer a suggestion which may well provide a
starting-point in the movement towards better health and
nutrition in India. Our temples should be, as they are in

1 60

CONCLUSION

China, a centre of social life. If they become living institutions,
we shall then find appropriate and effective channels through
which the people can be easily reached. Most of the temples
are richly endowed and ceremonies are performed there with
considerable splendour in the presence of an audience consis-
ting largely of the shrivelled bodies and protruding ribs of the
half-naked men, women, and children. Such a spectacle of
humanity cannot be pleasing to God; nor can it represent our
attitude of true worship of Him who is conceived as the
indwelling Spirit of man.

Conclusion

We have attempted in this chapter to describe the general
state of public health in India and the organizations that are
concerned with the problem. The state of public health and of
the environmental conditions which concern the lives of the
Indian masses are decidedly depressing. That it is an enormous
liability and involves India in a vicious circle has become an
indisputable fact. Her leaders must now realize that the longer
they take to liquidate this crushing liability of ill-health and
undernourishment, the worse the situation will become.

Diet is a vital factor both in attaining and maintaining
health. Investigations show that the conditions of people sub-
sisting on an insufficient diet affect in subtle ways the standard
of public health. For this reason the provision of adequate and
proper nutrition is recognized in every civilized State as an
integral part of its public health policy, and the responsibility
of the autonomous Indian provinces in this respect is of a most
serious character; for, if the physical deterioration of the wealth-
producing classes is not arrested, India's economic life will ever
remain depressing and political bondage perpetual.

161

CHAPTER FIVE
A Brief Account of Indian Foodstuffs

Since our immediate task is to make use of the available food
resources to the best advantage, it may be useful to give here
an outline of the common foodstuffs which enter into the Indian
dietaries. It is not within our province to go into details of food
production in India; our purpose will be served if we indicate
the sources upon which Indian communities depend for the
supply of their nutritional requirements.

Foods fall into two main divisions: those of animal origin
and those derived from the vegetable kingdom. As a source of
nutrients, the fundamental difference between these two classes
lies in the provision of carbohydrates (that is, starch and sugars)
which are obtainable chiefly from vegetable foods.

Food of Animal Origin

Food of animal origin may be classified into four groups:
(a) Milk and Milk Products; (4) Eggs; (c] Fish; and (d) Meat.

(a) Milk and Milk Products

Milk is regarded as nature's complete food, and owing to its
richness in most of the essential food constituents it should be
accorded a foremost place in human dietary. To the infant, it
is indispensable; to the young child it should invariably form
the essential protective food during the growth period, and for
the adult it is a most valuable adjunct to the normal diet.

It is composed of proteins, fats, carbohydrates, inorganic
salts, and vitamins, and all these five nutritive ingredients are
so harmoniously blended that it supplies all essential factors
necessary for the growth of the young animal.

162

FOOD OF ANIMAL ORIGIN

We are concerned here with cow's milk. The wide variations
in its composition are largely due to the breed, age, course of
lactation of the cow, and to the amount and character of her
ration. It is well known that the difference between the milk
of the indigenous Indian breeds and imported cattle is very
striking.

The following table composed from various sources gives an
average composition of cow's milk together with the limits of
variation.

TABLE VIP
Average Composition of Cow's Milk

Ingredients Percentage Limits of Variation

Percentage

Water 87-7 83-91

Solids 12-2 9-17

Fat 3.4 2-8

Casein 2-7 2-4-5
Lactalbunin \

Lactglobin \ ** ' M -3

Lactose (milk-sugar) 4-7 3-6-6

Ash (inorganic substances) 0-7 o-6-i

Wherein lies, we may ask, the superiority of milk over other
foods? In the first place the proteins of milk are of high biologi-
cal value and supply nearly all the amino-acids which are
needed for 'protective' nutrition. The carbohydrate of milk is
present in the form of lactose or milk-sugar. It is not as sweet as
cane sugar; nor is it readily fermented; and because it is so
easily digested, its use is recommended when a high calorie
carbohydrate diet is wanted. It is lactose which, under the
influence of certain micro-organisms, produces lactic acid,
causing milk to sour. The fat of milk floats in the liquid in
extremely fine globules. This highly emulsified fat is very easily
digested and is associated with the fat-soluble vitamin A. The
inorganic substances in milk add much to its unique value as a
protective food. No other food compares with it as a source of
calcium and where milk consumption is high there is no risk
of a calcium-phosphorus deficiency in the diet. Milk is poor in
iron although the small amount present is of great value in the
maintenance of a nutrient balance.

* Calculated from .various sources.
163

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

As milk is a rich source of vitamins A and D, one of the
subjects of absorbing interest in dairy research is to ascertain
the conditions under which these food accessories vary. It is
found that the vitamin content of milk is particularly depen-
dent upon the feeding of the cow; it is higher, for example, in
the milk obtained from stall-fed Scindi breed than in that of a
pasture cow of indifferent stock. A recent investigation in
Bengal, has shown 56 that an average sample of cow's milk is
about 60 to 70 per cent poorer in ascorbic acid content than
the milk obtained in England. Obviously the low vitamin
content in the milk studied in Bengal is due to the poor nutri-
tion of the cattle and to the inefficiency of its breed. But the
average milk yield of indigenous cows throughout India is
exceptionally low.* Even our selected breeds (e.g. Tharparkar,
Hariana) do not give more than 3,000 pounds of milk in a
lactation. The herbage of natural grasses is totally inadequate
for our milch cattle, the available fodders are generally deficient
in minerals and ordinary pastures are almost barren.

Milk is a perishable article as well as an ideal medium for
the growth of micro-organisms. Consequently in dealing with
this valuable human food, various methods have to be adopted
in order to ensure both its keeping properties and bacterial
purity. One of the methods is known as pasteurization. Milk
either in bulk or in the bottle is exposed to a temperature
between 145 degrees F. and 150 degrees F. for about 30 min-
utes, after which it is cooled. While the physical properties
remain unaffected, the temperature employed in pasteuriza-
tion kills all non-spore bearing organisms. The process does
not, however, sterilize the milk because a certain number of
organisms escape destruction. Nevertheless, pasteurization
does minimize the risk of milk-borne diseases and preserve the
keeping quality of the milk.

We need not pause here to dwell upon the nature of the
controversy, rife in the West, as to the advisability of pasteuri-
zation because of its adverse effects upon the nutritive proper-
ties of milk. The concensus of opinion is in favour of the
process and it is widely adopted in all countries where the
problem of milk supply has been taken in earnest; in circum-

* The average is only a little over 600 Ib. per year, which would represent
an average daily yield varying from 4 to 6 Ib.

164

FOOD OF ANIMAL ORIGIN

stances where the principles of hygienic milk production are
not likely to be observed compulsory pasteurization is recom-
mended.

In India at every step from the milking process down to the
vessel from which milk is sold, it is open to serious contamina-
tion. Here, in a warm climate., micro-organisms of different
kinds find in milk a favourable medium for growth; therefore
the only way of keeping the milk sweet or rendering it safe for
human consumption is to boil it as soon as possible. The prac-
tice does of course affect the nutritive value of milk but serves
to assure, to a great extent, freedom from pathogenic bacteria.
The heat treatment reduces the calcium content by about 50
per cent and affects vitamin C; Schwartze and his fellow-
workers found 57 that about 20 per cent of vitamin C is lost
when milk is boiled five minutes. It is, however, claimed that
the protein in boiled milk is more digestible than that of raw
milk. Milk should be heated slowly, and it is a rational practice
to submit boiled milk to aeration.

To Indians of every class, it is unnecessary to stress the value
of milk as food; they know it and are fond of milk and milk-
products; owing to its adaptability for combination with
various articles of diet, milk has a place of honour in Indian
dietaries. Intensive propaganda such as is carried on in the
West for increasing milk-consumption is therefore unnecessary
in India. The most essential step towards the improvement of
the nutrition of our people is to facilitate the production and
distribution of milk; but the perfunctory nature of efforts so far
directed by the Government to assist the dairy industry is yet
another example of their failure to apprehend the realities of
the day-to-day life of the peoples. A considerable proportion
of the Indian people dislike meat, partly from natural inclina-
tion and partly from religious scruples, and consequently the
supply of animal protein and fat has to be met through milk
alone. And yet the consumption of milk in India* is so incredi-
bly low that its liberal use even for infants and mothers is
unknown.

Milk of buffalo and goat is also used in India. Buffalo milk is
richer in fat and proteins, but it is not relished as a pleasant
drink although it is consumed in most parts of India. A great

* See Appendix III.
i. 165

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

bulk of this milk, however, is utilized for the manufacture of
ghee, a kind of soft cheese, curd, and other milk-products. Both
for dairying and draft purposes, buffalo has come to stay as an
important factor in Indian agricultural economy and sustained
efforts should be made for the improvement of its breeds. Goafs
milk is richer in inorganic constituents but is not suitable for
infant feeding because of the presence of certain insoluble acids.
It is, however, used by the poorer classes for this purpose when
the period of maternal nursing cannot be extended. Analysis
shows that its phosphatic content differs from that of cow's
milk and it is rich in iodine. Those who advocate the use of
goat's milk recommend that it should be taken raw because of
its superiority in vitamin B complex. Its food value depends, of
course, on the quality of grass, but this neglected animal has
also to subsist in India usually on scanty and poor pasture.

That the dairy industry in India a country where various
forms of milk products are so favoured by the people whose
dietary is largely vegetarian should be in such a state as it is
to-day is ample evidence of the lack of any relation between
the agricultural policies of the State and the dietary needs of
the people. Try as you will, it will not be found feasible to plan
proper dietaries for Indian communities without an adequate
provision of milk and milk products. There is indeed no other
means by which the nutrition of our people can be safeguarded.
The problem of developing the dairy industry in India is
therefore closely related to that of human nutrition, and no
time should be lost in organizing that industry on a national
scale. It is, we venture to think, more vital than the Khaddar
and in a more desperate state.

Meanwhile, imported milk products supply a small portion
of our requirements. Once we sufficiently realize the impor-
tance of dairying, the supply of butter, cheese, condensed
milk, and infant foods from foreign countries would be un-
necessary. Happily in recent years there has grown up a con-
siderable internal trade in certain classes of dairy products, but
the forces that should be mobilized for the dairy industry in
India are still scattered.

In the following table, we give the figures for imports and
exports of dairy products in India during the last six years.

1 66

FOOD OF ANIMAL ORIGIN

TABLE VIII
Imports and Exports of Dairy Products in India

Imports

Tear

Butter

Cheese

Ghee

Milk Con-
densed and
Preserved

Milk Foods
for Infants
and Invalids

1930-1
1931-2
I932~3
I933~4
1934-5
1935-6

Cwts.
2,625

3,570
3 ? 7?2
5,106
6,265
7,708

Cwts.
10433
7,349
8,858

9>87i
10,924
10,546

Cwts.
864

2,4!5

90

112
132
371

Cwts.
226,853

185,925
172,332
171,870
180,942
209,214

Cwts.

13:378
11,844
10,317
12,027
9^74
io,395

Exports

Tear

Butter

Cheese

Ghee

Milk Con-
densed and
Preserved

Milk Foods
for Infants
and Invalids

1930-1
1931-2
1932-3
1933-4
1934-5
1935-6

' Cwts.

4,337
2,879
2,241
1,911
1,898
2,289

Cwts.
52
54
34
29
29
3i

Cwts.
3M23
27,294
21,837
24,418
25,526
24,030

Over 65 per cent of the total output of milk is used for the
manufacture of various indigenous dairy products. Of the
important milk products, butter is universally favoured in the
Western countries for its high fuel value, taste, and flavour. It
contains the fat of the milk, worked into a homogeneous mass
in the process of churning and is perhaps the most easily
digested form of fat available to us. It is one of the most con-
centrated of all dairy foods. Well-prepared butter should con-
tain as much as 90 per cent of fat, 8 per cent of water, and
2 per cent of salt and other milk components. Most of the
organized dairies manufacture butter from pasteurized cream
which has been 'ripened' by the addition of lactic acid bacteria.
The total output of creamery butter in India is, however,
small, although demand for it in recent years has increased.
Ghee is clarified butter and constitutes an important item in

167

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

Indian dietaries. The deficiencies of a high cereal diet are
largely corrected by its use. The best quality of ghee is obtained
from the milk of cows, but owing to its scarcity the milk of the
buffalo is largely used for its preparation. Since the demand
for ghee, a good source of animal fat available to the vegetarian
Indian, is greater than the supply, the practice of adulterating
it with vegetable fats derived from cottonseed, poppyseed,
groundnut, mahua, and other similar inexpensive oils is ex-
tremely common. It is interesting to note here that adulteration
is usually effected, not by the dairymen, but by the traders.
Some of them do not even hesitate to use fats obtained from
the carcases of diseased and dead animals! The vast majority
of the people, however, cannot afford ghee of any kind and its
place is taken by various kinds of vegetable oils.

Of the milk products, curd is extensively used throughout
India by all classes of people. It is a nourishing and refreshing
food, easily digested. Dahi, as it is called in Indian languages,
is a form of fermented milk something like the Yoghourt pre-
pared in Europe and in America. Milk is boiled and a ferment
such as a little stale dahi or tamarind or lime juice is added
when it is nearly cold. While plain sour milk is drunk as a
common beverage, curd is used in various preparations. Rice,
curd, and salt constitute a meal of the poor classes and it is
especially favoured by those who do not eat meat or fish. For
a diet predominantly consisting of carbohydrates, curd is help-
ful in neutralizing the effects of intestinal fermentation. Curd
contains about 4-8 per cent protein, 3-5 per cent fat, and the
milk-sugar is transformed into lactic acid. Investigations show
that during the curdling process the vitamin in rnilk is some-
how stabilized. The food value of curd is now widely recog-
nized but it also should be carefully prepared under hygienic
conditions.

Casein is prepared by curdling milk with some acid substance
such as citric acid or alum. Acid acts upon the casein and
soluble calcium remains in the whey. The nutritive value of
casein depends of course on the quality of milk. When prepared
from whole milk, it contains about 22-6 per cent protein, 18-6
per cent fat, 1-75 per cent inorganic constituents, and less than
i per cent carbohydrate. A great variety of Indian sweets are
prepared with a combination of casein and sugar.

1 68

THE

IMPROVEMENT OF SOUTH INDIAN DIETS

BY

SKIMMED MILK.

(Growth of Children).

Group of Children on iroup of Children on

typical South Indian same diet + Skimmed

diet. milk.

4-7 Ibs

2-1 Ibi

Eight ounces of liquid
skiroroed milk were gioen daily.

VII.

FOOD OF ANIMAL ORIGIN
There arc various processes adopted in the West for manufac-
turing and curing different qualities of cheese but in India only
cream cheese, freshly made, is favoured. Certain tribes in
northern India make a kind of cheese known as milk-bread,
which is somewhat like a crude form of chcddar.

Butiermilk is the residual product that remains when fat is
removed from rnilk or cream, either sweet or sour, in the
process of churning. If not excessively diluted the nutritive
value remains sufficiently high to be of use in dietaries which
do not include milk at all. It is generally obtained as a by-
product of buttermaking, and if dairying in India were prac-
tised under modern hygienic conditions, buttermilk would not
be regarded as 'a drag' on the industry. Various forms of
beverage (sherbet) prepared from curd are also known as
buttermilk in India. If the fat is removed from curd, the
nutritive value of the residue is not diminished to any great
extent except in regard to fat and fat-soluble vitamin A; but if
buttermilk is derived from the process of churning cream, its
nutritive value is relatively low, since most of the nutrients
other than fat arc left in the original milk from which the
cream was separated. Buttermilk may also be prepared from
either whole or skimmed milk by using certain forms of fer-
menting bacilli. All forms of buttermilk are welcome as refresh-
ing drinks and they have also therapeutic value. Abt and
FeingokP advocate the use of carefully prepared buttermilk
in infant feeding, especially if infants show a tendency to
digestive troubles.

Skimmed milk is milk from which the greater part of the milk
fat has been removed. Its nutritive value is much the same as
whole milk except in fat and vitamin A. The high calcium
content of milk is retained, but the percentage of fat depends
of course on the methods employed in skimming. The milk
skimmed by a properly run separator does not contain over
oi per cent fat. Since the proteins, carbohydrates., and in-
organic constituents of milk arc retained in skimmed milk it
may well be an important item in dietaries which are deficient
in animal protein and contain little fresh vegetables. Produced
under hygienic conditions, skimmed milk can somewhat miti-
gate the shortage of milk supply at least for children and
mothers; but the problem of its distribution under Indian

169

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS
conditions bristles with the same difficulties as the transport
of whole milk.

Whey is another refreshing drink obtained in the process of
making casein. It contains all the milk-sugar, albumin, and a
small amount of fat and is fairly rich in inorganic constituents,
especially calcium; if prepared with lemon juice, vitamin G is
added to whey.

The nearest approach to condensed milk is the indigenous
preparation known as khir, which is taken fresh with rice and
other cereals. We have already quoted the figures for the
increasing imports of condensed milk in India. The scarcity of
milk for infant feeding and the spread of the habit of tea
drinking are largely responsible for the growing rate of its
consumption. It is manufactured by heating the milk to 212
degrees F. to sterilize it and then carrying on the process of
evaporation in a vacuum until it becomes thick. Considerable
amounts of cane sugar are added to sweeten the milk. The
keeping quality of condensed milk, which has a sugar content
of not less than 40 per cent, is undoubtedly an advantage,
especially in Indian climatic conditions. But the continued use
of condensed milk, especially in infant feeding, may lead to
gastro-intestinal disturbances and also to rickets. It is deficient
in vitamin C and owing to the presence of excessive sugar its
other nutritive constituents are 'unbalanced'.

Milk powder is usually prepared by drying good clean milk
in a very thin layer at a high temperature on a revolving drum
and then reducing the crusts into powder. The temperature
used in the process determines the extent to which the nutritive
constituents in milk are affected, but it is found there is no
great loss in proteins, carbohydrates, fats, and fat-soluble
vitamin A provided great care is taken in handling the milk.
The moisture content of milk powder should not exceed 5 per
cent in order to safeguard against bacterial decomposition or
fermentation. No ingredients should be added to the milk used
for the purpose. Milk powders are usually made from whole
milk and from half-skimmed milk; but where the fully skimmed
milk is likely to go to waste, it should certainly be used for making
milk powder. In this form, milk may be made available to the
areas in India where the supply of whole milk is scarce or the
distribution of fresh skimmed milk difficult. Milk powder is

170

FOOD OF ANIMAL ORIGIN

fairly free from contamination and may therefore be used for
infant feeding; it keeps well and is convenient for ready use;
and owing to its small bulk, transportation is easy. Carefully
prepared milk powder is not difficult to reconstitute in cold
water. It should, however, be remembered that it can never
replace the whole milk and that it is rather poor in anti-
scorbutic properties and in fat. In recent years, milk powder
has been used as food for infants in urban areas in India, but
it should be supplemented by the addition of orange, lemon,
or tomato juices and some form of liver oil.*

(b) Eggs

The egg contains a wide range of nutritive substances. It is
moderately rich in proteins of high biological value, easily
assimilated fats, and vitamins A and D. The digestibility of
egg protein is practically as good as milk or meat protein and
it is therefore a valuable supplementary food particularly in a
dietary rich in carbohydrate. As a suitable food for the young,
the egg ranks next to milk and it is a most desirable adjunct
to the diet of the expectant mother and of those suffering from
anaemia. The proteins of the egg may be classified in two main
groups: ovalbumen present in the white, and ovavitellin in the
yolk. These differ in amino-acid content but both supply pro-
teins of the best quality. A comparison of the white and the
yolk in regard to their nutritive values shows the superiority of
the latter, in essential protective food-constituents. Egg yolk
contains practically all the fats which exist in a form of fine
emulsions and a liberal amount of vitamins A and D. It also
contains a large part of the inorganic elements such as calcium,
phosphorus, and iron, all in forms readily absorbable into body

* We reproduce here a table of milk equivalents taken from one compiled
by Seymour-Jones 59 which may be helpful in reconstructing liquid milk
from various forms of preserved milk.

TABLE: MILK EQUIVALENTS

Ib. bulk concentrated milk 2 to 3 Ib. fluid milk

Ib. bulk concentrated skim milk 3 to 4 Ib. fluid skim milk

Ib. swcctened-condensed milk 2-33 Ib. fluid milk

Ib. swcctcncd-condenscd skim milk 2-75 lo 3-25 Ib. fluid skim milk

Ib. evaporated milk 2-25 Ib. fluid milk

Ib. dry milk 8 Ib. fluid milk

Ib. dry skim milk 10 Ib. fluid skim milk

171

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

tissue. Hess has shown 60 that the yolk has also considerable
anti-rachitic properties and therefore its therapeutic value in
rickets is much greater even than that of milk. But eggs and
milk go well in combination; for they supplement each other.
The egg deteriorates if it is not carefully handled and kept
fresh by storing at proper temperatures. Various methods have
been devised in the materially advanced countries of the
western world for reducing the loss of market eggs, chiefly by
the improvement of transport and storage. Dried and frozen
eggs are extensively used in the Western bakeries.

(c) Fish

Fish is an excellent source of protein and also contains cer-
tain valuable inorganic substances such as phosphorus and
iodine. Although its protein content is less than that of meat,
it is more fully absorbed than any other animal food. Sea fish
are more palatable than river fish but both are easily digestible
and nourishing and provide good sources of iodine. The ratio
of calcium to phosphorus content is usually high in fish.

Several species of mullet and pumfret, seer, hilsa (Indian
salmon), mackerel, whiting, bombay duck, and various kinds
of mango-fish (Polyenmus) are familiar examples of edible
fish available in Indian waters. Among the freshwater edible
fish, the Carp family (Cyprinidae) offers many varieties, of
which the rohu (Labeo rohita) the catla (Catla buchanani]
and the mrigal (Cirrhina mrigald) are well known to those
who live in the Gangetic valley. In the estuaries (e.g. the Sun-
derbans) the rivers and creeks teem with delicious varieties of
bekti (Late calcunfer] and mullet; in the hill-streams we have
trout. Then there are various species of perch which arc
prized for the delicacy of their taste.

There is no great difference in the nutritive value of fresh
and salt-water fish. While Indian rivers have great fishing
value, the tropical seas contain almost inconceivable quantities
of edible fish; but all these potentially rich resources have not
as yet been utilized for supplying fish to those in India who
have no prejudices against this invaluable source of good pro-
tein and easily digestible fat. It is noteworthy that fishermen
are usually healthy and have a better physique than those of
the same social class pursuing other occupations.

172

FOOD OF ANIMAL ORIGIN

The chemical composition of the edible portion of some of
the common fish in Bengal is given below:

TABLE IX
Chemical Composition of Some Bengal Fish

Protein Fat Mineral Salts

Rohi 18-35 7-56 I> 4 2

Magoor *9'49 o> 50 1*30

Koi (Anabas scanderes) 17-73 '4 2 I *^

Mango Fish 16-76 4-12 0-83

Tengra 17-28 0-30 1-15

Bhetki 16-26 4-12 0-84

Hilsa 14-85 9-23 0-95

The digestibility of fish depends largely on its fat content,
which varies from less than i per cent to more than 12 per
cent. Fish containing less than 2 per cent of fat are known as
lean fish and are more easily digested. They vary greatly in
vitamin value, the fat fish being very good sources of vitamins
A and D. Since fish store fat in their livers, the oils obtained
from these contain a high vitamin potency. Although systematic
research has not as yet been undertaken to determine the
sources and content of vitamins in Indian fish, the livers of
rohit (Labeo rokita), chitol (Notopterous chitol], vetki (Late
calcurifer), and mrigal (Cirrhina mrigala) are found to contain
vitamin A, and the liver oils of some of these have a vitamin
potency as high as the famous cod-liver oil.

Fish are extremely perishable. Even at a temperature of 32
degrees F. fermenting action cannot be checked. Since the
means and methods of insuring good preservation are not
usually within the reach of fishermen, the supply during the
seasons of big catch is often allowed to run to wanton waste.
The problem is, however, solved by various scientific processes
of drying and canning and also by refrigeration. The preserva-
tion of fishery products has become an important industry in
the United States of America and several European countries,
and recently Japan with her extensive fisheries has entered the
field. The industry is strictly supervised by the State authorities
and produces a clean high-grade product. To a large extent
the natural flavour of different kinds of fish is preserved and'
canned products do not undergo appreciable deterioration in
any climate.

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS
But, important as the industry of fishery is in all those
countries where the protein content of usual diets is low, no
systematic attempts have as yet been made in India to apply
scientific methods to fish culture. Fishing and the fish trade are
left in the hands of an illiterate, poor, and extremely conserva-
tive section of the community, and consequently the methods
adopted in exploiting the resources of Indian fisheries are crude
and wasteful.

(d) Meat

Meat the edible portion of animals has entered into hu-
man dietaries chiefly because of the concentrated forms in
which proteins and fats are readily available in it. It contains
over 20 per cent of protein with a variable amount of fat rang-
ing approximately from 2 to 8 per cent. A great portion of
meat protein furnishes in liberal measure the ammo-acids
which are essential for tissue building.

Mutton, beef, goat's flesh, poultry, and game are the main
sources of meat in India. While beef is extensively used by the
Moslem and other non-Hindu communities, mutton and goat's
flesh are largely consumed by the Hindus brought up in a
non-vegetarian tradition. The quality of meat depends upon
the breed and the nutritional state of the animal. Since no care
is taken to develop the livestock, most meats in India are thin,
tough, and poor in fat content as well as in the quality of
proteins. Mutton and goat's flesh are prized because of the
higher content of fat and better assimilated proteins.

There are many varieties of game birds in India which are
esteemed as a source of wholesome food and the treatises on
Hindu medicine recommend them especially for invalids. The
meat of game birds does not differ in nutritive quality from
that of other meats but it is not rich in fats nor is it easily
digestible. Poultry farming is undeveloped and therefore the
kind of chicken usually sold in Indian markets is scarcely fit for
human consumption.

Foods of Vegetable Origin

We now turn to some of the principal sources of vegetable
foods available* in India. The dietary value of foodstuffs
* For botanical names of plants, sec Appendix IV.

174

FOODS OF VEGETABLE ORIGIN

drawn from the vegetable kingdom lies in their richness in
protective nutrients, their comparatively low cost as sources
of energy and the roughage which they provide. All vegetables
are low in fat; while most of them supply carbohydrates, their
protein content varies in accordance with their type and form.

Vegetable foods may be classified under six groups, namely:
(a) Leaf and flower vegetables; (J) Stems and bulbs; (c) Roots
and tubers; (d) Fruit-vegetables; (e) Seeds; and (/) Fruits and
nuts. Consideration of some of the characteristic nutritive
values of each of these groups will enable us to assign it a
proper place in a planned dietary. Roots, tubers, and seeds
resemble each other in the sense that they are rich in starchy
substances but relatively poor in other essential nutrients; on
the other hand, leaves of plants contain abundant vitamins and
inorganic constituents.

It is found that c in both vegetable and animal tissues the
most actively functioning part possesses the vitamins'. The
leaves which contain most chlorophyl are richest in these sub-
stances and also supply a considerable amount of inorganic
elements such as calcium, phosphorus, iron. Owing to their
being alkalinic in reaction, leaves are helpful in maintaining
acid-base equilibrium in the body. These properties vary,
however, in accordance with the age and growth conditions
of the leaf. Thin leaves, for example, are comparatively richer
in vitamins and inorganic constituents than thick ones, while
leafy vegetables grown in poor soils arc also poor in these sub-
stances. Season, soil conditions, methods of cultivation., varieties
all these factors determine, to a great extent, the composition
of foods of vegetable origin.

(a) Leaf and Flower Vegetables

Various kinds of spinach enter into the dietaries of all com-
munities in India; but the supply is so precarious that the
poorer classes whose high-grain diets require a liberal amount
of leafy vegetables have to be satisfied with small quantities.
And yet the sources of leafy vegetables are abundant through-
out India and their supply can be increased if proper care is
given to their cultivation. Recent investigations into the nutri-
tive value of some of the common and inexpensive vegetables
show that they possess high nutritive value as good sources of

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

vitamins and inorganic constituents such as calcium, iron, etc.
Only a few of these leafy vegetables need be mentioned here:
Amarantkus gageticus (Lai sag). Spinach oberacea (Palong sag),
Bassela cardifolia (Puin sag), Murray a koenigii (Gurry leaves),
Ipomoca reptans (Kalmi sag), Moringa oleifera (Drumstick
leaves), etc.

The result of investigations at the Nutrition Research
Laboratories at Goonoor shows that amaranthus and drum-
stick leaves, eagerly sought for by our rural population, arc
rich in vitamins, calcium, phosphorus, and iron. Cabbage
combines well with other vegetables and is universally favoured
for its flavour and digestibility. It is poor in proteins and fat
but contains a fair amount of inorganic constituents and vita-
min C. Tops of radish, beetroot, carrots, and onions are also
used as leafy vegetables and their nutritive value is high enough
to entitle them to be classified as protective foodstuffs because
of vitamins and inorganic contents.

Great care is necessary in handling and cooking leafy vege-
tables if their nutritive value is to be adequately retained. They
should be used as fresh as possible because leafy vegetables arc
susceptible to the loss of vitamin in storage. Ranganathan (n
found that in storage at room temperature, the loss of vitamin
was 47 per cent after 24 hours and 95 per cent after 68 hours.
Since in the raw state they have the advantage of less loss in
essential nutrients, there is a growing concensus of opinion in
the West in favour of uncooked leafy vegetables.

(b) Stems and Bulbs

Stems of the Indian spinach, celery, asparagus, rhubarb,
beans, sprouts, and onions are a few representative vegetables
that fall under this group. Onions and garlic arc fairly rich in
vitamin C but it is destroyed by the manner in which they arc
usually cooked in India. Owing to the strong flavour, they arc
used for seasoning Indian dishes. Recent investigations in the
Kharkov Institute of Nutritional Research show that these
bulbs have antiseptic action and reduce intestinal putrefaction,
the best effect being obtained by combining 0-5 to i per cent
garlic with meat preparations. The use of garlic in the dietary
of patients suffering from tuberculosis is considered to be help-
ful. Both in Ayurvedic and Unani medicines, its therapeutic

176

FOODS OF VEGETABLE ORIGIN

values are recognized and garlic is recommended as a very
powerful restorative tonic.

Stems of various plants are used as vegetables in India.
While they provide a certain amount of carbohydrates and
roughage, the protective nutrients are generally lost in the
process of cooking. Beansprouts are rich in vitamin C, and as
they are easily cooked, the nutrient is not destroyed in the
process. They are extensively used by the Chinese and might
well be introduced into Indian dietaries which are deficient in
vitamin C.

(c) Roots and Tubers

This group of vegetables is rich in carbohydrates. Potato con-
stitutes one of the staple foods in most countries, and has become
popular since its introduction into India. It contains about
1 8 to 20 per cent carbohydrate but only 2 per cent protein; but
recent experiments in Cambridge and elsewhere have shown
that this small quantity of protein is of high biological value.
The chief food value of potatoes lies, however, in the avail-
ability of easily digestible starch; but the nutritive properties
of this universal tuber deteriorate if proper care is not taken
in the selection of varieties, manuring, and cultivation. The
sweet potato is rich in sugar, hence the Sanskrit name sakar-
kanda. It is one of the root-crops which are easily grown in
India and may be used during famine as a substitute for
cereals. There are several varieties of yam (vernacular: kham
alu] grown in India but the ones which yield small-sized roots
are the most valuable.

Among this group of vegetables we should include the
much-neglected taro, which yields starch as good as potato:
but both protein and starch content is high. There is no
reason why its cultivation should not be encouraged in those
regions where the supply of good and easily digestible starchy
foods will definitely improve the usual dietaries. The Hawaiian
national dish Poiis prepared from its corm and flour made from
dried taro is much used in the West Indies. Its petioles and
leaves may also be used as greens by boiling in a solution of
sodium carbonate to destroy the acridity.

Perhaps the most nutritious root vegetable is the carrot. It is
rich in inorganic substances, especially calcium, contains a fair;

177

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

amount of vitamin C and is rich in vitamin A. These nutrients,
however, decrease in quantity with the maturity of the root.
The sweet (Halwa) prepared from boiled carrot pulp, milk.,
and sugar in certain parts of India is nutritious and should be
popularized.

Red beetroot have a high percentage of sugar and the leaves
are rich in vitamins and inorganic substances. Whitebeet are
cultivated in plantations for the manufacture of sugar.

(d) Fruit Vegetables

Brinjal, cucumber, gourd, lady's finger, papaya, tomato,
and several other fruits are used as vegetables in Indian
dietaries. Some of them (e.g. cucumber, papaya) also find a
place among Indian fruits. Cucumber is often eaten raw and
is regarded as having digestive properties. Chopra and Roy 62
traced the presence of a fairly strong ereptic enzyme in it.
Various preparations are made with this favourite fruit. Sliced
cucumber with curd is a popular recipe in Indian dietaries. It
is one of the fruits which are included in the customary food-
offerings to gods in the Hindu temples. Other members of the
gourd family pumpkin, squash, vegetable marrow in numer-
ous varieties of all shapes, sizes, and colours arc eagerly
sought after. Their nutritive value is low, but they provide a
cheap and bulky source of vegetable food.

(e) Seeds

We now come to the most important source of foods derived
from the vegetable world. Grains, furnished by certain culti-
vated annual plants, form the principal food of mankind. Un-
like other foodstuffs, grains are non-perishable and consequently
can be stored under proper conditions for long periods without
deterioration.

For our purpose here the edible grains may be classified into
two main groups, namely (i) cereals, (ii) legumes. There is a
marked difference in the chemical composition of these two
classes and their nutritive value in human dietaries lies in
proper combination, cereals providing energy-bearing sub-
stances and legumes a certain amount of vegetable proteins.

(i) CEREALS* are the richest source of carbohydrates, their
* Latin, cerealis, pertaining to Ceres, Goddess of Grains and Harvest.

178

FOODS OF VEGETABLE ORIGIN

starch content varying from 70 to 78 per cent. On account of
their low protein and fat content, cereal foods must be supple-
mented by other kinds of foodstuffs containing these nutrients.

Rice is the chief article of diet of the inhabitants of Bengal,
Assam, Bihar and Orissa, and Madras; and it is in these pro-
vinces that the physique and health of the population are
particularly poor.

There are over four thousand varieties of rice grown in
India. While their nutritive values differ widely according to
the variety, locality, and season, especially in reference to pro-
tective food constituents, rice as a cereal is poor in protein and
fat and also in calcium; its phosphatic content is, however,
important. It supplies excellent carbohydrates consisting of
starch, sugar, and dextrine, but a rice diet would be useless in
normal circumstances unless it were enriched by the addition
of foodstuffs supplying protein, fat, and inorganic constituents.
The digestibility of rice depends largely on enzymic reactions
and it is found that the higher index of digestibility of certain
varieties is due to the presence of proteins, fat, and inorganic
constituents in varying degrees. Storage under proper con-
ditions improves the digestibility and taste of rice because of
the conversion of starch into sugar.

Some of the common forms, somewhat allied to 'breakfast'
foods of the West, in which rice is consumed are muri (puffed
rice), khoi (roasted paddy), and chira (flattened rice). These
are used by themselves with a little salt and pepper; or in
combination with milk, curd, molasses, shredded coconut, etc.
A mixture of fried grams and puffed rice usually constitutes a
midday meal for our poorer class.

We have already discussed in Chapter Three the injurious
effect of milling or polishing on the nutritive value of rice,
especially on its vitamin Bi content. It is frequently asserted
that the popularity of polished rice is due to its keeping quali-
ties, its comparative freedom from the attack of weevils and
its clean appearance. Nevertheless the use of this devitamin-
ized rice should be discouraged as one of the means of correct-
ing the grave deficiencies of the usual diet of a rice-eating
population, which is already poor in essential nutrients.

Wheat is one of the main cereals in India, but it enters princi-
pally into the dietary of the people of two provinces, the United

179

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

Provinces and Punjab, and their adjoining tracts. Its superi-
ority over other grains is fully appreciated but on account of its
high price its consumption is restricted, especially among those
who need the nutritive substances derived from it. Its proteins
are found chiefly in the glutenous portions, the inorganic and
vitamin substances in the germ and bran. The flour obtained
by grinding wheat-grains between millstones is called Atta,
which is of course coarser than the highly milled products.
Atta contains nearly twice the amount of protein that is obtain-
able in rice.

Millet is a small-seeded cereal. Jowar (Sorghum wlgare), bajra
or cambu (Pennisetum typhoideum), ragi (Elensine coracana), and
cholam (Andropogon sorghum) are some of the varieties grown
in India and they are the staple grains of a great majority
of the people. Compared to wheat and high-grade rice, these
grains are coarse, inferior, and cheap: and if habitually con-
sumed without adequate fresh vegetables, there appear pro-
nounced symptoms of calcium deficiency. Ragi contains a
high percentage of starch, but the digestibility and biological
value of its proteins are superior to low-grade rice. The
percentage of protein varies from 5 to 9 according to the
variety and soil conditions. Sorghum, which is known as a
poor man's grain, gains a respectable status in the estimation
of a nutritionist when it is sprouted; for it then becomes a
source of vitamins A and C. These minor cereals, as they are
called, are eaten in the same way as rice and wheat. They arc
boiled, parched, ground, and often prepared as gruel in com-
bination with milk or curd.

Bran has now received recognition from the scientific world
as being a valuable part of the grain. It contains vitamins Bi
and Bs and has a fair proportion of inorganic substances.
Owing to its influence upon enzymatic action, bran has a
special nutritive value.

The percentage composition of the bran of wheat and of rice
is as follows:

1 80

FOODS OF VEGETABLE ORIGIN

TABLE X

Composition of Bran

Substance Wheat Rice

Proteins 16-4 19-0

Ether Extract 3-5 2-0

Carbohydrates 43-5 43-0

Inorganic substances 6-0 8-7

Fibre 18*0 10-0

Moisture 12-5 8-3

Rice bran is considered superior to that of wheat. A variety
of bread, cakes, and pasties may be prepared with it. Its use
should be encouraged in all regions afflicted with beri-beri. It
is necessary, however, that bran should be fresh since it is likely
to get bitter and rancid owing to the presence of a high percen-
tage of proteins, fats, and water.

(ii) LEGUMES. The plants bearing peas, lentils, beans, vetch,
and groundnuts belong to the botanical order leguminosae
and their seeds are generally known as pulse. They are a valu-
able supplement to cereal diets as a cheap means of enriching
them with an increased amount of protein. In the cereals, the
protein content does not, as we have seen, exceed 1 2 per cent,
but most of the pulse contain as much as 24 per cent. But since
a high-percentage protein content is not a sole criterion of the
value of foodstuffs, we have to consider the limitation of the
availability of the proteins in the legumes. Legumin, which is
the chief protein principle, may be classed as c good', but owing
to the cellulose content of these seeds, the protein is not avail-
able to the body as readily as that of animal origin. Certain
kinds of pulse do not contain cystine, which is one of the impor-
tant groups of amino-acids. On the other hand, the nutritive
value of pigeon pea (Cajanus indicus) and of field pea (Pisum
arvense) have been studied in the Research Institute at Conoor
and they are found to be almost as good as casein. Peas are
deficient in two amino-acid groups, namely, cystine and
tryptophanc.

Pulse are fairly rich in carbohydrates and contain a small
amount of fat. They are not easily digested because of the
amount and quality of cellulose which forms the bulk of their
carbohydrate content. The large amount of hemicellulose, for

M 181

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

example, may lead to intestinal fermentation and flatulence.
Pulse must be well boiled and thoroughly macerated in order
to increase their digestibility.

Most of the legumes supply important inorganic constituents
such as phosphorus and iron. Some varieties of lentils are par-
ticularly rich in iron. From the following table we get an idea
of the food-values of a number of important pulse grown in
India.

TABLE XP
Percentage Composition of a Few Pulse Grown in India

Common
Name

Botanical Name

Pro-
tein

Fat

Carlo-
hy-
drates

Inor-
ganic
Salts

Black gram

Phaseolus mungo

23-8

i'5

55'5

3'4

Green gram

Phaseilus radiatus

24-0

i'5

56-0

3-5

Red gram

Cajanus indicus

21-5

1-8

57-o

3*5

Bengal gram

Cicar arietinum

19-2

2-9

61-5

2-4

Cow gram

Vigna catiang

22-5

o-5

52-0

3'i

Horse gram

Dolichos bifloms

22-0

'3

53 "5

3'4

Field bean

(dried)

Dolichos lablab

24-5

1-7

5^-5

3-2

Peas

Pisum sativum

20-5

r -4

56-5

2-4

Masur

Lens esculenta

24-0

0-5

58-2

2-4

Kheshari

Lathyrus sativum

25-1

0*9

57'4

2-9

Pulse, though not rich in vitamin A, are valued for their
rich supply of vitamin B and germinated ones for vitamin C.
The vitamin C content of legumes and lentils, though poor
in a dry condition, is found to increase on germination, but to
diminish if germination is allowed to proceed for any length of
time. The value of germinated lentils as a source of vitamin C
is shown in the following table:

* Compiled from various sources.

182

FOODS OF VEGETABLE ORIGIN

TABLE XII*
Germinated Lentils as a Source of Vitamin C

Lentils

Ascorbic Acid-\ as Estimated
Chemically: Mg. per 100 g.

Dry

Sprouted

Green mung
Black mung
Brown mung
Masur
Peas
Beans
White gram
Brown gram

3-0
2-7
2*3
3*0
2-7
1-25
3-0

2-5

23-0-25-0
10-5-18-7
11-7
15-0
9-1
14-2

7'3
7-8

Pulse are consumed in various forms; fried, roasted, soaked
in water, germinated, and cooked, and in combination with
cereals. A kind of water biscuit known as e papad 5 is prepared
from certain varieties of beans. Pulse are often preserved in the
form of dried paste known as 'barf. The paste is prepared by
crushing soaked pulse to pulp which is then dried in the sun.
The flour made from the varieties of split peas (dal) is exten-
sively used for the preparation of sweets.

In view of the importance of the vegetable proteins supplied
by these legumes, any agricultural policy designed to provide
the nutritional requirement of our people cannot overlook the
urgent need of improving the resources of leguminous crops in
India.

We will here mention one special crop groundnuts which
can substantially improve the average Indian dietary, especi-
ally because of the presence in it of certain nutrients in which
cereals are deficient. Not only is its protein content high, but
the group of amino-acids known as lysin makes groundnut
an excellent food for milch cattle. Groundnut flour, it is sug-
gested, can be mixed with wheat in the ratio of i to 4 for the

* Compiled from figures estimated by Dr. B. Ahmad, All-India Institute
of Hygiene and Public Health, Calcutta. 2nd. Jour. Med. Res., Vol. 22.

f The results are calculated in terms of ascorbic acid on the basis of the
average minimum dose of 0.75 mg. per day necessary to protect a guinea-
pig weighing 300 to 600 g. over a ninety -days' period.

183

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

making of bread or biscuits. In the United States of America
and in some European countries, though provided with abun-
dant sources of animal proteins, c peanut bread' and various
other products manufactured with groundnut as the basic
constituent have found a place in human nutrition.

But it is not surprising that so little attention has been paid
to improving Indian dietaries by an extensive use of groundnut
in varied forms. The demand for this legume, of great com-
mercial value outside India, has greatly increased in recent
years and India, being a debtor country, finds in this crop a
valuable asset for her export trade. Before the War, our export
to France alone came to no less than 35,000 tons per year.
Under the stimulus of export demand, there has been a rapid
increase in its cultivation: from about 93 3 ooo tons in 1901, the
output has reached the figure of nearly three million tons in
thirty-five years. The internal consumption however remains
low although its use in Indian dietaries, not merely in the form
of little salted peanuts, would have corrected a great many
nutritive deficiencies.

If)

Fruits fall within the category of protective foodstuffs because
they contain inorganic salts and vitamins; but they are also
valued on account of their base-forming properties. The pro-
tein and fat content is low but most fruits are rich in acid
salts; and contrary to popular belief these lose the acid radicle
by oxidation and are therefore helpful in maintaining the acid-
base equilibrium in the system. The importance of the citrous
fruits for the prevention and cure of scurvy has already been
emphasized. Pomelo (Batati lebu) is even richer in vitamin G
than lemon and orange. Among other fruits grown in India,
pineapple, papaya, mango, leechi, tepari (Phy sails peruviana),
have high values of vitamin C.

Most of the juicy fruits contain readily assimilable glucose
and they are very helpful in those cases where a supply of
carbohydrates is necessary without putting much strain on the
digestive organs. Pineapple or orange juice may be given to
babies with beneficial results. The chief sugars in fruits are
sucrose, glucose, and fructose. Grapes are exceedingly valuable
as a food because they contain glucose in a readily assimilable

184

FOODS OF VEGETABLE ORIGIN

form. For anaemic patients, fruits are more suitable than
vegetables.

Several kinds of citrous fruits are grown in different parts of
India, but their production and distribution are inadequately
organized. Oranges (sanatara, naringi, mandarin] , pomelo,
lemon, and various species of limes are universally prized and
furnish those protective food constituents in which the usual
Indian dietaries are so deficient.

Among the pulpy fruits, plantain deserves special attention. It
is one of the highly prized fruits in fhe tropics and there are
several varieties cultivated throughout India. Fully ripe plan-
tain is easily digested because in its green stage the starch con-
tent is converted into sugar and there is also a decrease in
acids. Though poor in vitamins, it appears to have anti-
scorbutic and base-forming properties. Its use in diet-therapy
shows that plantain is effective in reducing urinary acidity,
and it is regarded as a Valuable addition to the diet of young
children, particularly those for whom a gain in weight is
desirable'. 63 Certain varieties of plantain are used as a veget-
able; the flowerheads (mocha) and the inner portion of the
stem (thor) are also edible and enter largely into the dietaries of
the people. Owing to its richness in carbohydrates (starch and
sugar) plantain meal is prepared from unripe fruits. It is more
nutritious than potatoes and easily digestible. On the banana
plantations the meal is extensively used by the labourers.

Dates are rich in proteins, carbohydrates, and inorganic con-
stituents, and are considered a 'concentrated food'. In recent
years, they have become popular in the Western countries,
which import large quantities from Egypt, Africa, and the
Near East. In Iraq, dates are now mechanically cleaned,
graded, and packed for export.

Nuts are a highly concentrated food with very little waste.
Most of them are fairly rich in proteins and fats but generally
poor in carbohydrates, though there are nuts like chestnuts
and peanuts which contain a large amount. Nut proteins have
a high biological value and compare favourably with meat and
fish. They are therefore a palatable supplement to a diet poor
in protein; but, on the other hand, a diet composed of cereals,
legumes, tubers, fruits, and nuts c may be balanced so far as
chemical analysis can show but be defective in other respects'.

185

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

The nutritive constituents of nuts are of special value to Indian
dietaries and should be well utilized. Various kinds of nuts and
almonds should be included in the dietary of adults, especially
if good animal proteins are excluded from it. One distinct
advantage of nut proteins over flesh foods is that they are free
from toxic waste products. In coconuts we have a food of excep-
tional value, rich in both fats and carbohydrates. The liquid
inside the shell prior to the maturity of the coconut provides
a popular drink in India. The nut yields a nourishing oil and
is extensively used in Indian dietaries.

Sugar

Sugar cane and the juices of the date, coconut, and palmyra
palms are the chief sources of sugar in India but she has to
import a large quantity of beet-sugar from Java to meet her
internal demand.

Sugar is a form of readily available concentrated carbohy-
drates and consequently its food value is chiefly as an energy
producer. In a sense it acts as a good stimulant but the ten-
dency towards an excessive consumption should be checked
since it can do as much harm to health as excess of alcohol.

It is a serious dietetic problem that the consumption of
refined sugar, a product which has been deprived of important
constituents present in its natural source, should be increasing
at an exceedingly rapid rate in India. The wholly devitalized,
dernineralized, and devitaminized white sugar and its pro-
ducts 5 enter our markets and replace jaggery or gur. The latter
are not altogether devoid of the inorganic constituents of the
plant juices in the fresh state and are therefore more nutritious.
Gur is easily digested and absorbed. The' sugar of commerce is
not a natural food. The practice of drinking freshly crushed
sugar-cane juice, so common in India, is perhaps an example
of the instinctive adoption of a means of correcting certain
dietary deficiencies and should be encouraged. There arc
several varieties of edible sugar canes grown in India which
are not available for the manufacture of sugar, and these are
greatly enjoyed by the people as a source of a refreshing sweet
juice.

Jaggery is prepared from sugar cane and juices tapped from

186

FATS

the date, the coconut, and the palmyra palms. Properly speak-
ing, these palms are not cultivated but the aggregate areas
under them are considerable and provide a source of cheap
sugar supply. The yield of juice and the quality of jaggery or
gur (its colour, degree, and form of crystals) depend upon the
kind of palms, the soil conditions, and the season. The percen-
tage of sucrose present in jaggery is approximately as follows:

Sources of Juice Percentage of Sucrose

(1) Coconut 85

(2) Palmyra 82

(3) Sugar cane 70

(4) Date palm 55

If the manufacture of jaggery or gur from palm juices is
developed on the lines of organized cottage industries, it would
eventually free India from her dependence on sugar imports
and mitigate the disadvantages inherent in the capitalist
system of production, the mainspring of which is the motive
of profit. What is more, it may substantially reduce the con-
sumption of toddy, the fermented intoxicating beverage dis-
tilled from the palm juices. The policy of exemption from excise
tax imposed on palm trees should therefore be extended over
a wider area provided the juice tapped from them is used for
the making of jaggery.

Perhaps the most ancient of all sources of sugar is honey, and
it is the best form of concentrated sugar available to us. Its
medicinal properties are well recognized, and Indians highly
appreciate its value as an article of food. In the hilly tracts of
the Punjab, the United Provinces, and Assam, honeyis obtained
as a wild product. Its production and sale are not organized
and the scientific aspects of apiculture have so far received no
attention from the State. Honey contains more fructose (40-5
per cent) than glucose (34-5 per cent) and its content of sucrose
may be as low as 1-9 per cent. Its flavour is derived from the
aromatic substances of the flowers from which it is drawn.

Fats

The need of fatty substances in our diet has already been
emphasized. Of the sources of animal fats, we have already

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

mentioned butter, cream, and ghee, which are particularly
desirable because of their richness in vitamin A and their
palatability. There is a prejudice attached to the use of other
fats of animal origin such as lard, margarine, fish oil and liver
oil in Indian dietaries. Mustard, linseed, sesame, groundnut,
and coconut are some of the sources of edible vegetable fats on
which the greater part of the Indian population depends for
culinary purposes. Of these mustard oil is perhaps the most
popular. It is expressed from three kinds of mustard seed,
namely, Brassica juncea (Indian mustard) ; Brassica dichotoma
(Indian rape) ; Brassica campestris (Indian colza). It is a common
practice to adulterate the mustard oil with oils from niger,
sesame, linseed, and other oil-bearing seeds, or even with cheap
mineral oil. The difficulty in controlling the purity of mustard
oil lies in the fact that it may be adulterated with 20 per cent
or even more of these oils from adulterants and yet the
saponification and iodine values will remain within the limits
stipulated by the Pure Food Acts in India.

The oil expressed from the fruit of Mahua (Bassia laiifolia] is
largely used by the poorest inhabitants of Central India. Fresh
coconut butter is an excellent edible fat but it is in the form of
oil, extracted from the sliced coconut kernel, that a consider-
able quantity of the crop is consumed. Groundnut oil is another
good source of vegetable fat which bears a close resem-
blance to olive oil in chemical and physical characteristics.
There is no reason why its use should not be popularized in
India.

From the nutritive point of view, we should note that most
vegetable oils do not contain vitamin A; but red palm oil
extracted from the fruit of Elaeu guineensis,, grown in West
Africa, Malaya, and Burma, is considered rich in vitamin A
potency. Tests carried out in Nutrition Research Laboratories,
Coonoor, show that samples of Malayan and Burmese reel
palm oil contain about 5007 of carotene per g., which is almost
equal to the vitamin A content of good cod-liver oil. It has
also been found 64 that proper mixtures of this oil with some of
the common Indian vegetable oils would provide an excellent
source of vitamin A. In view of the fact that most Indian
dietaries are dangerously poor both in fat and vitamin A con-
tent, experiments for growing this palm in suitable parts of

1 88

FOOD ADJUNCTS

India should now be taken in hand and further investigations
should be made into its use for culinary purposes.

Food Adjuncts

(a) Salt and Condiments

Salt is an essential ingredient of food. It is indispensable for
the purpose of maintaining the normal osmotic pressure in the
tissues and fluids. It is found in the earth as rock salt and the
richest salt-producing tracts in India lie to the north-west of the
Indus, in Kashmir and Rajputana and in Sind; but nearly half
the world supply comes from the sea.

A diet consisting largely of grains and similar starchy food-
stuffs needs salt. While an excessive intake is not desirable, its
shortage leads to mineral deficiency and consequential symp-
toms of ill-health. The rate and amount of perspiration under
climatic conditions in India are more than that in the temper-
ate zone and therefore the loss of salt has to be made good by
its intake in our diet. The consumption in India varies from
province to province and it is estimated that nearly 3 to 5 per
cent of the income of the poor in India is spent on salt.

The tax on this essential component of our diet is a part of
the fiscal system of the Government, and under the Govern-
ment of India Act, 1935, salt tax is allotted to the Federation.*
But all sections of Indian public opinion have persistently
demanded that the Government monopoly in salt should be
abolished. Not only on the grounds of increasing the burden
of taxation on the poorer classes, but on the evidence of the
incidence of disease caused by insufficient salt consumption,
the Indian National Congress opposed the salt tax. C A tax on
salt is as undesirable from the biological point of view as would
be an excise duty on wheat in England,' observes Haldane 65 in
reference to salt tax in India. He says that it is, under the

* The revenue obtained from the taxation of this essential article of food
is as follows:

Rupees

1931-2 85,792,000

1932-3 100,736,000

1933-4 88,565,000

I 934~5 80,001,000

84,280,000

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS
circumstances in India, 'quite clearly detrimental to the health
of the people. No doubt its abolition would dry up an impor-
tant source of revenue, but in a civilization where biological
issuesquestions of life and death were regarded as equally
important with economic issues this would not be thought a
final objection. . . . The continuance of the salt tax is a biologi-
cal argument for Swaraj.'

The practice of using savoury substances in human dietaries
is of ancient origin. The extent of their use is probably deter-
mined by climatic conditions and the nature of foodstuffs. It is
known that they influence salivary, gastric, and pancreatic
secretions and may also deter to some degree the process of
fermentation. Turmeric (Curcuma longa] acts as a carminative
and adds colour to the cooking materials. Aniseed (Pimpinella
anisum}., cloves (Eugemia caryophyllata] , fenugreek seeds (Tri-
gonella foenum-graecum) are some of the spices which have
medicinal properties. Excessive seasonings of food, as usually
practised in Indian cooking and necessitated by the pre-
dominance of starchy food, have, however, deleterious effects
'both upon digestion and absorption. The high incidence of
gastric ulcer and carcinoma in south India appears to be
related to the excessive use of chillies.

Spices are obtained from various parts of trees and shrubs
generally grown in the tropics. For example, black pepper is
the dried, unripe seed of a climbing vine, while chillies are
fruits of a plant; ginger is the underground stem of a rccd-likc
plant and cinnamon is the bark from the young shoots of a
tree; clove is the dried unopened flower bud of an evergreen
plant and nutmeg is the fruit of another spice tree; caraway is
the seed of a small plant, and so on.

As regards the nutritive values of spices, most of them con-
tain inorganic substances such as iron, iodine, and calcium.
; Ginger is rich in starch and volatile oils, and is preserved by
,'the addition of sugar and honey to the boiled roots. Chutney
^prepared fresh with a mixture of dhania (coriander) leaves or
podina (Mentha awensis) and green mango pulp or tamarind
is a cheap source of vitamin C.

(b) Tea and Coffee

Perhaps the most important and widely used infusion of the

190

FOOD ADJUNCTS

leaf-buds and leaves is tea, which is picked from the bush
known as TJiea. It was originally consumed in China more as a
medicine than a beverage.

Tea obtained from the youngest leaf buds is called flowery
pekoe and the fresh and tender leaves next the buds produce
what is commercially known as orange pekoe because of their
yellowish tint. Other grades depend upon the quality and age
of leaves picked from the bush.

We may note here the difference between green and black
teas. The former is prepared from the young leaves by roasting
them soon after picking. It contains more tannic acid and
volatile oil but less caffeine than black tea which is produced
by submitting the leaves to a process of fermentation. The per-
centage of tannin is greater in black tea than in green tea.

Light tea has no deleterious effect upon general health if
taken very moderately. It may even aid digestion; but its
excessive consumption is harmful to a high degree. It causes
cardiac irritability, stimulates gastro-intestinal action to the
degree of interfering with the digestive processes and produces,
according to a body of American investigators, 66 c certain un-
mistakable nervous symptoms' if taken habitually in large
quantities.

The infusion made from the bean of coffea arabica, roasted
and then ground to powder, is another beverage which is
highly prized by millions on account of its stimulating effect
upon the nervous system. The pleasant aromatic flavour of
coffee is derived from its volatile oil, coffeol.

Tea and coffee are used rather for what is described as c a
mild cerebral stimulation' than for their actual food value.
They contain no substances which are essential for nutrition;
nor can these beverages be regarded in a real sense as valuable
food adjuncts.

(c) Drinks and Drugs

It is relevant to refer to the habitual use of alcoholic drinks
and of various drugs in connection with the subject of health
and nutrition, and we shall briefly state the nature and source
of these intoxicants which are available for consumption in
India.

We have seen that food is a substance which builds tissues,

191

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

furnishes energy, and preserves life. From its chemical com-
position it is evident that alcohol cannot function as a tissue-
builder. The actual amount of energy derived from its con-
sumption is small and generally promotes dissipation of heat.
It is estimated that a glass of milk yields about 184 calories
while the same quantity of good beer does not yield more than
1 68. The common belief that alcohol tends to develop any
permanent increase in neuro-muscular activity is not supported
by adequate evidence. It has, however, some stimulating value
under conditions of great exhaustion.

From the nutritional point of view the consumption of
alcohol tends to interfere with the normal process of combus-
tion of other substances. Its effects upon undernourished bodies
particularly or upon those who are suffering from disabilities
incidental to malnutrition, may cause irreparable damage and
aggravate the tendency to psycho-neurosis so common among
the majority of our labouring class.

But the prevalence of alcoholic neuritis, delirium tremens,
cirrhosis of the liver, and several other similar complaints
among the upper and middle classes should warn us that the
alcoholic drinks consisting largely of wines, whisky, brandy
and various brands of liquors are wholly unsuitable to their
physical constitution. Taking into consideration all the factors
prevailing in the tropics, Sir John Megaw, who has had a long
experience in the Indian Medical Service, came to the con-
clusion that the 'indigenous races of tropical countries should
be discouraged from the use of alcohol in any circumstances'.

It must be said to the credit of our people that drinking has
not become a national habit; nor do the people regard ab-
stainers as cranks or faddists. On the contrary, to the vast
majority of the unsophisticated, it is generally considered dis-
creditable to become an addict to intoxicants and narcotics.
That section of the upper and middle classes which has per-
ceptibly acquired the habit of drinking would remain abste-
mious but for the influence of the European community, whose
habits and traditions encourage them to regard the consump-
tion of drinks as providing an occasion for social relationship
between the Europeans and Indians.

The liquor traffic which affects our lower middle and poorer
classes consists of two forms of alcoholic drink. Country spirit

192

FOOD ADJUNCTS

(Arrak) distilled from fermented rice, millet, barley, mahua
flower (Bassia latifolia) or molasses is largely consumed by the
lower middle classes. It is more injurious than fermented
liquors (toddy, crude beer, etc.) because the spirits contain a
high percentage of ethyl alcohol, the toxic limit of which to the
human system c is more quickly reached and more easily
exceeded'. According to Lieutenant-Colonel Chopra of the
Indian Medical Service, even the excessive consumption of
carefully brewed beer is less harmful than that of strong coun-
try liquors. Reports of the Excise Administration in India,
however, show a tendency to increasing consumption of coun-
try spirit,* and in the provinces where, owing to economic
depression in recent years, the present level of its consumption
c is lower than it should be', it is the policy of the Government
to bring it to the desired level in the interest of the Excise
Revenue, j"

Toddy is prepared by fermenting juice obtained from the
spadix of the fan palm, date, and coconut trees. It does not
contain more than 5 per cent of alcohol and is fairly rich in
vitamins Bi, Bs, and C. Fermented liquors, somewhat akin to
beer, are also obtained from cereals but the alcoholic content
of most of these beverages is low. Owing to the presence of
yeast, they also provide vitamins to the ill-balanced diet of the
poor.

The aboriginal races and the poorer classes of our population
regard toddy both as a natural food and a cheap form of
stimulant. 'Toddy fills our bellies but distilled liquor does not,'
was the reply given to me by a Santal villager. The Nagas in
Assam never drink milk but use in its place rice-beer called
Zu, which is somewhat like a thick gruel. It is taken as a part
of their monotonous dietary. To most of the aboriginal and
backward races, the use of fermented liquors is also a part of
their religious and social festivals. While excessive drinking is
a feature of such festive occasions, Chopra thinks that c gross
instances of producing motiveless drunkenness from country
beers, corresponding to the excessive consumption of alcohol
in the Western countries are very rare'. He further observes

* Average consumption per 100 of the population in 1932-3 was 1-12
(L.P. gallons) and it rose to 1-52 in 1933-4.

f Sec Appendix V.

193

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS
that the areas where such beers are consumed are remarkably
free from many of the deficiency diseases.

Prohibition of the use of toddy without finding an effective
substitute for vitamin Bi may be detrimental to the health of
the people whose dietaries are usually deficient in this food
factor. Bray 67 gives us an account of what happened in Nauru,*
an island in the Pacific Ocean, as a result of forbidding by an
Ordinance the consumption of toddy made from fermented
palm juice. Beri-beri made its appearance especially among
nursing mothers, and infant mortality rose to 50 per cent. The
alarming situation necessitated the withdrawal of this Ordi-
nance and within a short time the infant mortality fell to 7 per
cent. The moral of this example from a biological point of view
is that prohibition of toddy can be successful only if it is fol-
lowed by the use of foodstuffs which would meet vitamin Bi
deficiency.

In any case, the task of controlling and finally abolishing the
consumption of toddy and other forms of fermented liquor has
to be approached with some caution as their suppression may
lead to the drinking of stronger spirits such as are distilled from
Mowha and cereals. Perhaps the most effective means of bring-
ing under control this form of liquor traffic would be to find
some wholesome substitute. In South India, a simple beverage
made of water sweetened with jaggery and flavoured with
pepper or tamarind is regarded as a c sacrcd drink'. To the
addicts, the various kinds of non-aerated drinks (sherbets) pre-
pared with fruit juices may not appeal at the first instance, but
if the prohibition campaign is based upon the physiological
effect of alcohol upon health, we believe that it should not be
difficult to make our unsophisticated masses realize the dele-
terious consequences of drinking habits. Now that the National
Congress is determined to safeguard the health and morals of
the people by declaring prohibition throughout India, it is to
be hoped that the movement will have the active support of all
workers in the field of medical and nutritional research.

That in consequence of the excise policy of the Government,
the problem of prohibition in India is confronted with stupen-
dous difficulties may be realized from their attitude towards
the campaign for suppressing the drink traffic. They urge with

* Governed by Australia under a mandate from the League of Nations.

194

FOOD ADJUNCTS

confidence the continuance of their policy because the traffic
yields a substantial revenue which the Government cannot
raise from other sources. But if one could estimate in terms of
rupees, annas, and pies the loss of health, physique, and econo-
mic efficiency consequent upon the drinking habit, the figures
would certainly exceed the sum of 15 crores* which the Govern-
ment derive from this degrading form of taxation. And one
should remember that the total money extracted annually by
the traffic exceeds 62 crores.

From the point of view of food supply, the prohibition is of
great importance to agricultural economy, since a considerable
quantity of cereals are now used in the production of liquors.
In Assam, for example, nearly 25 per cent of rice is thus con-
sumed. The utilization of juices obtained from palm trees for
the manufacture of jaggery would go a long way to meet the
demand for sugar, the consumption of which, as the experience
in the United States showed, is bound to increase with the
success of the prohibition campaign.

Opium is the dried juice of a poppy, Papaver somnifemm and
owes its soporific properties to a number of alkaloids of which
morphine is the chief. The plant is not indigenous to India; it
was introduced by the Moslem traders about the ninth century
and its cultivation and use received much encouragement from
the Moghuls. During their time the poppy capsules were exten-
sively used to prepare a beverage known as Koknar, and,
according to Chopra, this decoction is still drunk in parts of
the Punjab and Rajputana. The cultivation of the poppy, the
manufacture of opium, and its sale are organized as a Govern-
ment monopoly. For over two centuries a flourishing trade in
opium existed between India and China. In conformity with
their undertaking to the League of Nations, the Government
of India decided in 1926 to reduce exports to Far Eastern
countries Tor other than medical and scientific purposes' by
10 per cent annually.

As regards the consumption of excise opium in India, the
figures show a considerable decline; but the morphine habit is
spreading. Some of the chief areas of poppy cultivation are
situated in the Indian States and there the opium habit shows
no tendency to decrease. Not only in consideration of its
* i crore= 750,000.

195

A BRIEF ACCOUNT OF INDIAN FOODSTUFFS

deleterious effects upon health and well-being should the opium
habit be cured, but the fact that it demoralizes the addict and
greatly reduces his economic efficiency should concern the
feudal lords and industrial capitalists. The use of soya-bean
lecithin, a substance derived from the milk expressed from the
bean, is found to be efficacious in the treatment of opium
addicts. It has been demonstrated that daily doses of 60 to 90
grains of this substance for a few weeks produce 'spontaneous
gradual discontinuity 5 in the use of opium by the addict. Dr.
Wen-Chao Ma reports 68 that the substance is administered
orally after meals and it is easily assimilated, and that 'the
treatment reduces opium tolerance but is not accompanied by
any distressing symptoms of withdrawal 3 .

There is an urgent need for special institutions for the treat-
ment of opium addicts in India and it is hoped that the matter
of their cure will be approached with sympathy and under-
standing; for in many instances the habit is formed among the
undernourished agricultural labourers, coolies in the tea-
gardens, and the workers in the mining areas, because opium
stimulates physical energy and keeps their ill-clad body warm
in the cold season. The excessive consumption of inferior rice
tends to the craving for opium and narcotics.

Indian Hemp (Cannabis sativa) alone yields three forms of
drugs which, on account of their low prices, arc largely used
by the masses. The preparation obtained from the dried leaves
of the plant is known as bhang, that of the oleo-resinous
exudate as char as, and that of the flowering top as ganja.
These drugs have a greater hold upon the addicts than opium,
one of the reasons being their close association with rcligio-
social ceremonies. Among certain communities indulgence in
them is regarded as a symbol of 'divine intoxication 3 and they arc
included in offerings in the temples as being Toods of the gods' !

Another drug, not manufactured in India but whose con-
sumption is increasing especially in north India, is cocaine. It
is an alkaloid found in the leaves of the coca, c the divine plant
of the Incas'. It acts as a stimulant to the whole central nervous
system and its addicts seem to have a greater control over
hunger and to undergo much physical exertion without fatigue.
It is for this effect perhaps that the cocaine habit tends to
become so popular among the Indian labourers.

196

CHAPTER SIX
Diets of the Peoples of India

ihere is an incantation in Rig-veda* which runs as follows:
'Now will I sing triumphantly of food that maintains strength,
by whose stimulating power Trta rent Vrta limb from limb.
Whatever morsel we consume from waters or from plants of
earth, Som, wax thou fat thereby.' Information regarding
the dietaries and dietetic habits of the various Indian com-
munities and of individuals at different ages in different occu-
pations is meagre and unsatisfactory. We have nothing like a
proper diet survey. Those who have been so far responsible for
the welfare of the masses have no intimate knowledge of the
various types of food and dietetic preferences and peculiarities
of the Indian communities; but from the depressing state of
general health and the growing incidence of deficiency diseases,
it is clear that the nutrition of the greater part of our popula-
tion does not satisfy even the marginal requirements. Whatever
morsel they consume, it does not seem to make them c wax fat 3 .
In this chapter we shall attempt to describe the main features
of the usual dietaries of different Indian communities and to
collate such data as are available to show the extent and nature
of nutritional deficiencies so prevalent throughout India.

Hindu Concepts of Diet

From the Vedic literature we get an idea of Hindu dietary.
It consisted mainly of grains such as rice (Vrihi), barley (Yava),
varieties of beans and lentils, milk and milk-products, and
* Rig-veda, 1-87.

N 197

DIETS OF THE PEOPLES OF INDIA

fruits. Various preparations of porridge and gruel* are recom-
mended, and they are prepared with grains cooked with lentils
or milk. A Hindu meal is not complete without some kind of
sweets which are usually prepared with milk, rice, and sugar;
or various milk-products and sugar. According to Vatsyayana,
a normal diet should consist of rice, wheat, barley, pulse, vege-
tables, milk, and sweets. The comprehensive term for all that
we consume is 'Anna 5 .

In the Susruta Samhita wholesome diet is described as being
'that kind of food which can nourish the body, gladden the
heart, invigorate the system, maintain the bodily strength,
increase the appetite and vitality, improve the memory and
increase the energy and span of life'. The attainment of all
these beneficial effects is what the modern dietitian desires by
his advocacy of 'balanced diet'.

The classification of food in Sanskrit and Pali literature is
based on the forms in which it is taken. Buddhist monks
divided food into two groups, namely cooked and soft food;
and uncooked and hard food. Others divided food according
to its physical characteristics such as solid, liquid, food taken
by licking, and food that is chewed. But with the development
of knowledge of the production and taste of foodstuffs, the
classifications were made more systematic. Thus we have six
forms of food sweet, sour, salty, bitter, astringent, and pun-
gent. Finally, we have the elaborate therapeutic values of
foodstuffs based on what is known in Hindu medicine as Rasas.
All substances of vegetable, animal, and mineral origin arc
classified strictly according to the predominant taste and their
physiological action formed the basis of controlling diseases, f
It was held that tastes and flavour affect the digestive mechan-
ism and should be regarded as a reliable guide in the choice of
food. A Hindu feast prepared in the orthodox style must of
course be vegetarian. In southern India for example, it would
include the Navarasams> that is, nine tastes, beginning with
something bitter and ending with something sweet.

The predominance of cereal foods, the preference for vege-

* Here are a few Sanskrit names of the varieties of porridge and gruel :
Karambha, Yavagu, Vistarin, Mudgandana, Tilandana. The porridge
known as Payasa is prepared with milk and rice and sugar.

t A treatise on Dietetics in Hindu Medicine, known as Patyapatyam gives
an exhaustive list of foodstuffs describing their effects in health and disease.

198

HINDU CONCEPTS OF DIET

tables and fruits, the use of germinated pulse, the fondness for
milk and milk-products, and the consumption of sweets are the
main features of a Hindu dietary; and they have not substan-
tially altered in the march of time. The reason for this is not
far to seek. The development of transport, free social inter-
course among different communities, fresh knowledge of food-
stuffs, and consequent enterprises relating to their supply, and,
above all, the rise in the standard of living all these circum-
stances, which facilitated to a great extent the dietary changes
among the Western communities, did not arise in India. Food
instinct, sentiment, tradition, custom, and prejudice dominated
in the choice of diet.

And yet, owing to the geographical circumstances of the
Peninsula which determined the kind and amount of foods
available, there are certain common features in the dietaries of
the various races and communities. The basis of all diets is
cereals, pulse, vegetables, fruits, and milk.

It is true that the food rites and rituals which have evolved
around different stages of economic life, from the pastoral to
the settled agricultural, have left their mark on the bad dietary
customs and habits of our peoples. They have a tenacious
preference for diets determined by religious bias and are usually
averse to any change. Thus the influence of communal groups
and their pressure often functions as a deterrent to the choice of
new or tabooed foods. The non-vegetarian Hindus will not eat
fowl and fowl's eggs but have no objection to duck, geese, and
wild birds (e.g. plover, teal, etc.). The dislike of fowl may pos-
sibly be traced to its use in ceremonial propitiation by the
aboriginal tribes. Even the cult of vegetarianism may have
originated from the impulse to distinguish the 'Aryan' mode
of living from that of the other clans which used animals as
totemistic symbols. Be that as it may, a considerable section
of the Hindu communities, especially the higher caste, are
vegetarians.

There are elaborate rules prohibiting consumption of various
articles of diet on certain clays of the lunar month. For example.,
if patol (Trichosantlws dioica) is eaten on the third clay of the
moon, the consumer will have the bad luck of increasing the
number of his enemies; radish on the fourth day would mean
loss of wealth; coconut on the eighth clay would make the

DIETS OF THE PEOPLES OF INDIA

consumer a dunce; beans on the eleventh day would lead to
sinful acts; gourd and allied vegetables on the thirteenth day
might result in loss of one's son; if lentils are taken on the
fourteenth day of the moon, you will have chronic disease, and
so on. These rather amusing rules are carefully recorded in
the Hindu Calendar and one wonders what could be the
reason for such restrictions. They may have been designed as
an attempt to ensure stable conditions of food supply by regu-
lating the distribution of edible fruits and vegetables.

That the great majority of our people are conservative in
regard to the choice of foods and do not easily take to anything
foreign is undoubtedly true; but we have no reason to believe
that they are incapable of changing their food habits. There
are of course extreme cases of conservatism. The Namburi
Brahamins in Malabar a sect which surpasses all other Hindu
communities in orthodoxy would not, for example, cat potato
or tomato because they are of foreign origin!

The increasing consumption of wheat among the rice-eating
people, the popularity of potato, the use of refined sugar, and
of condensed milk are some of the instances which tend to
show that the conservatism of the Indian does not offer a
serious obstacle to effecting a change in his dietary. If he Is
made to realize the value of different kinds of foodstuffs which
are physiologically beneficial to him, and if the' means of pro-
curing them are within his grasp, he will falsify the common
assertion that owing to his religious bias the task of improving
the state of his nutrition is hopeless.

Moslem Concepts

While the Moslem dietaries are comparatively free from the
numerous restrictions imposed upon the Hindus, there are
taboos in the use of certain foods, which derive a religious
sanction from the early days of Islam. The flesh of those
animals 'that are cloven-footed, those that chew the cud 3 is
lawful food; but, to quote the words of the Koran, c that which
dieth of itself, and blood and swine's flesh, and that over which
any other name than that of God hath been invoked, is for-
bidden to you'. Fish found dead in water are prohibited but
if their death occurs after they are caught it is equivalent to

200

DIETARY HABITS

ritual slaughter. The emphasis laid upon ritual slaughter is
probably a sanitary code. It is interesting to note that the
custom of regarding animals killed for food as a sacrifice is of
ancient origin and may be compared with the rites by which
certain classes of the Hindus seek to remove the taboo of flesh-
eating. The Sesasht Brahmins of the Deccan eat only the meat
of a sacrificed goat, and in Bengal the priests of the Hindu
temples sell the flesh of sacrificed goats.

Having to draw upon the common supply of foodstuffs there
is no fundamental difference in the dietaries of the two great
Indian communities except that the Moslems habitually take
meat. A difference, however, exists in the methods of food
preparations. Moslem cooking delights in the extensive use of
spices which include a liberal supply of onions, garlic, and
ginger; and most of the dishes are rich in ghee. Rice is prepared
in various ways in combination with meat, eggs, pulse, nuts,
almonds, etc. Wheat is taken in the form of bread both leavened
and unleavened, but yeast is not used in baking bread. One of
the popular kinds of leavened bread is known as Baquirkhani,
named after its inventor, and Shirmal is sweetened bread made
of flour kneaded with milk. There are several kinds of un-
leavened bread baked on an earthern or iron plate prepared
with various combinations of butter, mincemeat, coconut ker-
nels, poppy seed, and pulse. Gram flour and pulse meal are
also used for the making of bread and different sorts of cakes.

Milk and milk-products enter largely into the Moslem diet-
ary. Curd and buttermilk are often used in combination with
flour of pulse (Phaseolus mdiatus) and with fruit-vegetables
like cucumber, brinjal, etc. Of the varieties of sweetmeats,
halwa made of cream of wheat, butter, and sugar, is perhaps
the favourite dish. Sweets of all kinds prepared from wheat,
rice, and gram flours in combination with milk-casein and
sugar are used by all Indian communities. Various forms of
spiced savoury are particularly favoured by our working class.

Dietary Habits

Our principal meals are two, one at midday and the other
at sunset. An account of the manner of serving meals in a
Hindu household (possibly of Bengal) recorded by a Chinese

201

DIETS OF THE PEOPLES OF INDIA

traveller in the ninth century may be of interest. He writes:

The first course is a small piece or two of ginger with a little
salt. It is followed by some form of rice preparation, and lentil
soup (Dal) is served with hot butter sauce as flavouring. Then
are served fruits and cakes (Pistakas). After the meal is finished
tooth-pick and water are supplied to the guests for cleaning
the mouth. Sometimes perfumed paste is given to rub the
hands with before washing in order to make them fragrant and
clean. Finally some betel-nuts, nutmegs with cloves, etc., arc
distributed. This helps to make the mouth fragrant, to digest
the food, and remove the phlegm.'

Broadly speaking, there has been no substantial change in
this manner of serving meals or of eating foods. The use of
knives, forks, and spoons is confined to a very small section of
the people but the custom of eating food without their aid
should not be discouraged. Among other advantages, the habit
provides an automatic safeguard against the risk of eating hot
food and drinking scalding hot liquids which may cause a
constant irritation of the stomach.

The habit of chewing betel leaf (pan)* is common among
our people. Its chief constituents are grated areca nut, unslaked
lime, catachu, cloves, and other spices, rolled within a betel
leaf. The combination is astringent and is thought to aid diges-
tion, but clinical observations tend to support the view that
the excessive use of pan may lead to buccal cancer. At any rate,
it affects the mucous membrane of the mouth and interferes
with normal secretions.

Over-indulgence in spiced foods and in sweets, irregular
meal times, eating too fast, are some of the habits which
seriously affect the nutritional processes. Even those who arc
in the fortunate position of being able to choose their diet as
they like, show crass ignorance concerning healthy dietary
habits. The diet of the well-to-do and educated is very often
characterized by an excess of seasonings; nor do they seem to
realize that any habitual excess of food, over and above what
is really needed to maintain health, is not only uneconomical
but positively harmful. In a previous chapter we have stated
some of the consequences of overfeeding. The observation of a

* Piper betle: a perennial dioecious creeper, cultivated for the sake of its
leaves.

202

COOKING

Chinese writer that one-fourth of the food consumed by the
rich goes to nourish them and three-fourths to kill them is not
an exaggerated statement. The ill-health and diseases from
which well-to-do Indians suffer may indeed be traced not only
to the inadequacy of this or that nutrient substance but also
to their dietary habits.

As regards wastage, no one interested in the food problem of
the country can view with equanimity what goes on in the
average household of the upper and middle classes in India.
On ceremonial occasions the varieties and amounts of food are
far in excess of actual requirements; course after course is
served with the idea of maintaining a false standard of prestige
rather than of satisfying the needs of the guest. This orgy of
over-indulgence, this gluttony, this form of grotesque dietary
habit should no longer be tolerated, and it is to be hoped that
in our social festivities a simple diet will come into vogue.

There are also other sources of wastage in transport, storage,
marketing, and preparation of foodstuffs. A food conservation
campaign throughout India is no less important than a cam-
paign for food production. Even in the kitchen the waste is not
inconsiderable and it arises mainly from ignorance in handling
foodstuffs as well as from the methods by which the risks of
contamination are avoided.

Food practices are regulated by complicated caste rules
among the orthodox Hindu communities. There are also
various forms of food taboos many of which appear to be
associated with hygienic considerations. They lay down what
kinds of food one should take, in whose company a meal should
be eaten, the nature of the vessels which should be used for
eating, drinking, and cooking, and a host of other rules.

Cooking

Most foodstuffs are cooked in order to make them more
digestible and palatable. Tissues in meat and cellulose sub-
stances in vegetables have to be softened, retaining at the same
time their nutritive value and palatability. Various methods,
such as boiling, steaming, baking, and frying, should therefore
be so adjusted to the type of food materials that over-cooking

203

DIETS OF THE PEOPLES OF INDIA
may not deprive them of much of their nutrient substances.
The problems of culinary art are thus fundamentally related to
nutrition, and should engage our attention if substantial im-
provement in our dietaries is desired.

But this business of cooking the Hindus leave to a profes-
sional class known as Thakur, and the Moslem to Baburchi.
While in the cooking of a variety of preparations out of simple
ingredients, Indian cooks exhibit a commendable skill, they do
not possess even a rudimentary knowledge of what happens to
the nutritive substances of the foodstuffs handled by them.
They cling tenaciously to traditional methods of cooking and
serve their preparations time and again without any change in
T taste, flavour, and appearance. Vegetables are over-cooked;
gruel of cooked rice, which contains vitamin Bi and certain
mineral salts, is thrown away; chapatis are often served under-
baked; and most of the preparations are highly seasoned with
.condiments and spices. In order to increase the palatability of
food, they often destroy its digestibility.

Our educated communities show little interest in the prob-
lems of culinary art. In our Press and educational institutions
we do not discuss how desirable changes may be brought about
in the field of nutrition by rational methods of food prepara-
tion. Our girls are not given any training in cookery except
what they learn from traditional sources and no initiative has
so far been taken by our public health services to give direction
to the people how best they could prepare meals with economy
and at the same time provide a balanced diet. The compilation
of cookery books for the guidance of the different income groups
in India should be taken in hand by appropriate organizations.
The training in proper cooking is as important as the dissemi-
nation of the knowledge of nutritive constituents.

It is time that attention was given also to the location of
kitchens, their general sanitary conditions, and the supply of
appropriate cooking utensils. An interesting reference is found
in Sanskrit where we are told that 'the kitchen should always
be on the south side and should be regarded as the most
sacred part of the house'. In orthodox Hindu households, a
part of the kitchen is used for the worship of deities a custom
which may have originated from the motive of enforcing the
habit of cleanliness. Nevertheless, very much remains to be

204

REGIONAL CHARACTERISTICS

done in the way of improving the sanitary conditions of our
average kitchen.

Then there is the problem of fuel. For the preparation of
most of our dishes, slow fires are suitable. Charcoal has been
and still is a chief article of fuel, although in urban areas, coal
is becoming popular. The practice of burning dried cowdung
that invaluable farmyard manure so essential for the main-
tenance of the productivity of the soil arises from the scarcity
of cheap fuel. The tragedy is that the villager is fully aware of
the folly of using cowdung as fuel but knows not how to save
it for manure.

Regional Characteristics of Indian Dietaries

Since there are great variations in physique and develop-
ment among the races and communities living in different
regions of India, a short account of the usual dietary in each
area may be of interest. That these variations depend upon
various factors such as racial habits, modes of life, religious
customs, climatic conditions, type of husbandry, availability of
foodstuffs, etc. is obvious; but with the information at present
available, we must confine ourselves to general descriptions of
these regional diets. It should, however, be borne in mind that
human nutrition is to a large extent guided by economic con-
siderations and that the prevalence of undernourishment and
malnutrition is a socio-economic phenomenon.

For our purpose we may divide India into six regional divi-
sions, namely, Gangetic Delta, Upper Ganges Valley, Indus
Valley, Deccan Plateau, Eastern Coast, and Western Coast.

(i) Gangetic Delta

The Presidency of Bengal falls within an area which is inter-
laced with several great rivers and their tributaries. It is per-
haps the foremost rice-growing region of the world. Oilseeds,
pulse, and sugar cane are the other important food crops
grown in this tract.

The staple food of the people is rice, chiefly parboiled. Pulse,
vegetables, fish, and various kinds of sweet preparations enter
into the usual Bengali dietary. Owing to the availability offish
in east Bengal, the quality of diet is better than that of the

205

DIETS OF THE PEOPLES OF INDIA
western part of the province. Mustard oil which is extensively
used in cooking is the main source of fat and only those families
not living in want can afford ghee or butter. The average yield
per diem from the diminutive milch cow of the province is so
low that there is a scarcity of milk. In many households, babies
are fed with rice or barley gruel. According to Sir John
Megaw's enquiry, only 22 per cent of the people of the province
can be regarded as being well nourished.

The daily food of the majority is thus characterized by exces-
sive quantities of carbohydrates consumed in the form of rice
and gur or sugar; it is deficient in fat of biological value and in
protein. The average intake of protein hardly exceeds two
ounces per day. The diet is poor in protective nutrients, a
defect which has much influence on the incidence of several
ailments common in the province.

(2) The Upper Ganges Valley

This tract embraces a considerable part of the United
Provinces. Rice, wheat, millet, oilseeds, and sugar cane are
the staple food crops grown but they are dependent upon
monsoon and irrigation.

Chapatis made of wheat flour or other cereals (according to
the means of the consumer), legume soup, vegetables, curd,
sweets, and fruits are the principal items in the dietary of the
people. Inferior qualities of rice (e.g. red rice) take the place
of wheat when its price is high. The poor generally have one
meal in the evening and eat parched cereals or germinated
gram during the day. During the season the Mahua flower is
largely consumed by the indigent population.

Cow milk is beyond the means of the majority of the popu-
lation but skimmed milk, curd, and goat's milk arc often used
as substitutes. One important feature of the dietary in this area
is the proportion of green leafy vegetables, which is higher than
that of other parts of India.

(3) The Indus Valley

The upper Indus valley is called the Punjab and the lower,
Sind. The chief food crops of the region are wheat, millet,
and sugar cane, grown under an extensive system of irriga-

206

REGIONAL CHARACTERISTICS

tion. The communities living in these provinces are reputed to
possess fine physique and stamina, and they are largely repre-
sented in the Indian Army. The main characteristics of the
dietaries of these north Indian peoples may be illustrated by
a description of the diet of the Sikhs, which is neither simple
nor inexpensive in comparison to that of other Indian com-
munities.

MacCarrison's investigation into the various diets of Indian
peoples led him to the conclusion that the Sikh regime was the
most nutritious of all those he examined. This diet consists
largely of freshly ground wholemeal wheat made into a form
of unleavened bread called chapatis, legumes, fresh vegetables,
and milk-products. The vegetables are usually cooked in
clarified butter and the milk-products include buttermilk,
curd, and soft cheese. The Sikhs do not take beef, but various
kinds of animal food enter into their dietaries. It is obvious
that a mixed diet of this nature is not likely to be deficient in
'good proteins', and the liberal quantity of milk and fresh
vegetables consumed by the average Sikh family ensures the
supply of other protective food substances. The Sikh children
are usually breast-fed for about two and a half years and are
then given diluted fresh milk. Towards the end of the period of
suckling, they are given curdled milk a sort of junket.

The dietaries of the other fighting races of India such as
Jats, Dogras, and Rajputs are very similar to the Sikh regime
with the exception of the Pathan diet. The indigent population
among these races, however, lives on inferior cereals and has
to eke out an existence with a much less varied diet. The
Pathans are fond of meat and consume it more than the other
races. Among the Rajputs the diets of those inhabiting the
western part of the Central States are superior to those usually
consumed by their compatriots domiciled in the United Pro-
vinces. They are not so rigid in the observance of caste regula-
tions and are hence more amenable to changes of dietary habit.

(4) Deccan Plateau

This area is situated in the centre of the Indian peninsula
and is characterized by a wide variation in physiographical
and climatic conditions. Of the main cereals grown, millet and
rice are largely consumed by the people. The varieties of pulse

207

DIETS OF THE PEOPLES OF INDIA
grown are of inferior quality and they are frequently consumed
in mixtures with grains.

Wheat is cultivated in the northern section of the plateau.
The proportion of pulse in the dietary is usually small and
vegetables, especially leafy varieties, are rarely consumed.
Milk consumption is even lower than the minimum in other
parts of India. The use of fruit is not generally in vogue.
Sesame and linseed oils are largely used in cooking and the
consumption of ghee is a rare luxury even among the middle
classes.

(5) Eastern Coast

We are now in the Presidency of Madras. Rice, millet, pulse,
and sugar cane are the main foodstuffs. The diet consists chiefly
of parboiled rice, millet, pulse, soup (dhal), vegetables, curd,
and tamarind water. Excepting those belonging to the lower
social scale, the peoples are generally vegetarians, and many
live on coarse rice seasoned with salt and chillies, and a small
quantity of vegetables. In the average dietaries of communities
living in this region, 'protective 5 foods are represented only by
vegetable proteins furnished by some kind of legume soup
(dhal) and by a small quantity of non-leafy vegetables. Green
leafy vegetables and fruits are absent from the usual dietary.
The proportion of milk and milk-products in the diet is ex-
tremely low. Babies are weaned on rice-water and children arc
fed on cereals and a few coarse vegetables.

(6) Western Coast

Various kinds of millet, rice, wheat, oilseeds, and sugar cane
are the main food crops grown in this zone; a certain portion
of the cultivated area is given to fodder crops.

The staple diet of the vast majority consists of chapatis made
of millet with a scanty supply of vegetables and dhal. Even in
the 'dairy zones', many families use considerably less milk and
milk-products than they did a few years ago. 'Congee', that is
the surplus water obtained in cooking rice, is given to babies
as a substitute for milk. Curd is a favourite product among the
Mahrattas and enters into the dietary of the poor in a very
diluted form. In recent years there has been an increase in the
consumption of fruits.

208

THE CULT OF VEGETARIANISM

The Cult of Vegetarianism

From our outlines of Indian dietaries it should be apparent
that the great majority of our peoples are vegetarians although
a diet exclusively drawn from the products of the plant world
is confined to a small minority. We have seen that milk and
milk-products are included in the dietaries even of those who
have an aversion to foods of animal origin. Some take eggs but
no meat and no fish., and some abstain from meat but not from
fish.

In Europe and America, the theory and practice of vege-
tarianism is confined to a small number of individuals, often
invalids or faddists, and to the experimental investigation of
physiologists. This is not the case in India, where the question
of vegetarian diet is bound up with the ethical principles
embodied in the doctrine ofAhimsa., which enjoins the moral of
reverence for all living things. Manu observes: 'Meat can never
be obtained without injury to living creatures, and injury to
sentient beings is detrimental to the attainment of heavenly
bliss.' The idea that the abstinence from animal food assists
man in his efforts to attain holiness by enabling him to control
animal passions encouraged the cult of vegetarianism which
became a part of the discipline of Buddhistic monasticism.*
But the precepts of Buddha did not lay stress upon food-taboos
as being essential for securing immunity from animalism. c lt is
not the eating of flesh 5 , declared this prophet of rationalism.,
'that defiles a man, but the doing of evil deeds.'

It may well be doubted, however, whether the origin of a
custom so widespread is to be found in religious sanction alone.
To the Aryan-speaking settlers meat was not a prohibited
article of food. On the contrary, they regarded it as a stimu-
lating sustenance and prescribed that pregnant women should
eat meat with a view to strengthening the unborn child'.! It
is very probable that the prohibition of meat originally had a
purely practical and healthful purpose. Meat decomposes with
extreme rapidity and is far more susceptible than most other

* The practice of vegetarianism was common among the Orphic
Societies in Egypt and among the Neo-Pythagoreans. The Chinese Bud-
dhists took religious vows of temporary vegetarianism during their pil-
grimage to a sacred mountain.

t Flesh, according to the Satapatha Brahmana, is the best of foods,

209

DIETS OF THE PEOPLES OF INDIA
foodstuffs to external infection from flies, cockroaches, and
other germ-carrying insects. This disadvantage is especially
great in a warm climate like that of India. Moreover, certain
diseases may be communicated to man through the consump-
tion of the meat of infected animals. Even in modern times
such objections have been raised, for example, by the well-
known French vegetarian Jean Nussbaum who observed that
'both physiologically and psychologically man is ill-adapted to
the consumption of such highly putrifactive material as flesh
foods'. And a dim realization of the ill-effects of diseased meat
is not uncommon even among primitive races. In the distant
past considerations of this sort may have first induced the
Indian people to renounce the eating of meat, and religion
later added dogmatic sanction to a practice enjoined by the
requirements of health.

However this may be, vegetarianism is in fact practised by
millions of the Indian people, whether from reasons of health,
inclination, necessity or religious prejudice. And the question
that presents itself is, how far is this practice compatible with
the optimum nutrition suggested by the results of modern
investigation? The problem can be reduced in general terms
to a question of amino-acids. That certain arnino-acids are, as
we have seen in Chapter Three, essential to the human
organism for the purpose of building tissue is one of the funda-
mental discoveries of nutritional science. The proteins of
animal products meat, fish, eggs, milk contain the essential
amino-acids in greater quantity and of better quality than do
vegetables or fruits. Animal proteins have a higher digestive
utilization and biological value than vegetable proteins.

Thus the physiological arguments afford a strong a priori
reason for preferring a diet which includes animal foods to one
which does not. On the other hand, it seems equally certain
that a purely vegetarian diet can support life in a state of good
health. Records of endurance exhibited by vegetarians on a
spare diet of fruits and vegetables, the bodily vigour and
longevity of some of them, and the low incidence of such ail-
ments such as Bright's disease, and high blood pressure, con-
tradict the assertion that a non-flesh diet necessarily has de-
bilitating effects upon the human body.

There are, however, two objections to a purely vegetarian

210

THE CULT OF VEGETARIANISM
diet. In the first place, although it is not impossible to construct
a vegetarian diet which would provide all the necessary pro-
teins in the required amounts, yet to do so would require a
certain care and skill an amount of skill and knowledge not
in general possessed by the average housewife. The truth is
that when we examine the actual vegetarian diets of the vast
majority of the Indian people we find that they are in fact
lacking in the essential proteins, or at best that they are only
on the margin of sufficiency. Where rice is the staple article
of diet it is most unlikely that the protein requirements will be
adequately supplied, for the protein of rice is very exceptionally
poor. The second objection is perhaps less serious, namely, that
a vegetarian diet which succeeds in providing sufficient pro-
teins is likely to be excessively bulky. The poorer the constitu-
ents are in proteins the bulkier will the diet have to be. And a
very bulky diet is not generally considered palatable.

But these considerations do not necessarily imply that meat
must needs be included in the diet in order to insure optimum
nutrition. There is a tendency in the Western world to adopt
this view, but it is not in our opinion a necessary consequence
of the latest researches on proteins. It has been shown by
Tcrroine that the addition of comparatively small amounts of
the proteins of high biological value contained in animal foods
to the less good proteins of cereals, legumes, and other vege-
tables has the effect of raising the biological value of the whole
protein mixture to a level as high or higher than that of the
good proteins. Now the proteins of milk and of eggs especially
of milk arc among the best which exist. It should be possible
therefore, without much difficulty, to devise diets which,
though the bulk of them be composed of vegetable foods,
would, by the addition of sufficient quantities of milk and eggs,
supply all the proteins required for optimum nutrition. Long
ago Rubner pointed out that the staple diet of the robust and
healthy Bavarian peasant consisting of bread, milk, milk-
products (e.g. cheese), and a liberal supply of vegetables was
not deficient in proteins. During the War the International
Allied Food Commission came to the conclusion that the pro-
teins of meat could be replaced by eggs, milk, and milk-products
and that there was no need for alarm at the reduction of meat
supply.

211

DIETS OF THE PEOPLES OF INDIA
We need not further recapitulate here the discussion of
'supplementing 5 which we have dealt with at length in Chapter
Three; we wish merely to point out the conclusions which we
think should be drawn from that discussion with regard to the
question of Indian diets. These conclusions may be very briefly
summed up as follows: a purely vegetarian diet, while it may
provide adequate proteins by including, for example, soya-
beans, nuts, etc., in large quantities, is always open to the dan-
ger that it may not. Such a diet should therefore be dis-
couraged. Where, for any reason, it is not possible to introduce
foods of animal origin into the diet, care should be taken that
the proteins be derived, not from one source alone, but from
a variety of foodstuffs; where possible, however, foods of animal
origin should be consumed. There is no need to include meat
and fish in the diet, though if there is no economic or religious
objection to their inclusion it should be borne in mincl that
their proteins are of the best. Milk and eggs, and milk above
all, added to an otherwise vegetarian diet, will in all cases
ensure an adequate supply of the best proteins. The first
object, therefore, of those who concern themselves with the
improvement of Indian nutrition should be to encourage by
every possible means the consumption of milk. When the time
comes when every Indian household is a large consumer of
milk and its derivatives and eggs, no further improvement in
diet will be necessary, in so far, at least, as proteins arc
concerned.

The Diet of Schoolchildren

A proper diet survey of our schoolchildren has not been
attempted; but we have seen in Chapter Five that the Reports
of the Public Health Departments record a high incidence of
eye diseases (e.g. xerophthalrnia and keratomalacia), stoma-
tis, unhealthy skin (e.g. phrynoderma), and other symptoms
of malnutrition among them. While the cause of these maladies
may be traced to defective development or pathological con-
ditions resulting from infectious and other diseases, there is no
doubt that dietary deficiencies must be regarded as a pre-
dominating factor in the appalling state of health of a large
proportion of schoolchildren in India.

We are indebted to Dr. W. R. Aykroyd and his colleagues

212

THE DIET OF SCHOOLCHILDREN

for initiating investigations into the state of nutrition of school
children in South India. Over 1,900 children between the ages
of 6 and 1 7 in three towns were examined with results which
show that a large percentage of children are suffering from
malnutrition due to deficient diet'. 69 Ordinarily the diet of
children of school-going age throughout India consists of
cereals, a small quantity of vegetables and thin soup (dhal)
made of legumes, and perhaps a little diluted curd. Among the
non-vegetarians, there may be a bit offish and meat. The usual
diet contains a disproportionate amount of carbohydrates and
is extremely deficient in proteins, fat, and vitamins. The zest
with which children indulge in feasts of meat suggests 'protein
starvation'.

Not only is the food thus provided absurd in its lack of pro-
portion between essential food constituents, but the absurdity
becomes a positive menace to the health of the growing chil-
dren when excessive seasonings with spices are used in its
preparation. Milk, which is of paramount importance, is in-
adequate or absent; and their diet does not usually include
fresh or dried fruits.

The science of nutrition has shown beyond doubt that
adequate and proper feeding during the formative period is
essential for the health and well-being of the child, and that
if it suffers from undernutrition and malnutrition, the conse-
quent retardation of both physical growth and mental develop-
ment cannot be made good at a later stage. Not only does a
growing child require more food than an adult in proportion
to his body-weight, but there must be an adequate supply of
protective food constituents in his normal diet. What the pro-
portion should be, has to be determined by careful investiga-
tion. It is estimated that the diet should contain for every unit
of protein, one unit of fat and five of carbohydrates and that it
should provide fruits and vegetables as a safeguard against
vitamin deficiencies.

As a result of recent experiments in Russia carried out on an
extensive scale on the nutrition of schoolchildren, it is found
that in their average diet the protein level need not exceed 1 3
per cent, and the fat content may vary from 18 to 22 per cent
according to age. Children from 8 to 1 2 years require more fat
than those from 13 to 1 6 years.

o 213

DIETS OF THE PEOPLES OF INDIA

Similar experiments are being conducted in those countries
where the feeding of schoolchildren is included among the
duties of the public health services, and it is imperative that
this all-important problem should now be a part of the con-
structive programme of the Indian Ministries. They may well
begin the task by instituting a system of strict supervision of the
nutrition of children in residential hostels, orphanages, and
similar institutions. Partly because of the low level of expendi-
ture allotted to food and partly because of the ignorance of the
authorities in regard to the dietary needs of the inmates placed
in their care, institutional feeding in India does not provide even
the barest minimum of essential nutrients for the growing child.

As an illustration of the shortcomings of the dietary of pupils
in a number of hostels under the supervision of district school
authorities in India we append here a table composed from
data supplied in a note published by the Office of the Director
of Public Health in Bihar and Orissa.

TABLE XIII
A Statement of Various Hostel Diets in Bihar and Orissa*

Quantity of

Rate per

Uncooked

Name of Hostels

Month

Food per

Attached to the High

Community

(in rupees)

Head per

Calories

English Schools

f

Day (in

ounces]

Rs.as.p.

Monghyr Hostel

Hindu

IO

26-5

2,232

Monghyr Hostel

Moslem

800

25-5

2,092

Chapra Hostel

Hindu

880

28

*>9?6

Hazaribagh Hostel

Hindu

780

29

2,230

Purnhia Hostel

Moslem

780

26

1,908

Purnhia Hostel

Hindu

700

27

1,796

Southal Hostel

Hindu

700

28

2,158

MuzafTarpur Hostel

Hindu

700

24

*>944

Northbrook Hostel

Darbhanga

Hindu

700

3 1

2,318

Raghunathpur

Hostel

Hindu

5 I0

3i

2,520

Average

_

780

27-7

2,124

* Notes by Jahar Lai Das, the office of the Director of Public Health,
Bihar and Orissa, 1928. f One rupee equals is. 6d.

214

VIII, The dry and atrophic skin (Phrynoderma) in a man aged 20 also suffering
fromKeratomalacia,
SM vfDi If, R.

THE DIET OF SCHOOLCHILDREN

The diet is largely composed of parboiled milled rice and the
chief pulse is that inferior legume Arhar (Cajanus indicus}.
Vegetables are provided in small quantities. There is no varia-
tion in diet; seasonal fruits do not form a part of the dietary of
these children and milk is excluded because f of its cost and
also of its availability'. And all this in a province which is
known as the most fertile region in India!

The situation in other parts of India is no better. The growth
of about i ,000 children attending the primary schools in Bom-
bay was recently studied by an association interested in dietary
reform. It was found that the pupils were nearly 22 per cent
below the standard weight arid their growth with reference to
age and height furnished enough evidence to show that they
were undernourished. In their investigations covering some
thirty residential hostels for schoolchildren in south India,
Aykroyd and Krishnan found 70 that the diets supplied were
generally of low nutritive value and that the incidence of
angular stomatitis, phrynoderma, and xerophthalmia the
conspicuous symptoms of malnutrition were common among
a considerable percentage of the children living in these insti-
tutions. The Students' Welfare Committee of Calcutta reported
not long ago that out of every ten students six were definitely
suffering from some effects of malnutrition, two were complete
wrecks, and only two physically fit.

These arc not isolated instances; poor physique, impaired
vigour, gastro-intestinal disturbances, low resistance to infec-
tions and other pronounced symptoms of malnutrition all
these features are common among schoolchildren throughout
a great part of India. Even in those 'ideal 5 institutions which
claim to aim at the creation of a healthy body and healthy
mind, the diet provided to the inmates is far below their nutri-
tional requirements. Is it any wonder that these institutions
succeed in producing both physical and psychical morbidity
rather than positive health?

But the problem of improving the state of nutrition of our
schoolchildren is not so intractable as it appears. It has
assumed such serious proportions chiefly because of the com-
placency of our educated classes and of the incompetence of
those responsible for the government of the country. It now re-
quires a new orientation of the entire educational system and a

DIETS OF THE PEOPLES OF INDIA
close co-operation with agriculture and small-scale industries.
In most instances, the level of expenditure for food in homes or
in hostels is kept, of necessity, so low that any improvement in
diet schedules is impossible. The commendable efforts to sug-
gest cheap balanced diets costing less than five rupees per
month may not remove the conspicuous deficiency of 'good'
proteins and essential vitamins. In our judgement, the true
method for the improvement of institutional feeding is to be
found in providing a fruit and vegetable garden, which should
be an indispensable part of a residential hostel for schoolchil-
dren. In its initial stage, such a farm may require a subsidy or
block grant from the State, but it should be able to run even-
tually on a self-supporting basis supplying a substantial quota
of foodstuffs for the hostel. Running the farm would also offer
ample opportunities for providing instructive manual work for
the inmates of the hostel. As regards the feeding of day-school
children belonging to indigent families, the responsibility must
rest with the State.

The difficulty in the way of cooking or preparing food at the
school may be solved by adopting the system practised in
Norway, where the diet of schoolchildren is supplemented by
the regular provision of free or cheap meals. As a result of
successful experiments carried out some years ago by Professor
Schiotz at Oslo, the system suggested by him has drawn the
attention of public health departments in European countries
for many years past. The originality of the system lies in the
fact that the main objective aimed at is to ensure that the
children may be protected against any form of vitamin or
mineral deficiency which might be found in their home diets.
The 'Oslo breakfast' as it is called, consisting of milk, scones
made of whole wheat or rye flour, a piece of cheese, an orange
or apple or a raw carrot, is served half an hour before the
opening of classes. Not only has a considerable improvement
in the physique of the children been noticeable as a result of
this form of supplementary feeding, but parents themselves are
enthusiastic over the success of the experiment.

The suggestion that the necessary steps should be taken by
the State without delay to ensure adequate and proper nutri-
tion to malnourished schoolchildren in India appears to have
been received with approval in high official quarters. In the

216

THE DIET OF SCHOOLCHILDREN

course of an eloquent speech, on the occasion of inaugurating
a scheme for providing milk in schools in Simla, Lord Linlith-
gow, the Viceroy of India, observed: e What indeed is the use
of spending public funds on objects such as education, welfare
schemes and the like if the people have not the health and
vigour of mind and body to take full advantage of them and to
enjoy them? What indeed can we hope from a political con-
stitution unless we apply ourselves without delay and with
persistence, vision, and courage to the improvement of the
physical constitution of the common run of man and woman?
For, in truth, the response of the individual to the opportunities
of life, whether economic, cultural or political, is inevitably
inadequate in the absence of that vigour and ambition and of
that joy in life which belong to the possession of a healthy and
balanced mind linked to a healthy body.'

The ideal to which the Viceroy draws our attention is that
of optimum health which can only be attained by the provision
of an optimum standard of diet including both the energy-
bearing and protective foods. And this standard must be pro-
vided during the school years as well as in early childhood.
What satisfactory results have been achieved by encouraging
a liberal consumption of milk and other protective foods is
shown in the experience of those countries where the well-
being of the young generation is regarded as an obligation of
the State. If definite measures are now to be adopted in India
for providing for the nutritional needs of schoolchildren, it is
to be hoped that they will be made an integral part of the
educational system. The supply of safe and abundant milk to
the army has been assured by setting up well-organized mili-
tary dairies, and there is no reason why the milk-in-schools
scheme for India should not also be placed upon such a secured
basis. The provision of milk for schoolchildren, nursing and
expectant mothers, and for infants requires concerted action
on the part of the State and the informed public, and I believe
that the time is propitious for the establishment of a number
of special dairies throughout India, which would both provide
a fundamental basis for nutritional development and render
real assistance to the dairy industry.

DIETS OF THE PEOPLES OF INDIA

The Diet of the Industrial Worker

Let us now inquire into the worker's diet. Rising at dawn he
usually takes a hasty snack of cold, stale rice or a few pieces of
chapati; and consequently long before the hour provided by the
factory management he feels the need of the morsel of food he
is able to secure from all sorts of food vendors and cheap
restaurants. The haphazard and unsatisfactory ways in which
the Indian worker feeds, during his working hours/ observes
the Royal Commission on Indian Labour, is one cause of his
slackness and half-hearted working.' Then, the period of recess
allowed is far too short for his midday meal and no suitable
accommodation is provided for him to take it in any reasonable
comfort. He is therefore tempted to resort to the cheap eating
places where the food served is of doubtful quality and is
highly seasoned with spices, and it is here he usually contracts
the habit of drinking liquor.

In order to assess the state of nutrition of the industrial
workers, we have to set up a standard of their minimum
dietary requirements, and also to calculate its cost. In their
memorandum to the Royal Commission on Labour in India,
the Bombay Textile Labour Union, in arguing the case for a
minimum wage, based their estimates of expenditure on food
upon the cost of the first six of the nine articles listed in the
prison diet at the prices ruling in December 1929. The figure
arrived at was Rs.* 5, 4 annas, 2 pies per adult male. Of course
the estimate varies with the nature of the industry and the
province where it is located. Concluding from the enquiry of
the conditions of labour of the workers in the jute industry in
Bengal, Chowdbury 71 calculates the average expenditure on
food per equivalent adult male in the families with an income
of Rs. 20 to 30 per month, as Rs. 5-12-3. Allowing for the dis-
crepancies in these two estimates, mainly due to the variations
in prices, we may accept for the purpose of comparison the
standard of expenditure on food allowed in the prisons of Bom-
bay. It is, however, necessary to bear in mind the circumstances
under which the worker is able to purchase the foodstuffs with
this sum of Rs. 5-4-2. Usually he depends on credit which petty
grocers allow him, but for this favour the prices of his purchases
* i Rupee^= is. 6d.
2l8

THE DIET OF THE INDUSTRIAL WORKER

are raised at least by 10 per cent. There are also other dis-
advantages in dealing with small shops, where retail prices are,
let us note, higher than those in the organized markets on
whose figures the prison statistics are based, and here among
the small vendors the practice of food adulteration is very
common.

Before we turn to some family budgets of our industrial
workers, we may set out in a table a quantitative estimate of
daily food consumption per adult male worker as against that
of a prisoner.

TABLE XIV

Showing the comparative daily consumption of food per

adult male in the homes of free industrial workers and in

the prisons of Bombay

Items of Foodstuffs

Industrial Workers

Indian Convicts in the
Prisons of Bombay

Bombay
Textile
Industry

Madras
Textile
Industry

Light
Labour

Hard
Labour

Cereals
Pulse
Meat
Salt
Oils
Food Adjuncts

Ib.
1-29
09
03
04
02
07

Ib.
1-13
07

05
03
09

Ib.
i-38

21
04
03
03

Ib.

i'5
27
-04
03
03

Total

i*54

i'37

1-69

1-87

As regards the qualitative value of the prison diet, its gross
nutrient content is estimated as follows: proteins 7*1, fat 2-8,
carbohydrates 34-6 ounces per day.

Since the appointment of the Royal Commission on Labour
in India, several enquiries into the worker's family budget have
been instituted by Provincial Governments. Investigations are,
however, not sufficiently comprehensive in the sense that they
do not include details in regard to the state of nutrition of our
industrial workers. Here we shall attempt to analyse certain
relevant data obtained by these enquiries, confining ourselves

219

DIETS OF THE PEOPLES OF INDIA
to those income groups which are officially recognized as being
truly representative of the Indian working class.

In the first place, we take the three income groups of the
working class families, namely: (i) below Rs. 30; (2) between
Rs. 30-40; (3) between Rs. 40-50. Families whose income
levels exceed Rs. 50 are not included because the Royal Com-
mission on Labour regarded them as being outside the proper
category of the Indian working class.

Secondly, within these groups we ascertain the average com-
position of the family in terms of adult males, adult women,
and children and calculate the number of equivalent adult
males in each group for the purpose of estimating the food
requirement of the family. The expression 'equivalent adult
male 5 needs explanation. Physiologists hold the view that a
woman normally requires less food than a man, and the food
requirements of children would of course vary with their age.
Consequently it is necessary to lay down a scale of relative
requirements of men, women, and children. One such scale
which is widely used is suggested by Cathcart and Murray 72
and is recognized by the British Medical Association. The scale
is as follows: If we take the needs in terms of food of an adult
male as i, a family would require food in the following pro-
portions:

Adult male i

Adult women 0-83

Child 10 to 14 years 0-83

Child 6 to 10 years 0-7

Child i to 6 years 0*5

Thus a family consisting of a man, a woman, and a child in
each age group would require as much food as 3-86 adult
males. Since the ages of the children are not mentioned in the
budget estimates, we have to rely upon an average age ap-
proximating the child as being equal to -68 of an adult male.
Thirdly, the average expenditure of a family on food per
month within a given income group is divided by the average
number of equivalent adult males per family in that group.
This would show the average food expenditure per month per
equivalent adult male for the income group. Lastly, we calcu-
late as nearly as possible the cost of food at the time of the
budget enquiry for an adult male based on the standard of

220

THE DIET OF THE INDUSTRIAL WORKER

the prison diet of Bombay, to which we have already re-
ferred.

The results thus obtained may be summarized in the follow-
ing tables:

TABLE XV

Summary of average food expenditure of Industrial
Workers

(b} Textile workers in Sholapur (based on 623 family budgets)

Income Groups

Number

f.

Families

Families:
Percen-
tage
of Total

Average
Monthly
Expenditure
on Food
per Family

Average
Number
of Equi-
valent
Adult
Males

Expenditure
on food
per Equi-
valent
Adult
Males

Below Rs. 30
Rs. 30-Rs. 40
Rs. 4O-Rs. 50

180
297
385

20-88

34-45
44-67

Rs. as. p.

12 9 5
16 o 3
19 6 5

2-64
2-72
2-94

Rs. as. p.
3 14 8

5 14 3
4 6 i

(a) Textile workers in Bombay (based on 862 family budgets)

Rs. as. p.

JRs. as. p.

Below Rs. 30

207

29-7

*3 5 *

2-92

4 13 6

Rs. 3o-Rs. 40

231

33-i

16 14 8

3-64

477

Rs. 4o-Rs. 50

185

46.5

20 4 4

3-99

573

(c) Textile workers in Ahmcdabad (based on 548 family
budgets)

Rs. as. p.

Rs. as. p.

Below Rs. 30

146

25-8

14 14 o

2.71

432

Rs. 30-Rs. 40

182

32-2

18 13 o

2-9

679

Rs. 40-Rs. 50

220

39-o

22 10 6

3-25

633

(d) Textile workers in Madras (based on 73 family budgets)

Rs. as. p.

Rs. as. p.

Below Rs. 30

26

32-9

16 i 7

3-89

422

Rs. 30-Rs. 40

24

30-4

10 19 ii

4-93

3 15 I*

Rs. 40-Rs. 50

23

29-1

25 4 7

6-05

4 2 10

221

DIETS OF THE PEOPLES OF INDIA

In scrutinizing these budget estimates, it should be remem-
bered that they cover only a portion of Indian labour, for the
lowest wage-earning groups are omitted; nor do they include
the unskilled labour usually recruited through the labour con-
tractors. The estimates themselves may be regarded as being
inadequate for the purpose of drawing any definite conclusions.
And yet they are sufficiently indicative of the state of nutrition
of our working class. Indeed, it is impossible to avoid the
general impression that over 60 per cent of them are underfed
and that the percentage would show a great increase if all
classes of labour were taken into consideration.

The family budget enquiries do not give us any information
about the quality of the working-class diets. That their nature
differs with region, religious observance, caste, and income is
obvious; but on the whole, the diets which can be procured
within the limit of the average expenditure on food per work-
ing class family resemble each other in composition and show
similar deficiencies. They are low in proteins especially of high
biological value and absurdly deficient in fat. The intake of
milk and milk-products, and of adequate quantities of proper
vegetables, is far below any dietary standard which may be
regarded as balanced. The symptoms of physical ailments in
consequence of an inadequate supply of vitamins A and D and
calcium are markedly present among the bulk of the Indian
working class.

In a memorandum submitted by medical authorities to the
Royal Commission on Indian Labour, it was pointed out that
the usual diet available to the bulk of industrial labour was not
balanced and altogether inadequate in energy value. It is',
states the memorandum, e too bulky; it contains a very small
amount of milk, butter, and animal fats and consequently does
not give any appreciable power of endurance and resistance.
Up to 25 per cent of the food calorics should be from fat in a
perfect diet. In the case of the working classes in Bombay city,
however, 91-6 per cent of the calories are derived from cereals
and pulse. Besides this, the diet does not provide enough vita-
mins or accessory food factors. 5 Even rice, which is, as we have
seen, poor in proteins, is so prepared for consumption that its
nutritive value is greatly impaired. The grain allowance given
in some mills and factories as compensation for low wages does

222

THE DIET OF THE INDUSTRIAL WORKER

not in any way improve the quality of the labourer's diet.

Dr. Margaret Balfour's investigation 73 into the diet of women
workers in Bombay shows that they do not receive on an aver-
age more than 2,121 calories, and of the essential nutrient con-
stituents in their usual diet, there is a marked deficiency in fat.
In order to understand the actual state of nutrition of these
women industrial workers, it must be remembered that the
burden of household duties in the midst of a most depressing
environment falls on them, and that their standard of dietary
should be as high as that required for hard work.

The inevitable consequences of living on an inadequate and
ill-balanced diet are reflected in the physique of the workers as
well as in their efficiency. Here is a table composed from the
memorandum of the Government of the Central Provinces to
the Royal Commission on Labour.

TABLE XVI

Showing Comparative Body-weight of Spinner
in Mills and Prisoner in Jails

Provinces

Average
Weight of
Spinner

Average
Weight of
Prisoner

Difference

Bombay
Central Provinces
Burma
United Provinces
Bengal
Eastern Bengal & Assam
Punjab
Madras

102-9
100-92
117-14
107-01

I0 7-93
108-00
113-08
113-64

112-12

110-45
125-70
115-08
115-05
110-85
115.05
114-38

10-3

9-53
8.56
8-07
7-12
2-84
i-97
o-75

It is a matter of common sense that in order to attain any
high standard of efficiency in industrial production, the health
and well-being of workers must be the primary factor. In India
a male weaver tends on an average less than two looms as
against 5-5 by a woman in Japan. A cursory examination of
our entire productive system whether agricultural or indus-
trial, would show that it is both inefficient and insufficient, and
it can never stand the strain of the demands put upon it by any
increase of population and by the economic exigencies of the

223

DIETS OF THE PEOPLES OF INDIA
modern world of commerce. One of the fundamental weaknesses
of the system is inefficient labour, and this will continue unless
immediate steps are taken to eliminate from that system such
factors as are steadily undermining the physique of our working
class.

One characteristic feature of the Indian worker is that he is
still an immigrant from the countryside driven to seek employ-
ment in the industrial centres. The census figures from twelve
cities and towns show that over 48 per cent of their inhabitants
are born in rural districts. The transformation of a nation from
an agri-industrial to a manufacturing community, as it has
taken place in Great Britain, exercises a grave influence on the
physique of the race. The process not only disturbs the balance
between agricultural economy and handicrafts but fundamen-
tally affects the health and nutrition of all communities. The
population in the centres of urban life could not subsist without
imported and processed foodstuffs; on the other hand rural
areas could not retain for the growers themselves what was
needed for a healthy subsistence.

Drawing upon the experience of the West, our task in India
must be to maintain as far as possible the equilibrium between
agriculture and industry, between urban and rural life. Econo-
mic necessity has brought India on to the road of industrializa-
tion, but she must guard against the risks of the disintegration
which it eventually brings about in social, economic, and
physical life. On account of certain socio-religious customs, the
institution of factory feeding, as it is adopted in some of the
Western countries, may not be a practical proposition in India.
We should therefore explore other possibilities by which the
workers* dietary requirements may be satisfied. While it should
be obvious from our study of the family budgets that the wages
of the workers are totally inadequate for even bare subsistence,
we can imagine what must be the state of nutrition of those
drawing wages far less than those of the first group in these
budgets.

'All enquiries go to show', observes the delegation of the
British Trade Union Congress to India in 1928, that the vast
majority of workers in India do not receive more than about
is. per day. In the province of Bengal, which includes the large
mass of industrial workers, investigators declared that as far as

224

THE DIET OF THE INDUSTRIAL WORKER

they could ascertain, 60 per cent of workers were in receipt of
wages of not more than is. per day in the highest instance,
scaling down as low as yd. to gd. for men and 3d. to yd. in the
case of women and children. Upon these miserable pittances
the workers are expected to keep body and soul together and
labour throughout the whole working day (often in a vitiated
atmosphere and under most irksome conditions) which on the
average cannot be less than one often hours. 3

In Cawnpore, nearly 70 per cent of the wage-earners have
an income below Rs. 30, and the dock labourers do not
average more than Rs. 20, per month. As for the mining
industry, the conditions of employment, the irregular atten-
dance and the character of the labour employed are such that
no reliable estimate of income and expenditure on food can be
easily calculated; but the average daily earnings of workers (in
English equivalents) in seven coalfields in British India during
1918-31 were: overmen and sirdahs, 2s. id.; miners, is. 4|d.;*
loaders, is. ijd.; skilled labourers, is. 4d.; unskilled, iod.;
females, 8d. (Many women earn only 4^d. per day.) Referring
to the income of the labouring class in the Central Provinces
and Berar, Colonel Wilson observed: their wages are so low
that they can hardly afford two square meals a day, even by
spending on them the whole of what they earn daily'.

That the low rate of wages seriously affects the health and
nutrition of dependent children is obvious. On discovering that
the third non-working child of a labourer in a tea-garden in
Assam did not survive, its proprietors decided to pay 30 per
cent extra wages to a coolie who had three non-working chil-
dren. This enhancement had the effect of reducing the death-
rate of children in that plantation.

Under the existing economic system, the most practical
method of ensuring adequate and proper nutrition to the
working class is to establish a legal minimum wage. Such a
minimum wage should be calculated on the basis of a careful
estimate of the necessary requirements of a working-class
family. It should include adequate provision at least for the
following items: (i) Food; (2) Rent; (3) Fuel and Light; (4)
Clothing; and (5) Sundries. In estimating the allowance

* This amount appears to represent the joint earnings of a miner and his
carrier, who is sometimes his wife.

225

DIETS OF THE PEOPLES OF INDIA
necessary for food, the standard of dietary requirements issued
by the League of Nations or some other reputable authority,
should be used as a basis. It would then be necessary to trans-
late this standard into the terms of a practical dietary, taking
into consideration on the one hand the national, social, and
religious customs of the people, and on the other, the most
economical method of satisfying nutritional needs. The cost of
such a dietary could then be calculated and added to the cost
of the other necessaries to form the standard of the minimum
wage. Naturally the cost of all these items would differ con-
siderably in the different provinces of India; and for this reason
it would probably be better for the provinces to establish their
minimum wage scales independently.

In suggesting a system of minimum wages for England, Mr.
Seebohm Rowntree in his book, The Human Needs of Labour *
considers that the introduction of such a system should be
gradual and spread over a period of years. For the sudden
imposition upon industry of wage scales appreciably higher
than formerly would merely have the effect of raising prices.,
thus negativing the benefits of the minimum wage. But Mr.
Rowntree argues that if a minimum wage were set as a goal to
be achieved gradually over a period of, say, five years, industry
would be able so to adapt itself to the new conditions by effec-
ting economies of organization, that it could support the
added burden without transferring it to the consumer. This is
especially true of India, where the productivity of labour is
shockingly low compared with the advanced Western coun-
tries. A higher wage scale would involve, and indeed necessi-
tate, a marked rise in the productivity of labour.

That a system of minimum wages is both practicable and
efficacious is proved by the example of New South Wales
where such a system has long been in force. We have discussed
the experience of New South Wales in Chapter Seven; and a
careful study of that experience the standards on which the
minimum wage is based, the methods devised for allowing the
scale to rise and fall with variations in the prices, the actual
effect of the system on industry and on the conditions of work-
ing-class life would certainly provide much useful guidance
in introducing the system into India.

* B. Seebohm Rowntree, The Human Needs of Labour, 1937.
226

THE DIET OF THE INDUSTRIAL WORKER

Another important measure for insuring adequate and,
above all, wholesome nutrition to the Indian working class is
the control and supervision of the food vendors and eating
places in the industrial areas. As we have already shown, the
inferior and even adulterated food sold in these eating places
is one of the causes of the malnutrition of the workers. The
laws against adulterated and injurious foodstuffs should be
extended and perfected, and they should be rigorously en-
forced. A certain number of approved food vendors and res-
taurants should be licensed by the Government or the Local
Authority, and their wares should be kept under constant
supervision by a staff of expert inspectors. Unlicensed restau-
rants should be suppressed. In this way it would be possible
to keep a real control over the wholesomeness of the foods
usually sold to the working people.

The experience of Soviet Russia seems to show that the
establishment of communal restaurants in factories and work
places goes far toward ensuring a satisfactory diet to the people.
Such a system, however, is probably not practicable under the
present conditions of Indian industry, and might in any case
prove unpopular with the work people on social and religious
grounds. But there can be no doubt that the system has many
advantages, and while not recommending it for universal
application in the factories themselves, we would suggest that
it might profitably be introduced in a modified form by the
trade unions. Thus some of the larger trade unions could open
modernized and scientifically run restaurants for their own
members in the chief centres of industrial activity. Besides
providing meals in accordance with the requirements of
modern nutritional science, such restaurants could serve a
most useful purpose in propagating and popularizing know-
ledge of nutrition among the working class. We have no doubt
that, if the prices charged were such as the workers could
afford, the venture would meet with great success and would
spread rapidly. It would confer a real benefit on the nutrition
of the working class.

Finally, an intensive campaign of education and propaganda
in nutritional knowledge should be carried out in a systematic
way, particularly among the women workers. The instruction
given should be practical rather than theoretical, and should

227

DIETS OF THE PEOPLES OF INDIA

confine itself to what is possible in the way of diet in relation
to the extremely low wages of the working class. But as we have
had occasion to emphasize more than once in the course of
this book, education and knowledge by themselves are not
enough. The working class suffers from malnutrition not be-
cause it is ignorant but because it is poor; and it is established
beyond doubt that without the provision of an adequate living
wage, the greater part of the industrial and agricultural pro-
letariat cannot have the primary requisites of healthy living.
Doubtless ignorance makes worse a condition which would in
any case be bad enough; but the root cause is poverty. There
is every reason to believe that if working-class incomes were
adequate, the nutrition of the working class, while it might not
be ideal, would at least be adequate also. Thus education can
only serve a really useful purpose when the income level has
been raised at any rate to a minimum standard.

The Diet of the Peasantry and Plantation Labour

In a country where farming is largely on a subsistence basis,
one might assume that the tiller of the soil does not suffer from
undernourishment. But the truth is that, in most cases, both in
quantity and quality, his diet is below the standard of normal
requirements. It would be a mistake', observed McGay in
summing up his investigations, c to suppose that the average
dietaries of the mass of the population outside the jails is on a
par with the jail dietaries. 3 The diet E of the jail code in the
United Provinces consists of about 23 oz. wheat, 5 oz. gram
dhal, 6 oz. vegetables and condiments; as against the average
daily consumption per adult outside the prison estimated at
1 6 oz. cereals, 4 oz. dhal, and 4 oz. vegetables and condiments.

Very little statistical information is available regarding the
exact state of nutrition of our peasantry, and in view of the
wide variations in conditions of life from one region to another
it is difficult to convey an accurate idea on the basis of frag-
mentary data. Yet the inadequacy of nutrition among a large
percentage of the population engaged in food production is a
fact that at once strikes those who take the trouble to enquire
into the economic aspects of rural India. About five years ago
Sir John Megaw of the Indian Medical Service published the

228

THE DIET OF THE PEASANTRY

results of a survey of 'certain public health aspects of village
life in India'. It snowed that, taking India as a whole, only 39
per cent of the people might be regarded as being well nour-
ished.

Below our peasantry, there is still another even more helpless
working class whose diet is alarmingly inadequate and ill-
balanced. One of the inevitable consequences of present-day
agricultural economy in India is the growth of a landless pro-
letariat and in a great part of India this vast population is
reduced to conditions of life reminiscent of serfdom. In 1921
for every 1,000 cultivators there were only 291 farm labourers
but within the following ten years the number increased to
407. The average wage in rural areas even in the comparatively
prosperous province of the Punjab varies between yd. to is. 2d.
per day.

The morning meal of our agricultural labourer in the rice-
growing regions is a portion of cooked rice set aside and
allowed to soak in water overnight. It becomes slightly acidu-
lous and is eaten with curds, chillies, or dhal. In the wheat or
millet areas, the labourer's breakfast consists of stale chapati
with gur, or a few morsels of soaked gram. The subsequent meals
are mainly composed of cereals. The major part of the wages of
an agricultural labourer is spent on grains, the amount of which
is usually determined by custom and not by his needs or those
of his family.

Of the plantation labour, the workers in the Assam tea-
gardens may be taken as a representative group. They are
largely recruited from Bihar, the United Provinces, Central
Provinces, and Madras Presidency on a short-term contract.
The policy of maintaining a constant influx of new labour
forces is advantageous to the plantation owners because it
keeps the scale of wages down. The average monthly wage for
an adult male is Rs. 14 (2 is.), adult female Rs, 10-8 (about
155.), and children Rs. 7-4 (about ios.). They arc provided
with huts and in some cases an allotment of land.

Although most of the workers come from wheat- or millet-
growing areas, they have to live on rice in Assam. Their average
diet consists chiefly of low-grade highly milled rice and a small
quantity of vegetables and dhal; milk and milk-products are
rarely used but fruits are available in certain seasons. Various

p 229

DIETS OF THE PEOPLES OF INDIA

kinds of greens (sags) fried in mustard oil are popular. Quali-
tatively the diet is very deficient in fat, poor in all vitamins,
and its protein is almost entirely obtained from vegetable
sources. As regards quantity it is decidedly less than that pro-
vided in hospital or prison. Dr. Margaret Balfour's enquiry
into the diets of a certain number of families shows that each
adult receives about 15 ounces of food yielding approximately
1,460 calories. It is not surprising that anaemia and stomatitis
are so common among tea labourers of both sexes in Assam.

Discussion of Indian Dietaries

Before summing up the chief defects of the dietaries described
above, we should refer to a series of striking experiments con-
ducted by McCarrison at Coonoor. He sought to determine for
the first time the relative values of seven typical Indian dietaries
by feeding groups of albino rats on foodstuffs 'resembling as far
as possible those that are habitually consumed by the Sikh,
Pathan, Mahratta, Gurkha, Kanarese, Bengalee, and Madrassi
communities. Starting from the same age and weight, the rats
at the end of two months and a half yielded the following
results:

TABLE XVII
Experimental Data on Seven Typical Indian Dietaries

Diet

Mean Body-
weight

Body-weight
gain in Percentage

Sikh
Pathan
Mahratta
Gurkha
Kanarese
Bengalee
Madrassi

235
230

225
200

185
1 80

155

60
58

54
40

35
33
23

In the first place, most of these diets are strikingly deficient
in proteins, especially those of animal origin. It is argued that
the relatively low protein and high carbohydrate content of

230

.mza Hillnwr Diet
)Q\n cereal grains
lainly wheat), imlk,
getabie* and abcm-
int fruits- apr!cota,dc,
cat occasionally.

Average representative*, showing wdghl in cjrare> of 7 groups of rate
fed from the same early age on certain national diets ot India.The
best of thcsi? die-tA (6ikh)W composed of whole wheat, butter, milk
tajuwes, vegetables with meat occasionally. The worst tflengahs and
one composed mainly of rice.

at coas.t cultivator: Diet:
ce with dhal and vegetables
>d a Amall aroount offish,
Uk, and butter. Protein from
D to 70 grams dally : c&loriw

Tibetan Hillman = i-cpre&entaUvc
of d&ndy carriers, ricbhAW-inen
etc- Very hard worked. Average
protein intakz 175 grams dail
ot which over 607. is derived
from anip?l source*. The ha
value of their dirt may be as
much as 6,000 calorie* dsvilij
<= V

Percentage increase in body-weight of 7 groups*
of young rats,of the same imtwJl aggregate weight
ted on crUtn national diets of India. (vide
photograph za>ovc-).

Ncpalese. HUlman(Goorkha).prot
120 to 130 gram5,of which lc
than one; third b derived frop
animal >ourcb.CAlori. 3,000
to 3,200. 5uch people eat lanjd
the belter tl cereals- whcad
i^aizc and good njill

tengali - JDitft; rice , dhzvl,
ixble&,oU with a little fish
j>d perhjvp.<s o,liltlc milk.

Pathan

Typical ol- ritt-i\iipfl
Madra.",i . Diet contains
little, or no animal protei
Calories low.O^Cfty)

K. Note line physique of races (Mahratia, Sikh, Pathan) whose diets are v
Diistituted, and poor physique of those (Bengali, Madrassi) whose diets ;
1-constituted". Note similar eilect in rats led on these diets. From left to rii
ic rats represent Sikh, Pathan, Mahratta, Goorkha, Kanarese, Bcng

Madrassi.

DISCUSSION OF INDIAN DIETARIES

most of the typical Indian dietaries may be regarded as a form
of dietetic adjustment to physiological needs. The average food
intake of almost all the communities, however, even if it sup-
plies the calorie requirements, provides no margin to serve as
'reserve energy'. Among the bulk of the rice-eating population
the supply of protein has reached almost its lowest limit. In the
wheat-growing tracts, the average daily protein intake, though
below the standards of minimum requirements, is relatively
large. Indeed the problem of an adequate supply of 'good'
proteins throughout India should be investigated in all its
aspects if the nutritional status of the masses is to be correctly
assessed and understood. According to McCay the capacity of
absorbing proteins varied among the different racial groups
that came under his observation in Bengal prisons. He found
a somewhat close connection between the physique of different
races and tribes and the levels* of protein metabolism attained
by them, and showed how in consequence of the low rate of
absorbability, a considerable part of the protein intake is
wasted. A few instances cited by McCay in elucidating his
thesis will be of interest. He observed that the absorption of
proteins from cooked rice is actually diminished when exces-
sive quantities are eaten. For example, 81gm. were absorbed
when 19 oz. of rice were eaten daily, but only 61 gm. when 30
oz. were consumed. The larger ration does not make up for the
poorness in proteins of the diet but rather the reverse, while the
excess of carbohydrates upsets the balance of the diet.

Certain vegetable sources of protein arc unsatisfactory. From
a diet of millet, dhal, and vegetables containing 1 6 gm. of protein
in all, only 9^ gm. were absorbed, whereas from a diet of
wheat containing 16 gm. of protein as much as 13 gm. were
absorbed. Thus, a diet containing atta indicated a better per-
centage of nitrogen than the usual Bengalee food.

Secondly, although our fat requirement is not as much as

* Nitrogen metabolized per kilo of body weight was estimated by McCay
as follows:

gram

Nepalese Bhutia 0-42

Tibetan 0-35

Sikkim Bhutia 0-25

Nepalese 0-18 to 0-25

Behari 0-14

Bengalee & Oriya o- 1 1

231

DIETS OF THE PEOPLES OF INDIA

that of those living in temperate regions, our diets are generally
poor in fats, most of which are of vegetable origin. The low
proportion of animal fats (e.g. butter, ghee) in the diet is, as
we have seen, one of the causative factors of deficiency diseases.

Thirdly, the diets are singularly poor in 'protective 3 food-
stuffs. The supply of green vegetables is inadequate, and milk
and fruits rarely enter into the dietary of the masses. It is esti-
mated* that the per capita daily consumption of milk through-
out India is not more than 7 ounces as against 35 ounces in the
United States of America. 'Protective 5 foods are relatively ex-
pensive and their use is closely correlated with family incomes
as is shown by the studies of family budgets in Great Britain
and elsewhere. In recommending well-balanced but cheap diets
to our undernourished people, one must not overlook the fact
that a dietary expressed merely in terms of total calories may
not supply adequate protective foods; calorific value is not by
itself a safe criterion of a balanced diet.

Fourthly, carbohydrates form the main constituent in our
monotonous diets. It is estimated that the average daily carbo-
hydrate intake in India exceeds 480 grams per person. The low
nutritive value of cereals usually consumed by the majority,
excess of starchy foodstuffs, and inadequacy of vitamins and
inorganic constituents are some of the disquieting features
which render our cereal diets extremely liable to serious de-
ficiencies. Sugar consumption in India is high because it
provides a considerable part of the daily energy requirements;
but this is an entirely devitaminized article of food and the
increasing habit of using it, we repeat, should be discouraged.

We have already dealt with the question of dietary stan-
dards. That because of variable conditions of life, racial habits,
physique, and climate in different parts of India, it is impos-
sible to suggest a standard of energy requirements applicable
throughout the country is obvious. However, in suggesting a
standard of dietary, we should bear in mind that it must not
only provide the bare nutritional requirements but must ensure
a margin of safety and a degree of resistance to disease.

Taking into consideration all these factors, Aykroyd puts the

minimum calorie requirements of an 'average' Indian at 2,600

calories per diem and suggests a scale applicable to the different

* See Appendix III.

232

DISCUSSION OF INDIAN DIETARIES

age and sex groups, which may be 'sufficiently accurate for
practical nutrition work in India'.

TABLE XVIII
Scale of Average Calorie Requirements

Age Group Calories Required

Adult male (over 14) 2,600

Adult female (over 14) 2,080

Child 12 and 13 years 2,080

Child 10 and n years 1,820

Child 8 and 9 years 1,560

Child 6 and 7 years i ? 30O

Child 4 and 5 years 1,040

Child 2 and 3 years 780

Child o and 2 years 520

If we take this figure of 2,600 as the basis of an adequate
adult diet, the question is, how to plan a diet yielding this
number of calories which is at the same time in other respects
'well-balanced' and which is yet within the means of the
average Indian worker or peasant. In the diagram in Appen-
dix VII Aykroyd shows first an ill-balanced diet which, he
says, is 'typical of diets consumed by millions in India'. Below
he shows how this diet could be improved by a decrease in the
quantity of rice and its substitution by a substantially increased
intake of milk, vegetables, greens, fruits and fats. 'The well-
balanced diet', he says, 'contains protective foods in reasonable
quantities, though actually it is far from being an optimum
diet according to modern standards.' When, however, we
enquire what is the difference in cost between these two diets
the answer is discouraging. Aykroyd writes: 'At current retail
prices in South India, the ill-balanced diet would cost about
three rupees and eight annas (five shillings) per month per
adult. The well-balanced diet would cost about five rupees
(seven shillings and sixpence). Considered in relation to the
level of wealth and wages in India, the difference is enormous.
If a coolie has to support himself, his wife, his father, and three
children on 16 rupees a month, the diet of the family will
inevitably be ill-balanced, and probably insufficient in quantity
as well. It will, in fact, be waste of time to attempt to persuade
him of the advantages of the well-balanced diet, which is
quite beyond his means. 5

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DIETS OF THE PEOPLES OF INDIA

These observations of Aykroyd fully confirm the main thesis
of this chapter, namely, that any substantial improvement in
Indian dietaries is out of the question if the income of the
working class and the peasantry remains at its present low
level. Minor improvements might, perhaps, be effected by the
substitution of, say, millet for a part of the rice, or by the use
of unmilled rice. But the only real solution for the problem of
malnutrition, which afflicts large sections of the Indian com-
munities and debilitates the population, is an appreciable
increase in the income of the workers and peasants. If poverty
is the root cause of malnutrition, only the removal of poverty
will provide a solution of the problem.

234

CHAPTER SEVEN

Nutritional Research and Practice in
Different Countries

The Responsibility of the State

In previous chapters an attempt has been made on the one
hand to present in outline the history of the development of
nutritional science, and on the other to show the precise effects
of malnutrition and general undernourishment. From this dis-
cussion two facts should have become obvious. First, that the
consequences of malnutrition arc extremely serious and are
sufficiently widespread to constitute a problem demanding
serious action in all countries which consider themselves civi-
lized. Secondly, that our present knowledge of the scientific
principles of nutrition, though still in many respects imperfect,
is sufficiently advanced to enable this problem to be met and
overcome as soon as public opinion has been aroused to the
point where governments are compelled to take it seriously in
hand.

The duty and responsibility of the State with regard to mal-
nutrition is not obscure. During the last hundred years the
realization of the function of the State as organizer of what may
in a wide sense be called the social services has been constantly
increasing. Since the middle of the nineteenth century one
sphere of social activity after another has been undertaken
either in whole or in part by the State. Education, conditions
in factories and mines, public health, came, in England and in
most European countries, under the control of the Government
before the end of the century. Old-age pensions, social insur-
ance, the maintenance of the unemployed were added just

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NUTRITIONAL RESEARCH AND PRACTICE

before or just after the War. Now, the insurance of adequate
nutrition to that class of the population which is economically
unable to procure it for itself quite obviously falls into the same
category. Nutrition is clearly recognized as a branch of public
health; and there is no stronger argument for supplying medi-
cines free to those who stand in need of them than for supplying
them with food. Indeed, if one had to choose between the two
it would be more rational to supply food than medicine since
the conclusion to which the science of nutrition points is that
a very large proportion of the diseases from which people suffer
is due directly or indirectly to malnutrition and undernourish-
ment; and prevention is better (and ultimately more economi-
cal) than cure.

If, as was formerly thought, malnutrition were an excep-
tional phenomenon with which only a minute percentage of
the population were afflicted, it might be argued that the State
need not concern itself with the problem, that it could safely
leave it to be dealt with by voluntary charitable organizations.
But this is not the case. It is not only in India that malnutrition
is in large sections of the community the rule rather than the
exception; the same is true also in England, though not to the
same extent nor in the same degree. The full gravity of the
situation in England, and therefore a fortiori in most other
European countries, was not generally realized until the ap-
pearance of Sir John Boyd Orr's study, Food, Health, and
Income. 74 ' This authoritative work is the result of a prolonged,
scientific investigation of the income of various sections of the
population in relation on the one hand to the price and on the
other to the nutritive value of the common foodstuffs consumed.
Orr divides the community into six income groups; the lowest
and the highest group each contain 10 per cent of the popula-
tion, while the four middle groups each contain 20 per cent.
The two lowest groups which together contain 30 per cent of
the population are shown to suffer both from malnutrition
and from sheer undernourishment, that is, from an inadequate
caloric intake, for the income of the individuals who compose
these groups is too small to purchase the requisite amount and
type of food. The lowest group suffers in addition from an
inadequate intake of protein and fat. In other words, i o per
cent of the people of England subsist on diets that are inade-

236

THE RESPONSIBILITY OF THE STATE

quate in every constituent, while 30 per cent subsist on diets
that are lacking in calories, vitamins, and minerals. The sur-
prisingly large percentage of the population which has an
inadequate calorie intake would seem to support Professor
Terroine's conclusion, referred to in Chapter Three, that the
major problem of malnutrition is to ensure a proper number
of calories in the diets of the people. The third group, while it
is adequate in energy value, protein, and fat, is below standard
in minerals and vitamins. Only in the three higher groups does
the diet become adequate in all its constituents. In the cold
light of number these results may thus be summarized: about
50 per cent of the people of Great Britain approximately
22,500,000 suffer in some degree from malnutrition; 30 per
cent 13,500,000 live on a diet that is deficient in energy
value, vitamins, and minerals; and 10 per cent on a diet that
in addition is deficient in proteins and fats.

These figures provide a better answer than any amount of
abstract argument to those who maintain that the problem of
malnutrition need not or ought not to be undertaken by the
State. Ill-nourishment is essentially an economic problem and
consequently its ultimate solution lies in increasing the spend-
ing power of the great mass of the community. If the situation
is as appalling as Sir John Orr depicts it in England where real
wages are higher than in any other European country, it must
be truly indescribable in some of the poorer countries on the
Continent. When once sufficiently aroused, public opinion
must force even the most reactionary governments to eradicate
a scourge so widespread in its manifestation and so devastating
in its effects.

And, indeed, already in many countries of Europe and
America a beginning has been made in this direction. Although
almost everywhere the methods adopted are inadequate to
meet the real gravity of the situation, yet the experience gained
in many fields may provide some sort of useful basis of organi-
zation for countries which have yet to make a beginning in
tackling this pressing problem. It is the purpose of this chapter
to discuss some of the methods in use in Western countries
which have proved to be successful as far as they go, in the
hope that they may be suggestive to those who are now respon-
sible for the welfare of the people of India.

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NUTRITIONAL RESEARCH AND PRACTICE
The discussion naturally falls into the following sections: a
description first of the organization, both international and
national, of nutritional research and propaganda; then of the
actual methods adopted in a few selected countries to deal with
malnutrition among various special sections of the population
mothers and infants, children of school age, and certain
classes of adults.

Organization of Nutritional Research

(a) International

In spite of the rapidly increasing interest in the problems of
nutrition during the years since the War, there was a rather
surprising slowness to co-ordinate the organization of nutri-
tional research on an international scale. In 1925 the Assembly
of the League of Nations requested the Health Organization
to investigate certain problems connected with the manufac-
ture of food products. This was the first sign of interest by the
League in nutritional research. The following years saw a
number of investigations of special problems in various coun-
tries organized by the Health Committee.

In 1928 the French Government asked the Health Com-
mittee definitely to place nutrition on its programme of work.
It was not until four years later, however, that a serious begin-
ning was made on the international organization of nutritional
research. By 1932 the disastrous effects of the economic crisis
on the physical condition of the working classes could no
longer be ignored, and co-ordinated international action be-
came imperative. In this year, accordingly, two Conferences
of Experts were convened. The first met at Rome in September
to consider the question of dietary standards and to draw up
a scale of family coefficients for international use in order that
the enquiries on the state of nutrition in various countries
might be made comparable. The second, meeting at Berlin in
December, considered the physical standards and the clinical
and physiological methods best calculated to detect states of
malnutrition.

In 1934 the Health Committee appointed Dr. E. Burnet and
Dr. W. R. Aykroyd to draw up their now famous Report on
Nutrition and Public Health 15 which, since its publication in

238

NUTRITIONAL RESEARCH

1935, has rapidly become one of the fundamental documents
in the development of nutritional science. Almost all subse-
quent work on this aspect of nutrition has been explicitly or
implicitly based on the conclusions arrived at in this Re-
port.

During the Sixteenth Session of the Assembly of the League
of Nations, in September 1935, delegates of twelve countries
suggested to the President that 'the question of the relationship
of nutrition to the health of the population which has become
a social and economic problem of widely accepted significance,
and is recognized as having an important bearing on world
agricultural problems, should be placed on the agenda of the
current session of the Assembly 5 .

The Burnet-Aykroyd Report was considered at length by the
Assembly, and a three-day debate on nutrition, led by Mr.
Stanley M. Bruce, the Australian delegate, and Lord De la
Warr, took place in the Second Committee. The Assembly
adopted the following resolution:

'The Assembly, having considered the subject of nutrition in
relation to public health and of the effects of improved nutri-
tion on the consumption of agricultural products, urges Gov-
ernments to examine the practical means of securing better
nutrition and requests the Council:

e (i) To invite the Health Organization of the League of
Nations to continue and extend its work on nutrition in rela-
tion to public health;

'(2) To instruct the technical organizations of the League
of Nations, in consultation with the International Labour
Office and the International Institute of Agriculture, to collect,
summarize, and publish information on the measures taken in
all countries for securing improved nutrition; and

'(3) To appoint a Committee, including agricultural, econo-
mic, and health experts, instructed to submit a general report
on the whole question, in its health and economic aspects, to
the next Assembly, after taking into consideration, inter alia,
the progress of the work carried out in accordance with para-
graphs (i) and (2) above. 3 *

* As a result of these recommendations, eighteen States Members have
now set up National Nutrition Committees, but the great majority of these
are European and North American. The Go-ordination Committee of the

239

NUTRITIONAL RESEARCH AND PRACTICE

To give effect to the first paragraph of the Assembly resolu-
tion, the Health Committee appointed a Technical Commis-
sion. The Commission considered the question of dietary
standards and published its findings in a Report on the
Physiological Bases of Nutrition, a work to which we have
often had occasion to refer in previous chapters of this book
and which has superseded the work of the Rome Conference
of Experts. This report forms Volume Two of the Report on the
Problem of Nutrition, presented to the League in 1936 as a result
of the resolution of the Assembly.

To give effect to the second paragraph of the same resolu-
tion, the Secretary-General, in November 1935, requested
Governments to forward to the Secretariat, in the form of a
general statement, any information which appeared to them
to have a direct bearing on the improvement of nutrition. This
material has been arranged and published as Volume Three
of the Report on the Problem of Nutrition under the title Nutrition
in Various Countries We have drawn greatly on this volume
for the information contained in the present chapter.

To give effect to the third paragraph of the Assembly
resolution, the Council set up the Mixed Committee on the
Problem of Nutrition, which held two sessions in February and
June 1936 under the chairmanship of Lord Astor. Members
of the Technical Commission of the Health Organization, and
representatives of the International Labour Office and of the
International Institute of Agriculture sit on the Mixed Com-
mittee, whose title emphasizes the diversity of the interests
bound up in the problem of nutrition. The Mixed Committee
has published its findings in an Interim Report which forms the
first volume of the Problem of Nutrition. 11 This volume discusses
the question of nutrition in relation to public health and makes
certain 'preliminary recommendations 5 . These recommenda-
tions are very varied, and urge upon the Assembly, inter alia,
the necessity of encouraging nutritional research both nation-
ally and internationally, and of co-ordinating the information
acquired; of considering steps to relieve the nutritional needs

League of Nations has recently drawn attention to the desirability of
forming similar committees in other parts of the world and to the close
connection between nutrition and the question of rehabilitation of rural
life.

240

NUTRITIONAL RESEARCH

of the poor, especially by the provision of milk in schools; of
decreasing food prices while at the same time safeguarding the
farmers; of improving the distribution and marketing of food-
stuffs; and finally of considering the desirability of modifying
the economic and commercial policies of certain states in order
to assist the reorganization of agricultural production.

The International Institute of Agriculture has prepared a
report on Statistics of Food Production, Consumption, and Prices
which is published as Volume Four of the Problem of Nutrition.

In August 1937 the Mixed Committee issued its final report,
a document of more than 300 pages, in which are summed up
the conclusions of the four volumes of the interim report
together with such additional research as has since been under-
taken. The recommendations referred to above from the in-
terim report are here reiterated and they constitute the testa-
ment of the League in regard to the problem of nutrition. This
valuable report is divided into three parts. The first gives a gen-
eral survey of the problem and indicates the role the science of
nutrition has played in effecting improvement in public health.
The second part is devoted to the influence of food on health
and contains a resume of the first volume of the interim report.
The third part deals with the economic and agricultural
aspects of the problem together with the evidence of mal-
nutrition in a number of countries, *which can be directly
traced to the effects of poverty,

Toverty and ignorance 5 y states the report, 79 'remain formid-
able obstacles to progress; the disparity between food prices
and incomes increases the difficulty experienced by the poorer
sections of the community in obtaining an adequate supply of
the proper foods. In countries of the most diverse economic
structure and general level of consumption appreciable sec-
tions of the population are, for one reason or another, failing
to secure the food which is essential to their health and effi-
ciency. Millions of people in all parts of the globe are either
suffering from Inadequate physical development or from disease
due to malnutrition, or are living in a state of subnormal health
which could be improved if they consumed more or different
food. That this situation can exist in a world in which agricul-
tural resources are so abundant and the arts of agriculture have
been so improved that supply frequently tends to outstrip

241

NUTRITIONAL RESEARCH AND PRACTICE

effective demand remains an outstanding challenge to con-
structive statesmanship and international co-operation.'

To those countries where agriculture is in a backward state
and the agricultural policy is not related to the problem of
nutrition, the expert opinion of the Committee should be of
special interest. It is argued that planned action towards better
nutrition should have a far-reaching effect upon national
agricultural systems, bringing about consequential changes in
the health and well-being of a vast population.

We now turn to another publication of international impor-
tance which laid special stress on the state of nutrition of
workers. While the health organization of the League had been
engaged in collecting data for the Reports mentioned above,
the International Labour Office had not been idle. At its
Conference in June 1935 it had discussed the question of
nutrition and had resolved to continue its investigations of the
problem, particularly in its social aspect, working in collabora-
tion with the organizations of the League, with a view to pre-
senting a report on the subject to the 1936 session of the
Conference. Accordingly a long Report 80 was submitted under
the title Workers* Nutrition and Social Policy. The Report
brings together a very large amount of important material on
the living conditions of the working class throughout Europe
in relation to nutrition. It finds that undernourishment and
malnutrition are widespread and are not the result merely of
the economic crisis but are present also in times of normal
business activity. 'Low income or lack of purchasing power',
the Report states, 'is thus the root cause of the inadequate
nutrition of large numbers of workers and their families.' The
Report as a whole is of the greatest interest because it confirms
on a wider scale, although on a less precise basis, many of the
general conclusions of Sir John Orr's Report, of which we have
already given an account.

This then in brief outline is the history of the investigations
of the problem of nutrition which have been undertaken on an
international scale. The Burnet-Aykroyd Report, the four
volumes of the report on the Problem of Nutrition and the report
of the International Labour Office are excellent examples of
what international co-operation and co-ordination can achieve
in the space of a few years. Together they contain an extra-

242

NUTRITIONAL RESEARCH

ordinary wealth of material and they must remain for many
years to come the starting-point of all further work on the
subject.

But while these investigations had been proceeding inter-
nationally, many of the nations had been going into the prob-
lem on their own account. Some of them had conducted
elaborate and valuable research on the subject from the
national point of view, and had set up organizations to deal
with the most pressing effects of malnutrition. To these national
efforts we must now turn.

(b) Great Britain

Since the War, interest in and research on the problems of
nutrition have been constantly increasing in England. The
Government department responsible for this work is the Minis-
try of Health, which, since its foundation in 1919, has always
insisted on c the vital importance of nutrition as a fundamental
factor in personal and public health'. The Ministry's activities
with regard to this subject fall into two categories: supervision
of the administration by local authorities of the legislation
designed to safeguard the purity and wholesomeness of the
food supply; and educational and propaganda work with a
view to disseminating knowledge of food values and the needs
of the human body. The Minister of Health is responsible for
bringing before Parliament such legislation as may be neces-
sary. He also has parliamentary responsibility for the work
done by the local authorities with regard to nutrition in
schools, although this work is actually organized and super-
vised by the Board of Education.

Besides its annual reports, which contain both scientific
and popular information on nutrition, the Ministry publishes
special reports from time to time the object of which is
to supply useful information to health officers, physicians,
teachers, and others who have opportunities for spreading
scientific knowledge among the people. Finally, in conjunction
with other scientific organizations and with local authorities,
the Ministry carries out both theoretical research and practical
investigations of various aspects of the problems of nutrition.
Thus, for example, in 1921 the Ministry in conjunction with
the Medical Research Council made arrangements for exhaus-

243

NUTRITIONAL RESEARCH AND PRACTICE

tive investigations by Dr. Corry Mann, extending over four
years, into the nutritive value of milk as compared with other
foodstuffs. In conjunction with local authorities, moreover, the
Ministry has carried out from time to time extensive investiga-
tions of family dietaries both from a quantitative and qualita-
tive point of view, the object of which is to ascertain the nature
of the diets consumed by people in different parts of the coun-
try.

The Medical Research Council gives extensive financial
support, from funds provided by the Government, to work on
nutritional research. With its aid research has been carried out
on such subjects as the function of the various dietary con-
stituents in maintaining health, the pathology of deficiency
diseases, the nature and distribution of the vitamins and their
standardization, the analysis of common foodstuffs, and many
other related problems.

Another important organization for research in this field is
the Advisory Committee on Nutrition which was appointed in
1931 c to advise the Minister of Health on the practical applica-
tion of modern advances in the knowledge of nutrition 3 . In
1935 it was reconstituted and enlarged for the purpose of
enquiring 'into the facts, quantitative and qualitative, in rela-
tion to the diet of the people', and of reporting c as to any
changes therein which appear desirable in the light of modern
advances in the knowledge of nutrition'. The Committee is
composed of distinguished scientific authorities, physiologists,
statisticians, and economists.

Under the Milk Act 1934, there was set up a Milk Nutrition
Committee which is now conducting an extensive investigation
into the effect of feeding milk to schoolchildren. A total of
about 8,000 children in various areas is divided into four
groups; a control group; a second group which receives one-
third of a pint of pasteurized milk once daily; a third group
which receives one-third of a pint of pasteurized milk twice
daily; and a fourth group which receives one-third of a pint of
raw milk twice daily. The children are medically examined
before the supplementary feeding and at intervals of three
months over a period of at least a year. When this experiment
is completed we shall be in possession of precise information as
to the effects not only of the amount of milk but also of the type

244

NUTRITIONAL RESEARCH

of milk pasteurized or raw on the health and growth of
children.

We have already had occasion to mention in this chapter the
extensive investigations summarized in Sir John Orr's report
on Food 9 Health, and Income. This research was done under the
auspices of the Market Supply Commission in conjunction
with the Rowett Research Institute, and is an example of the
admirable work on nutrition which is being undertaken by
organizations which are not directly concerned with dietary
problems. As we saw above the result of this enquiry was to
demonstrate that the problem of malnutrition in England was
far more serious and widespread than had formerly been
supposed.

In addition to these official or semi-official institutions
directly financed by the State, there are in England a number
of organizations run wholly or partly by private initiative
which study various aspects of the problem of nutrition. Much
work on this subject is done, for example, in the universities,
especially at Cambridge where there is an important depart-
ment for the study of nutrition. Perhaps the most famous
organization of this kind is the Rowett Research Institute
attached to the University of Aberdeen to which we have
already referred. Although primarily an institute for research
into animal nutrition the Institute possesses extensive experi-
mental farms important surveys and investigations of human
nutrition are also carried out under its direction, as the
pioneer enquiry of Sir John Orr testifies. For example, a large-
scale survey of the dietaries of certain sections of the popula-
tion of Scotland was undertaken to determine the extent to
which various minerals iron, phosphorus, and lime were
lacking in the usual diets, and what were the effects of this
deficiency. Again, the famous investigation of the diets of the
two African tribes, the Kikuyu and the Masai, to which we
have referred in Chapter Two, was undertaken under the
direction of the Rowett Institute. In addition to investigations
of this kind, the Institute edits a quarterly journal, The Nutritioji
Abstracts and Reviews, which contains summaries of all impor-
tant articles on the different aspects of nutrition that appear in
the scientific and medical journals of the world.

It seems doubtful whether any other Western country has

fc 2 45

NUTRITIONAL RESEARCH AND PRACTICE

undertaken the task of nutritional research so extensively as
Great Britain. We have therefore selected Japan, the most
highly developed country of the East, as affording another
example of efficient and well-planned research on nutri-
tion.

(c) Japan

Japan has the distinction of possessing one of the oldest
organized institutions for nutritional research in the world. As
far back as 1902 the Ministry for Home Affairs established the
Research Institute of Nutrition. It was a small organization,
consisting of only six experts and nine technical assistants, and
its work has been overshadowed by the later and more exten-
sive organization for nutritional research.

The Imperial State Institute for the Study of Nutrition was
founded at the end of 1920. The threefold aim of its investiga-
tions is thus summarized by Dr. Saiki, its director: (i) To
determine what natural products can satisfy food require-
ments, and then select those the consumption of which would
be most advantageous from a purely physiological point of
view; (2) to select from the latter group the substances which
best meet the requirements of national economy; and (3)
proceed, in this last group, by selection based on social con-
siderations, to draw up a "food code" which, though it may
not be perfect, will, under existing social conditions, be the
nearest approach to perfection we can attain. 5

The large and highly skilled staff of experts of the Institute is
conducting detailed research into a variety of problems. An
important series of investigations have been made on the
physiological bases of nutrition with special reference to Japan-
ese men and women. Interesting studies have been carried out
on basal metabolism, not merely of normal or average people,
but also of people in different specified professions and trades,
especially labourers of various sorts. Methods of measuring
energy exchange and body surface area have been improved
and applied to the Japanese.

Among the studies of individual foodstuffs, those on rice are
of particular importance. In order to determine the digesti-
bility and biological utilization of rice of different grades of
polishing and cooked by different methods, an elaborate and

246

NUTRITIONAL RESEARCH

well-controlled series of experiments was carried out not on
animals but on people. The general conclusion of these experi-
ments is that: c The digestibility and utilization of rice are always
better when the grades of polishing are higher. The ration of
actual energy derived from the rice to the total energy value of
the rice eaten varies directly with the digestibility. 5 Moreover,
the satiety value of unpolished rice appears to be high, with
the result that there is a tendency to consume less of other
foodstuffs when the staple article of diet is unpolished rice.
Thus the caloric value of such a diet is definitely insufficient
for the requirements of the body. This conclusion is disturbing
in view of the fact, which we have several times had occasion
to emphasize, that polished rice contains no vitamin Bi while
unpolished rice is rich in this substance. If the researches of the
Japanese Institute on this subject are borne out by further
investigation, the problem of overcoming beri-beri among
populations whose staple diet is rice cannot be so easily solved
as by the simple substitution of unpolished for polished rice. It
would seem necessary to introduce into the diet some other
substance, say unmilled wheat, which is rich in vitamin B.

The Institute has undertaken some interesting and highly
important experiments on vitamins, especially vitamin A. As
we have shown in the course of our discussion on the effects of
vitamin deficiency, the best known and most pronounced result
of lack of vitamin A is keratomalacia. Dr. Fujimaki of the
Japanese Institute, however, seems to have established a rela-
tion between vitamin A deficiency and urinary and bile-duct
calculi (stones) and also gastric carcinoma (tumours or cancer
of the stomach) . If further work along these lines supports the
conclusions of Dr. Fujimaki, it is clear that a very important
advance will have been made both in our knowledge of the
aetiology of these diseases and in their treatment.

From these few examples it will be seen what admirable
work is being carried out by the Japanese Institute of Nutrition.
With the possible exception of the similar Institute in Soviet
Russia, the Japanese Institute appears to be the most extensive
and the best organized and equipped which exists.

So far we have drawn examples of nutritional research and
organization from two countries, one in the western and the
other in the eastern hemisphere, where the political and

247

NUTRITIONAL RESEARCH AND PRACTICE

economic structure is based on the capitalist system. Here the
doctrine of laisser faire modified under the exigencies of cir-
cumstances, governs the general order of the state and society.
It will now be interesting to consider some of the activities of
similar institutes of research functioning under circumstances
altogether different in the Soviet Union. Here we find a new
form of State and a sphere of economics where laisser faire is
totally replaced by planned economy; and here the demand
for social reconstruction comes not from a governing class but
from the voice of organized labour.

[d] The Soviet Union

In nutrition as in so many other fields the U.S.S.R. provides
a number of important and instructive examples. The Soviet
Union, unlike all other countries, considers food supply a
public service. c The state does not merely inspect foodstuffs
from a health point of view and punish fraud (as in all other
civilized countries); in conformity with the doctrine of the
Communist Party, it aims at organizing the nutrition of the
people in accordance with the laws of physiology and the
norms of hygiene. The nutrition of each individual should be
determined, not by his income, but by his needs.'

Nutritional research is carried out by the National Institute
of Nutrition, which has its head office at Moscow. Subsidiary
institutes have been established in Leningrad, Kharkov, Kiev,
Rostov, Novosibirsk, and Tiflis. The Institute of Nutrition is
not an administrative organ, but an institution for scientific
research and a technical adviser to the Government. Unlike
many other States, however, the Soviet Government appears
to be most willing to accept and put into practice the advice
tendered by the scientific authorities of the Institute.

The Institute is divided into six sections. The physiological
and bio-chemical section lays down norms or standards. The
food hygiene section investigates problems connected with the
sanitary conditions of food preparation and, in particular,
with the technique of cooking and serving food. The work of
the department concerned with the development of the tech-
nique of treating food materials is of particular importance in
connection with collective or social feeding, which will be dis-
cussed below. The department of dietetics and therapeutic

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NUTRITIONAL RESEARCH

nutrition investigates the function of nutrition as a branch both
of preventive and of curative medicine. Another department
is engaged in the general education and training of a technical
staff. A fifth section deals with the nutrition of mothers and
infants. Finally, there is an economy section which issues plans
and statistics.

The institute is engaged on a varied and extensive pro-
gramme of research. Of particular interest is its work on vita-
mins and the preparation of vitamin concentrates. The most
acute of the deficiency problems of the U.S.S.R. is scurvy, pro-
duced as we have seen by lack of vitamin C. Scurvy is particu-
larly common in the northern regions of Russia and Siberia.
With the increasing concentration of population in these
regions, the problem of overcoming the lack of vitamin C
bearing foods has become pressing. The Institute of Nutrition
has for some time been experimenting with various prepara-
tions of vitamin G in a concentrated form. For centuries the
hunters of the arctic and sub-arctic regions have known that
an infusion of pine needles would prevent scurvy. Such an
infusion, however, is excessively bitter and must be taken in
large quantities. The research workers of the Institute dis-
covered a method of preparing a highly concentrated extract
of vitamin G from pine needles, which could be inserted in
small quantities into chocolate-creams and other sweet sub-
stances without imparting a disagreeable taste. Extracts of this
vitamin have also been prepared from reeds, turnips, black
currants, cedar needles, rose hips, and several other things;
rose hips, as it appears, being the richest source of vitamin G.
As a result of these discoveries by the Institute, factories have
already been established to manufacture this extract, 10,000
man-doses being turned out daily by a small factory in Lenin-
grad. Much larger factories are in process of erection. It is
believed that by the extensive use of this extract, scurvy may
be stamped out even in those regions which cannot produce
sufficient quantities of fresh vegetables containing vitamin C.

Another branch of research undertaken by the Institute is
the investigation of the varying food requirements of workers
in different occupations. The general dietary standards -for
proteins, carbohydrates, fats, etc. set up by the Institute are,
as we have already noted, considerably higher than those

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NUTRITIONAL RESEARCH AND PRACTICE
recommended by nutritional experts in the West. 'The stan-
dards adopted', say Burnet and Aykroyd, 'are about 15 per
cent higher than the standards allowed in western Europe or
in the United States of America.' And this is confirmed by
Clark and Brinton. 81 These standards, however, both those pro-
posed by Western and by Soviet authorities, are in their very
nature only approximate, since they take no account of differ-
ences of occupation, climate, and so forth. The trend of
nutritional research in the U.S.S.R. is away from such rough
averages in which important individual differences are sub-
merged, and toward a precise investigation of the variations
in dietary requirements, first among different occupational
and climatic groups, and finally even in individual cases.
Extensive research has been undertaken in both these fields,
for a parallel to which one looks in vain in any other country.
The occupations examined 5 , according to Clark and Brinton,
'include those of carpenters, brick-carriers, masons, plasterers,
engine-drivers, stokers, guards, carriage-couplers, loaders,
sorters, mechanics, blacksmiths, workers in rolling shops and
foundries, tractor-workers, machine-threshers. This is only a
part. In agriculture such processes as horse-ploughing, scythe-
mowing, machine-mowing, sheaf-binding, work on root crops,
have all been investigated. We append a table showing some
of the estimates of average daily energy expenditure in calories
for a normal day's labour (now at most seven hours in all
industries) ;

Engine-drivers 2 ,900-3 , i oo

Heavy work in chemical plants 3,800-4,100

Plasterers 3>90O

Foundry workers 4,000-4,500

Brick-carriers 5A

Scythe-mowers 7,200

The very great variations displayed in this table from 2,900
to 7,200 are of the greatest interest when compared with the
rough average standards of calorie intake proposed both by
Western and by Soviet authorities: we have seen that the stan-
dard generally accepted in the West is about 3,000 while that
proposed by the Soviet Institute is 3,644.

One further aspect of Soviet nutritional research must be
noted, namely the attention given to nutrition as a branch of

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NUTRITIONAL RESEARCH

curative and preventive medicine. Naturally, with the dis-
covery of the real aetiology of the various deficiency diseases,
and with the increasing realization that incorrect or inadequate
diet plays a large part in the predisposition to other diseases
not specifically due to any definite deficiency, the importance
of diet either as a cure or as a preventive has been widely
appreciated. But in no country has so much practical work been
carried out on this subject as in the U.S.S.R. Professor Pevsner
is the pioneer and inspirer of this work. Already in 1922 the
reports of his investigations began to be published. Gradually
his theories became widely accepted, and in 1930 a Clinic of
Therapeutic Dietetics was established at Moscow, well equipped
with a laboratory and 100 beds for patients. Other such clinics
have been established in some of the chief cities of the Union.
Of course the hospitals and rest homes have all accepted the
general principle of specific diets. Among the diseases studied
in relation to diet Clark and Brinton mention tuberculosis,
various forms of rheumatism and kidney complaint, heart
disease, colitis, gastritis, gastric ulcers. Nutritional therapeu-
tics is not at all confined, moreover, to clinics and special
hospitals. Professor Pevsner was chiefly interested in seeing
how far the appearance of these diseases in an acute form could
be prevented by a timely dietetic treatment. This was rendered
easier by the custom of collective feeding which we shall discuss
at some length below. Here we need only say that in a large
number of factory and other restaurants a variety of special
diets is served. Clark and Brinton mention plants which serve
as many as eleven different diets, and five or six appears
to be quite common. The number of workers receiving these
special meals is estimated by Burnet and Aykroyd at about
600,000, by Clark and Brinton at 590,000. From an analysis
of health statistics in factories Clark and Brinton conclude that
this work has achieved considerable results, though it appears
to be too early to estimate precisely the extent of its impor-
tance.

Nothing testifies more clearly to the newness of the science
of nutrition than the extremely rudimentary organization of
nutritional research supported and directed by the State,
whether in Europe or America. With the exception of England,

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NUTRITIONAL RESEARCH AND PRACTICE

Japan, and the Soviet Union, there is scarcely a country where
the State has established any adequate institution for research
into the problems of nutrition. That the need for such an
institution is widely felt, however, is made clear in Volume
Three of the Report on The Problems of Nutrition in which
country after country, admitting the present lack of proper
research organizations, gives detailed plans of what it intends
to do in this direction in the future.

Several governments have of late years appointed Com-
mittees for Nutritional Research which are generally connected
either with the Ministry of Health, the Ministry of Agriculture,
or the Ministry of the Interior, and sometimes with all three.
But such committees are still too rudimentary and too recent
for the importance and usefulness of their work to be properly
judged. That they are being appointed, however, is clearly a
good thing, and it is to be expected that if they are given
adequate financial support and are free from interference they
will do much toward elucidating the nutritional problems
which confront the various countries.

Nutrition of Mothers and Infants

As we have shown in previous chapters of this book, the
period of life during which adequate and scientific nutrition is
particularly vital is the period immediately preceding and
immediately after birth. It is at this time that the individual is
being formed. Defective diet at this early stage will almost
certainly leave lasting effects which any amount of corrective
feeding at a later date will be powerless to overcome com-
pletely. Perhaps the commonest effect of inadequate diet at
this early period is rickets, the cause of which, as we have seen,
is lack of vitamin D; and an early deficiency of this vitamin is
also largely responsible for defective and carious teeth. Both
rickets and dental caries can of course be checked and to some
extent corrected by adequate nutrition later on; but no amount
of care after the fact can overcome the irremediable effects of
these diseases.

Not only does defective diet in infancy lead to deficiency
diseases the effect of which endures throughout life, but also to
diseases which may prove immediately fatal or, if not so severe

252

NUTRITION OF MOTHERS AND INFANTS
as this, may at least weaken and undermine the infant's con-
stitution. Such diseases are of two sorts. They maybe deficiency
diseases proper, as for example scurvy, which is common
among the children of the poor in many parts of Europe and
America, or infantile beri-beri which ravages large areas in the
East, slaughtering the infant population, and is thought by
some authorities to be not unknown also in certain Western
countries. On the other hand, these diseases may not be
deficiency diseases properly so called but diseases fostered by
the lack of stamina and the lowered power of resistance, to
which malnutrition leads. We have already shown that tuber-
culosis is the most common as well as the deadliest of those
diseases which are indirectly caused or encouraged by defici-
ency in diet.

During this early period of an infant's life it is at first wholly
and then in large part dependent for its nourishment upon its
mother. Hence the supreme importance for pregnant and nur-
sing mothers of an adequate and scientific diet. And this is no
less essential for the mother herself, for only in this way can the
tremendous strain of pregnancy be successfully borne. Defi-
ciencies in the diet during this period lead to no less injurious
and fatal results in the case of the mother than in that of the
child. Various forms of anaemia, for example, are common
among pregnant women whose diet is deficient in iron. Again,
it is during pregnancy that the danger of osteomalacia is
especially acute; while, as is well known, pregnancy has a
particularly deleterious effect upon the general health which
can only be overcome by an adequate and correct diet.

The principle of the proper nutrition of mothers and infants,
then, has been clearly established and emphasized by the
science of nutrition. Its practical importance is now universally
realized. During the last ten years or so the governments "of
most of the European and American countries have officially
recognized the obligation of the State to ensure an adequate
protective diet to those mothers and children who, through
poverty, are in danger of suffering from malnutrition. The steps
taken by the various countries to give effect to this are many
and differ from country to country. We will give some typical
examples chosen from the chief countries of Europe and
America which illustrate the kind of method adopted.

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NUTRITIONAL RESEARCH AND PRACTICE

In Great Britain the importance of nutrition for mothers and
infants was first officially recognized in the 'Maternity and
Child Welfare Act' of 1918. This Act gave power to the county
and borough councils and the urban and rural district councils
to provide extra nourishment to expectant and nursing mothers
and to children under five years of age. In 1930 this power was
greatly extended and the local authorities were permitted,' with
the sanction of the Minister of Health, to increase this form of
provision at their own discretion.

By the end of 1934 there were 422 maternity and child
welfare authorities in England and Wales, the vast majority
of which were supplying milk and often other foodstuffs to
expectant and nursing mothers and to infants. In most cases
also there are health visitors and instructors who give advice
on the feeding of infants; and at the maternity and child
welfare clinics instruction in problems of diet is given both
individually and collectively.

Since 1929 there has been a great expansion of attendances
at the maternity and child welfare clinics. Thus in 1934 the
attendances of children under five was over eight million; this
was an increase of nearly one million over the attendances in
1931. At the same time the attendances of women at the ante-
natal clinics increased from about two hundred thousand in
1931, to two hundred and fifty thousand in 1934. Toward the
end of 1934 the local authorities were again urged to supply
milk, either free or at less than cost price, in all cases where it
seemed to be necessary or advisable.

In France the responsibility of the State to guarantee ade-
quate nutrition to its citizens is only just beginning to be recog-
nized, and methods of carrying out this obligation are still, to
a large extent, in the state of being planned rather than actu-
ally put in practice. In certain districts of the country, how-
ever, milk dispensaries organized on a voluntary charity basis
have been established to provide milk to expectant and nursing
mothers and to infants. Even this is not, except in special
cases, given free, but merely at prices somewhat lower than the
commercial price. Instruction in nutrition is, however, provided.

The recent institution of social insurance by the State has
had the effect of curtailing these voluntary milk dispensaries,
because the industrialists who finance them plead, charac-

254

NUTRITION OF MOTHERS AND INFANTS

teristically enough, that since they contribute, at least osten-
sibly, to the social insurance, they cannot 6 afford 5 to contribute
to other undertakings.

In the United States the problem of ensuring adequate nutri-
tion to mothers and infants is dealt with by the Federal
Children's Bureau which works in the individual States
through the child hygiene divisions and infant welfare agen-
cies. These together with certain other public or private relief
agencies, distribute milk and other foodstuffs to children and
nursing mothers. It is to be expected that these services will be
very much expanded under the new Social Security Act, which
provides for a considerable increase in Federal aid to State and
local public health agencies, and for the improvement and
strengthening of the Federal public health service itself.

In the Soviet Union the practice of social nutrition has not
yet fully caught up with and fulfilled the theory. The theory,
however, is both remarkable and excellent, and for this reason
the experience of the Soviet Union should be carefully studied,
since on examination it appears that it has set many examples
that might with advantage be followed by more advanced
countries.

In accordance with the communist principle that the nutri-
tion of the individual should be governed not by his income
but by his needs, the diet and general welfare of mothers and
infants has been made a special care of the State. Throughout
the country, food centres or milk kitchens have been estab-
lished where suitable milk and other essential foods can be
obtained. Especially important is the attention paid to pro-
tective foods. Not only are fish oils of various sorts provided,
but also preserved fruit juices, particularly necessary in the
northern regions of Russia where fresh fruit and vegetables are
often hard to obtain in winter, preparations of irradiated yeast,
and similar vitamin extracts or concentrates. The centres pro-
vide the milk and foodstuffs either at a reduced price or free
of charge. Thus, according to Clark and Brinton, in Lenin-
grad in 1935, 15 per cent of the children were receiving their
food free. In addition to supplying suitably prepared food at
reduced prices or free, the centres provide expert advice on the
nutritional needs of the infants and mothers after careful con-
sultation and examination.

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NUTRITIONAL RESEARCH AND PRACTICE

The truly remarkable thing about the Soviet organization of
infant and maternal nutrition, however, is not so much what
the centres actually provide for this, as we have seen, can be
paralleled in other countries, although it is doubtful if any
other country lays so much stress on protective foods as the
vast, and indeed almost universal, extent of the system. In the
towns of the U.S.S.R. at any rate 98 per cent of the infants are
regularly seen at the centres, and the remaining 2 per cent
probably represent merely change of residence. No other coun-
try can show a figure anywhere approaching this. It is clear
that when the general level of production of the Soviet Union
reaches that of the advanced Western countries, it will possess
a social service in this respect unrivalled and as near to perfec-
tion as can well be attained.

Nutrition of Children of School Age

The adequate nutrition of children of school age is scarcely
less important than that of infants and pregnant mothers. As
might be expected, the necessity of ensuring a correct and
sufficient diet to schoolchildren has been more widely recog-
nized and at an earlier period. This is natural enough, since
children who are at school come, in most of the advanced
countries, under the constant supervision of the government
authorities; their general state of health and development can
be frequently observed. Any defect or illness arising from mal-
nutrition is easy to discover, is indeed impossible to overlook.
Governmental authorities, who in general ignore the existence
of what is not forced on their attention, cannot in this case so
easily shirk their responsibilities.

The results of malnutrition among children of school age are
in many cases the same as among infants. Thus rickets may
develop not only in infancy but also in early childhood; the
same, naturally, is true of dental caries. The medical authori-
ties of Great Britain reported in 1 932 that 88 per cent of school-
children showed bone deformities (e.g. spinal curvature) and
that over two and a quarter million pupils needed dental treat-
ment. In general, moreover, children in schools arc more
exposed to contagious diseases than are infants. A state of
imperfect nutrition weakens resistance to these diseases and

256

NUTRITION OF CHILDREN OF SCHOOL AGE

encourages their rapid spread. Also, when the constitution is
debilitated by lack of proper nourishment, it is more severely
attacked and more easily succumbs.

Another and more general result of the imperfect nutrition
of children is the stunting of their growth and development.
An individual's maximum height, for example, is deter-
mined by heredity, but whether or not he attains this height
depends almost entirely on whether he has an adequate and
correct diet. Not merely is a child's height, however, adversely
affected by malnutrition, but also its development as a whole,
both physical and mental. Aykroyd, 82 partly quoting from a
report on the results of giving extra milk to schoolchildren,
picturesquely compares the appearance and behaviour of well-
nourished children with those of children who arc suffering
from lack of the proper diet: In practically every case, they
(the children who were being fed extra milk) showed that
sleekness peculiar to a well-fed animal; their hair was glossy
and bright, their nails smooth, resilient and polished. General
alertness was common to all, and they were also more difficult
to control. Their joie de vivre runs away with them. Under-
nourished children are apathetic, do what they arc told, and
are generally all that an adult can desire of children!'

To prevent these undesirable results of malnutrition among
schoolchildren, many countries have developed an elaborate
and well-planned system of school feeding by which those
children who need it are provided with extra nourishment
during school hours, either free of charge or at a very moderate
price. We shall discuss two such systems those obtaining in
England and in France to illustrate the various ways in which
the problem may be dealt with, and the types of organization
which experience has shown to be useful.

The extent and danger of malnutrition among children of
school age first began to be realized in Great Britain after the
passing of the Education Act 1870, which made school atten-
dance compulsory. Thirty-six years were to elapse before any
official action was taken to deal with the widespread malnutri-
tion and sheer under-nourishment which were found to exist
among the children attending school. But during this period
a good deal of experimental and preparatory work was being
done by voluntary organizations to provide extra food, and

257

NUTRITIONAL RESEARCH AND PRACTICE

sometimes whole meals, for those children who were most
obviously suffering from inadequate nourishment. The experi-
ence of the Boer War brought the problem of malnutrition
sharply to the foreground of public attention. It was found
during the recruiting for that war that three out of every five
men were physically unfit and had to be rejected. As a result
of- this unexpected situation various public enquiries were
carried out to ascertain the cause of the widespread physical
unfitness of the population. The most important of these
enquiries was that of the Interdepartmental Committee on
Physical Deterioration. The unanimous conclusion of all the
enquiries was that the deterioration of the population was
mainly due to malnutrition in childhood.

The result was the Education (Provision of Meals) Act of
1906. The Act provided that all undernourished children were
to be supplied with a school meal, sold at cost price, to those
who could afford to pay, and given free to those who could not.
The immediate effect of this Act was an enormous increase in
the number of meals served. From the 2~ million in 1907-8,
the figure jumped to 29^ million in 1914-15. During the War
the number of meals served fell off considerably; but since 1918
there has again been a great increase. Thus in 1929-30 the
figure was nearly 33 million and since that date it has steadily
risen to its present size of over 68 million. The figures of the
number of children fed are also interesting: from 156 thousand
in 1913-14 they rose, with certain fluctuations, to 265 thousand
in 1929-30 and 406 thousand in 1934-5.

The method of selecting the children to be given school
meals varies considerably in different parts of the country.
Sometimes the selection is solely by the application of an
income test, sometimes it is made by the educational authori-
ties' medical officers more or less regardless of income. The
Board of Education has emphasized the view that 'selection
by reference to an income test alone is not justifiable, and that
regard should be had to the special circumstances of the child.
The need of a child for feeding should not be considered only
upon an application from the parent; the authorities should
themselves take steps to ascertain what children are in need of
feeding, by inviting reports from . . . those in regular contact
with the children from day to day.'

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NUTRITION OF CHILDREN OF SCHOOL AGE

There is also a certain variation in the type of meal served.
The general practice is to provide a midday dinner; but some
authorities serve breakfasts, dinners, and teas. The meals are in
general supervised by the medical officers or other qualified
persons, with a view to nutritional requirements. For the most
part they are served in the school buildings or in adjacent
canteens, though the experiment has been tried of contracting
for the meals with a nearby restaurant, and even of sending the
food to the homes of the children.

The cost of the meals was in 1935 approximately 557,000
and about 406,000 children were receiving them. When it is
considered that there are in England and Wales nearly
8,000,000 children of school age, and that therefore little more
than 5 per cent of them are receiving meals; and when further
we remember that, according to Sir John Orr, about 50 per
cent of the population as a whole suffers in some degree from
malnutrition, it would seem doubtful whether the State were
in fact discharging the duty laid upon it in the Education
(Provision of Meals) Act of 1906, to provide that c no child
should be deprived of the full value of his education because
of lack of food'. In short, although the system of school feeding
in England is probably better and wider in scope than that
obtaining in any other capitalist country, it is obvious that
only the merest fringe of the problem has as yet been touched,
and that what is being done is totally inadequate to meet the
need that has been shown to exist.

During recent years the importance of milk as a protective
food has been increasingly realized and insisted upon by doc-
tors and dietary experts. When, therefore, the Government in
1934 yielded to the vested agricultural interests and set up the
Milk Marketing Board, a useful and attractive way of keeping
up the price of milk to the general public and yet disposing of
some of the farmers' 'surplus', was found in the Milk-in-Schools
Scheme. The Government placed 500,000 at the disposal of
the Milk Marketing Board which in turn was to supply milk to
schoolchildren at a halfpenny instead of a penny for one-third
of a pint. The response to this arrangement which was of
obvious benefit to every one,, for the Government pleased the
farmers, the farmers got their profits, the public paid more for
their milk and the parents of the recipients of the halfpenny

259

NUTRITIONAL RESEARCH AND PRACTICE

milk did not realize that they were paying the extra halfpenny
in increased taxation (on tea and beer!) was immediate. By
the end of 1935 nearly 3,000,000 school children were receiving
extra milk in school at the reduced rate; or, in the case of some
quarter of a million children, free of charge. There can be no
doubt of the extremely beneficial effect of this increased con-
sumption of milk, and it is to be hoped that it is not beyond the
ingenuity of man to devise some more rational method for
extending the scheme.

In France the system of school feeding is not a function of the
State but of the municipalities. For this reason there is inevit-
ably a certain lack of uniformity in the methods adopted; but
in spite of this, there are some characteristics of the French
experience which are worth noticing.

School feeding in France originated (rather earlier than in
England) on a voluntary basis. Volunteer caisses des ecoles or
school fund committees were founded in many of the towns
and cities. Among many other activities, these committees
undertook to provide meals for indigent school children. From
the first, the local municipal councils frequently made grants
to the caisses., and as time went on these grants became a larger
and larger proportion of the total funds, until to-day the volun-
tary contributions form a negligible part of the whole (less than
2 per cent) . Thus school feeding has gradually, almost imper-
ceptibly, ceased to be a voluntary activity of charitable organi-
zations and persons, and become a duty of local public
authorities.

The caisses des ecoles appoint canteen committees to supervise
the school feeding in the various districts. As in England, the
meal chiefly served is midday dinner, though occasionally soup
is given in the morning to children whose poverty and under-
nourishment is particularly obvious. In 1921 the number of
those receiving meals was about 187,000. Of these, approxi-
mately two-thirds had their meals free, the rest paying for the
cost of the food but not for the service or the equipment. Since
1921 the number receiving meals has, as in England, greatly
increased.

One of the most salutary characteristics of the French system
is the absence of c the charity atmosphere so prevalent in the
English schools'. Mr. J. C. Gebhart, the American investi-

260

NUTRITION OF CHILDREN OF SCHOOL AGE

gator, in stressing this fact, gives the following explanation:
'This is avoided by an ingenious system of tickets. On entering
the room each child passes through a booth where he secures
a ticket. Those who can, pay; those who cannot are admitted
free, but receive a ticket the same as those who pay. The home
conditions of the indigent child are then investigated, and if it
is found that the parents really cannot afford to pay, he is
given a ticket each day without further comment. In this way
the children are kept in ignorance of those who pay and those
who do not.'

In other respects the French system of school feeding does
not differ materially from the English. But it is important to
note that the English and French systems represent two types
of organization for dealing with malnutrition of children of
school age. In England there is a centralized State organiza-
tion under the Board of Education in conjunction with the
Ministry of Health. The Board lays down general principles
and supervises, controls, and inspects the work of the local
education authorities; while the financing of the system also is
very largely undertaken by the central government. The local
authorities are granted only so much autonomy as is consistent
with a fundamental uniformity of administration. In France,
on the other hand, the State as such, has no concern with the
system of school feeding. The whole responsibility, financial
and administrative, is left to the local authorities, which, urged
on by the early voluntary work in this field, have organized a
highly developed system of meals in schools. They bear also,
as we have seen, more than 98 per cent of the cost, the re-
mainder being made up by voluntary contributions.

One or other of these two systems has been adopted by all
the countries in which the problem of malnutrition among
school children is being dealt with by public authorities. It
would be merely repetitious to describe the working of the
system elsewhere, nor would it be worth while since in most
countries the organization of school feeding is in a far more
rudimentary condition than in England and France. It may,
however, be of interest to mention one further example of
school feeding which has been particularly effective.

According to the League of Nations' report on Nutrition in
Various Countries, 'the Riga municipality has arranged for hot

R 261

NUTRITIONAL RESEARCH AND PRACTICE

meals to be distributed to pupils in all elementary schools. In
1935, the total number of elementary school children in Riga
was 30,740, of whom 19,397 shared these common meals. Of
these 19,397 school children, 1 1,407 were fed free at the cost of
the municipality. The total number of rations distributed in
1935 was 3,315,014, of which 1,902,192 were given free. The
cost of a ration is about 15 centimes. The distribution of hot
meals costs the Riga municipality about 300,000 lats* a year.
The school board decides when meals are to be given free/
The case of Riga as thus described must be almost unique in
Europe. It will be observed that nearly two-thirds of all the
elementary schoolchildren in the city receive school meals, and
that considerably more than one-third receive them free. If
this is compared with England where, we have seen, only
about one-twentieth of the children receive meals, whether
free or at a low price, it will be seen how admirable the system
is. Doubtless the extreme poverty of the Latvian people makes
the problem of malnutrition even more pressing than it is in
England. Still, need, however great, does not always compel
governments to action, and the Riga municipality is to be
congratulated on its thoroughness.

In the Soviet Union., the organization of the nutrition of school
children, like that of mothers and infants, is chiefly remarkable
for its thoroughness and wide extent. The ultimate plan, to
which the actual organization is approximating as quickly as
the resources of the Soviet Union will allow, is that all children
of whatever age are to be provided with restaurant meals at
least twice, and later perhaps three times during the day,
whether in the school period or not. This ideal has not yet been
attained; but already in the cities at least, and particularly in
Leningrad, which appears to be in advance of other cities in
matters of nutrition, practically all the children receive at least
one hot meal daily in their school dining-rooms. 'The regula-
tions prescribe that they should have at all events a mid-
morning lunch and a hot midday meal, 5 say Clark and Brin-
ton; and they add: As far as we could sec, this is carried out.'
The younger children are already provided with three meals
daily; and there are special dining-rooms for delicate children.
About 20 per cent of the meals are given free, and the rest at
* .1=25-22 lats.
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NUTRITION OF ADULTS

an extremely low price. Clark and Brinton testify that the
kitchens and dining-rooms in the newer schools, at least, are
fully mechanized and tastefully decorated, tables for four or
six being provided. The diets served are practical but scientifi-
cally planned to meet the nutritional needs of the children.

It will be seen at a glance that the Soviet system of school
feeding by far surpasses anything known in the most advanced
countries of the West; and this although it is admitted by the
Soviet authorities that the system is still far from having
attained the high aim proposed for it. Clearly, there is much
to be learnt by a close study of this organization.

Nutrition of Adults

Undernourishment and malnutrition, as we have seen, are
phenomena not confined to special categories of the population
nor to backward or undeveloped countries. Surveys of the
leading industrial countries of the Western world have shown
conclusively that malnutrition is a scourge which affects large
classes of the population. It will be remembered that according
to Sir John Orr at least 50 per cent of the population of Eng-
land sufler to some extent from inadequate nutrition. The
physique of the adult population shows signs of deterioration.
It is estimated that workers insured under the National Health
Insurance lose on an average 28 days work per annum through
illness compared with 16-5 days some fifteen years ago. The
rejection of nearly 47 per cent of the recruits who recently
offered themselves for service was a revelation.

In spite of these facts, however, no government, except that
of the Soviet Union, has thought it worth while to take mea-
sures to ensure adequate nutrition to the bulk of the adult
population. Such measures as exist are cither confined to
special cases, limited to comparatively small categories of the
population, or designed only to meet a special emergency.
There are several reasons for this neglect. In the first place,
unlike malnutrition among schoolchildren and, to a lesser
extent, among infants and mothers, which is constantly being
forced on the notice of the authorities, malnutrition among the
working population is comparatively easy to ignore and even
to deny. Secondly it is clearly far more difficult to deal with

NUTRITIONAL RESEARCH AND PRACTICE
the problem on such a huge scale as is obviously required in the
case of the adult population; the expenditure involved is prob-
ably too great to be willingly undertaken by any of the
governments at present in power. Finally, it would seem very
doubtful whether the problem is in fact capable of solution
under the present organization of social economy. Under this
system the only permanent cure would be the elimination of
unemployment and a steady and very perceptible rise in the
wages of the working class. It does not appear likely that either
of these things will take place so long as the welfare of the com-
munity as a whole is sacrificed to individual interests under
laisser faire conditions in economic affairs. Meanwhile, the eco-
nomic depression and the chronic crisis in agriculture have
brought the problem to the fore, and it is worth while to notice
briefly some of the methods which have been adopted to deal
with the worst manifestations.

The Federal Government of the United States, for example,
attempted to deal with the agricultural and unemployment
crises at the same time. It bought large quantities of agricul-
tural products (meat, milk, butter, flour, fruit, etc.) from the
farmers who were finding it difficult to dispose of them at
reasonable prices, and distributed them, through the various
State relief agencies, to the unemployed. The same thing has
been done in Austria, and in some other countries. Clearly,
however, this is not a measure to improve the nutrition of the
adult population, but merely to prevent the actual starvation
of the unemployed. Another method adopted in the United
States of America, Austria, Italy, and other countries, is the
provision not of raw food but of actual meals to the unem-
ployed. Thus, in Italy, 'soup kitchens' have been set up in
various towns, which give one meal a day to persons c whose
circumstances entitle them to receive it. 5 These meals are
generally equivalent to 1,300 calories, or rather less than one-
half the amount of energy needed daily. The following statistics
show the extent of 'adult feeding' in the Fascist regime: 'In
i933> the Relief Organization . . . distributed 46,333,335 meals
through soup kitchens and, in other forms, supplied 72,2 18,536
food rations in kind and 4,813,981 litres of milk.' It is clear that
in Italy this work has been carried out on a fairly large scale.

Another, and more permanent, method of ensuring better

264

NUTRITION OF ADULTS

nutrition to the working class is by means of canteens in the
factories and work places where meals are served to the
employees at a moderate price, or in certain cases free of charge.
This is not, of course, a measure undertaken by the State,
but by the private initiative of factory owners. Some States,
however, appear to encourage the practice. In Italy, the fac-
tory canteens f enable the workers to obtain an ample and
well-prepared hot meal at a very low cost served during the
mid-day interval in appropriate and comfortable premises.
Workers are thus enabled to recover the calories necessary for
further productive work. These canteens are to be found in
almost all large and medium-sized undertakings, some of
which themselves issue hot soup at their own cost. Other
canteens, on the other hand, are almost entirely managed by
the local workers' union. Such, for example, is the case of the
canteens of the General Electricity Company at Milan or the
harbour workers at Genoa.' There is no evidence to show
whether or not this system has in fact done anything to raise
the standard of nutrition among the workers for whom it is
designed. In any event, its scope, even if it were universal in
the factories, would not be very wide, since the majority of the
Italian population are peasants.

Perhaps the most efficient method of dealing with the prob-
lem of adult nutrition, except that in the U.S.S.R., has been
worked out and applied by the Government of New South
Wales. As we have said above, the crux of the matter is clearly
the income of the working class: where this is adequate, the
standard of nutrition, while not perfect, will be likely to be
more or less satisfactory; where it is inadequate, malnutrition
in some form is practically certain to occur. In New South
Wales the Government has established a legal minimum wage,
and this wage is scientifically calculated in relation to the
estimated cost of the primary necessities of life food, shelter,
clothing, fuel, light, and miscellaneous requirements. The
dietary scale adopted appears to be worked out with great
care and is fairly generous, sufficient anyway to insure the
minimum requirements of an adequate diet at least. Clearly,
such a system will not work automatically. If for any reason,
the other primary requirements can be obtained only at a
higher price than that estimated for the basic wage, the wor-

265

NUTRITIONAL RESEARCH AND PRACTICE

ker's nutrition will suffer in consequence. This possibility is,
however, guarded against by fairly frequent revisions of the
minimum wage to correspond with changes in the cost of
living. The scales of relief paid to the unemployed are calcu-
lated in very much the same way, though they are somewhat
lower. The weak spot in this system is that the dietary scales
are drawn up by authorities who have a far wider knowledge
both of the elements of nutritional science and of the possi-
bilities of the market than is possessed by the average house-
wife. Almost certainly she will be unable to make her income
go as far as is estimated by the scales. Nevertheless, the New
South Wales system is probably the best that can be devised
in the circumstances, because it goes to the root of the problem
wages instead of merely touching the fringes like most of
the systems in use in other countries.

The only country which has tackled the problem of adult
nutrition directly and radically is the Soviet Union. Although
the Soviet system of 'social feeding' as it is called, could prob-
ably work on a large scale only under a planned, that is,
socialized, economy, yet the system itself is of such interest that
it is worth while describing it in some detail.

In practically all the big factories and collective farms in the
U.S.S.R. communal dining-rooms have been established where
the workers and their families, if they wish to, can obtain their
meals. For the most part the dining-rooms, like the factories
themselves, are controlled by the State; others, and especially
those on the collective farms, are under the control of the
co-operative societies. In both cases, elective committees of
workers have a general power of supervision, and it is often on
the initiative of these committees that extensive alterations and
improvements are made. Though there is naturally a good deal
of variation in the efficiency and attractiveness of these restau-
rants, yet with the increasing prosperity of the Soviet Union
they tend to become progressively better organized and more
pleasantly appointed.

The kitchens which serve the restaurants arc often highly
mechanized and fitted with the most modern devices, both for
cooking and for preserving food. The diet served is very care-
fully worked out on scientific principles to meet the nutritional
requirements of the workers. Great attention is paid also to its

266

NUTRITION OF ADULTS

palatability. As we had occasion to mention one department
of the Institute of Nutrition is devoted to the study of methods
of cooking for large numbers. Various sauces and condiments
have been devised which combine pleasantness of taste with
definite nutritional value; and these are widely used. The diet
is as varied as possible. We have already seen that many of
these factory restaurants have special rooms in which various
therapeutic diets are served.

The price of the meals is reasonable. It is estimated that they
cost considerably less than an equally nutritious meal in the
home could be procured for. Also they are more palatable and
more varied than any but the best housewife could prepare.
Finally and this is one of their chief advantages they relieve
women of much of the drudgery of housework.

To cater for the smaller factories, workshops, and various
institutions which do not have facilities of their own, 'kitchen
factories 5 have been established, which are designed as large
modern food plants. Here meals can either be cooked to serve
in the restaurants which are attached to the plants themselves,
or they can be partially prepared and despatched to the places
where they will be eaten. In Leningrad alone there are 27 such
kitchen factories, and many more throughout the country. A
few of them are very large indeed, and prepare 200,000 dishes,
wholly or partly cooked, in a day.

We need not enquire here how far such a system of social
feeding is applicable to other countries. Its advantages
economy at once of resources, time, and labour, scientific plan-
ning of diet, hygienic conditions both of food preparation and
of food consumption, and the increased freedom of women
from household drudgery are obvious. There can be no
doubt that those who are faced with the practical problem of
improving the nutrition of the working class will find much to
learn from the Russian experiment.

It should be clear even from the sketch presented in this
chapter that the problem of nutrition both in its theoretical
and its practical aspects has begun seriously to attract the
attention of the governments of many of the advanced Western
states. Material of great interest and importance has been col-
lected on an international scale by the League of Nations; re-

267

NUTRITIONAL RESEARCH AND PRACTICE

search of real value is being conducted by various governments
into different branches of nutritional science; and a certain
beginning at least has been made in the application of the
'newer knowledge of nutrition 3 to special sections of the com-
munity. The advance of our knowledge of the scientific prin-
ciples of nutrition and the increasing realization, supported by
extensive surveys and the accumulation of reliable data, that
undernourishment and malnutrition are extremely widespread
in their incidence and disastrous in their effects, make it im-
possible for governments any longer to ignore a problem of such
vital importance. Steps are everywhere being taken in the
West to deal with the situation. If many of the measures adopted
are hopelessly inadequate, the experience of the Soviet Union
shows clearly that a co-ordinated and planned nutritional
policy for the entire population can be of the utmost benefit.
It is doubtful whether, under the present economic system,
such a policy could be introduced into India; but in the next
chapter we shall examine what practical steps could even now
be taken to alleviate the widespread suffering, the moral and
physical deterioration, caused by malnutrition.

268

CHAPTER EIGHT

Facing the Problems in India
*

Overcoming Inertia

In attempting to improve the state of nutrition of our people,
we Indians are indeed faced with difficulties far greater and
more complex than those in most of the advanced countries.
The magnitude and character of the poverty which afflicts the
greater part of the population is unparalleled; it imprisons
them in a vicious circle from which they can find no way of
escape. A great deal of unnecessary suffering among them may
be attributed to dietary prejudices and social customs. But at
the root of all the fundamental problems relating to their wel-
fare lies the dead weight of inertia. Because of the circumstances
in which they live, the masses have developed a fatalistic
quietism. Moneylenders, landlords, traders, priests, and hosts
of others take away the fruits of their labours, while they can-
not provide themselves with the essential requisites of life; the
State and vested interests of all descriptions flourish, while the
environment and physique of the farming population and the
working class deteriorate; the circumstances which are making
India prosperous are also releasing forces which create poverty
among the bulk of its population; and the masses of the greater
part of the world are becoming conscious of economic and
social maladjustments, while in India they cannot even say JVb
to those who exploit them.

The recurrence of famines, floods, and pestilences, the in-
ability to cope with the circumstances which relentlessly expose
them to exploitation, the depressing environment which sur-
rounds their daily life, the submission to all forms of social

269

FACING THE PROBLEMS IN INDIA
tyranny all these have inevitably led to a pessimistic view of
life. It is the overwhelming sense of helplessness that breeds the
spirit of resignation to fate and paralyses the will to live; despair
has engendered such perverse concepts of life that the masses
regard existence itself as an evil. To them the docility with
which they tolerate the social and economic disabilities im-
posed on them has become a symbol of spirituality.

So long as this defeatist attitude towards life dominates the
outlook of the masses, the impetus to improve their conditions
of life will be found lacking. Therefore it is this attitude which
has to be changed if India is to arrest the symptoms of decay
so conspicuous among the population. But, as Lord Hailey
observes, the Government 'have never deliberately attempted
to effect that change in the psychology of the peasant, and in
his social and personal habits, without which it is impossible
materially to improve his conditions of life. 5

That task cannot be fulfilled by mere philanthropy or by
organizing here and there a number of 'welfare centres'. What
is needed is the kind of awakening of social consciousness
which brings about a determined will to alter the scale of
values hitherto dominating our social and economic relations.
It cannot be denied that in matters relating to the health and
nutrition of the greater part of our population, the privileged
classes have shown nothing but complacency; otherwise things
would not have deteriorated to the point of such degrading
conditions. To my mind, this complacent attitude and almost
callous indifference towards the need of a fundamental change
in the outlook on life may also be traced to 'intelligentsia-
pessimism 3 (to quote a phrase used by Lenin) . That coherent
social force which alone can weld together heterogeneous
interests has not as yet emanated from our political agitation.
The horizon of our social life remains narrow and that is why,
as one of our religious teachers lamented, India has done so
little for the welfare of the masses in comparison with the social
achievements of the West.

It may appear strange that this should be so, but India's
spirituality has not enabled her to realize the value of existence
itself. She has lost the capacity of transforming or resisting the
environment of life the process by which a people develops
the dynamic quality and attains the consciousness of nation-

1270

OVERCOMING INERTIA

hood. Our failure in this respect is due to a lack of spiritual
endeavour; yet we are regarded as a people whose life centres
round religion; our vision transcends the world of sense and
rests upon the world of spirit. But we may ask ourselves, how
is it that our life does not seem to move towards a creative
advance? If Dharma is to indicate the way of life, why are we
lost in chaos and confusion?

The truth is, the other-worldliness which masquerades under
the cloak of spirituality is in reality a symptom of defeatism.
The Aryan spirit which once delighted in expressing itself in
colourful creative activities by fully acknowledging the world
of our senses has become suspicious of life itself; originally it
did not seek refuge in a renunciation which distorts the funda-
mental spiritual values of life by presenting them as antagonis-
tic to the world of reality. If we do not see life with sanity
to-day, it is because we distrust its urge and devise elaborate
ideologies to suppress it; if we focus our gaze upon life beyond,
it is because we fail to recognize the rhythm of life here which
manifests itself in a 'plurality of forces'. Let the blunt truth be
told: we shall never be able to solve the complexities of the
problems of health and nutrition in India so long as the spirit of
resignation to fate among the masses and of the spirit of com-
placency among the privileged classes are not overcome by a
nation-wide crusade against malnutrition and ill-health; for
the crux of the problem is to have the desire for 'better living'
the desire which springs from the realization of the value of
life.

But when the need of such a crusade against disease and
devitalization is so urgent, it is tragic that leaders of Indian com-
munities cannot yet sink their differences over issues which are
of minor importance. Whatever rivalries may exist among
them in the sphere of political and social life, it should be
obvious to them that in poverty, in sickness, in servitude, in
the misery of existence they have a common danger. The prob-
lem of health and nutrition thus transcends the barriers of
caste, colour, and creed; and in the task of rescuing the great
bulk of their countrymen from the perilous status of poverty,
there is no room for communal and party strife.

271

FACING THE PROBLEMS IN INDIA

Problem of Overpopulation

The problem of population in India has recently attracted
much attention, and the opinion is frequently expressed that
the appalling poverty and undernourishment of the Indian
masses can never be overcome if the population continues to
increase at its present rate. It is argued that by 1941 the
numbers of the population will have caught up with the avail-
able food supply, and that the grim Malthusian law of popula-
tion.,* whereby numbers are limited by starvation and want,
will begin to demonstrate its validity in India. Those who argue
in this way point to the fact that between 1921 and 1931 the
population rose by 50,000,000 more than the entire popula-
tion of the United Kingdom. It is added that the rate of increase
during the present census decade seems likely to be at least as
high, thus bringing the total population to the enormous figure
of 400,000,000. The argument is even put forward, on the
basis of these facts, that it would be dangerous to do anything
that would have the effect of raising agricultural production,
or improving the health and social services. An increase in the
food supply of the people, or a reduction of morbidity and an
improvement in housing and sanitary conditions would merely
have the effect of still further raising the birth-rate, since,
according to Malthus' law, population always has a tendency
to increase up to the limit where it is checked by actual starva-
tion. This depressing conclusion, though it would seem to be a
confession of defeat in developing potential resources of food
supply through the application of science, is yet maintained by
many eminent authorities.

In our opinion, however, the whole argument is based on
completely false reasoning. In the first place, the figures of

* Malthus wrote: 'In an endeavour to raise the proportion of quantity
of provisions to the number of consumers in any country our attention
would naturally be first directed to the increasing of the absolute quan%
r nSUt * dm that ' as fast as we did this > ^c number of con^
*' and that with a11 our exertions we
Sh Uld be C0nvinced that

272

PROBLEM OF OVERPOPULATION

population, though unassailable in themselves, are not nearly
so alarming as they are made out to be. Thus the rate of per-
centage increase of the population of India during the decade
1921 to 1931 was 10-6. If we compare this figure with the rate
of increase of the population of England, we find that, although
for the corresponding decade the Indian figure is nearly twice
as great as the English, yet for every decade of the nineteenth
century the rate of increase in England was greater, in some
cases almost twice as great, as the present rate in India.
Throughout the nineteenth century the rate of increase never
fell so low as 10-6: the lowest figure is 11*7, while the highest,
for the decade 1811 to 1821, is as great as 18-1. The rate of
increase of the population of England has fallen sharply during
the twentieth century; even so the population of England has
increased during the last 50 years by 53-8 per cent as compared
with an increase of only 39 per cent during the same period in
India. It would appear, therefore, that there is nothing in itself
alarming or extraordinary in the rate of increase of the Indian
population.* Those who find in India's overpopulation a pri-
mary cause of poverty and chronic malnutrition and tell us
that nothing could really be done unless the 'devastating tor-
rent of babies' is held in check, do not seem to realize that our
agricultural production has not as yet received deliberate and
sustained application of technological knowledge and that no
alarm can be justified while we are still remiss in drawing from
our land all that agricultural science can achieve.

The statement that the population will by 1941 have caught
up with the available food supply, is based on the tacit assump-
tion that, in the intervening period, the agricultural produc-
tion will not in fact have materially increased. Now it may be
admitted in theory that if the food supply remains stationary,
a time will come, perhaps in 1941, perhaps later the available
figures are not in our opinion sufficiently precise to make
accurate prediction possible when the population will in fact
catch up with the food supply. The law of diminishing returns,
upon which Malthus based his predictions, will ultimately hold
good in India as elsewhere. But when we inquire why this law
did not begin to operate in England as quickly as Malthus
expected, the answer immediately presents itself: because the
* See Appendix II.

273

FACING THE PROBLEMS IN INDIA

structure of productive economy, both in agriculture and in-
dustry, adapted itself to the increasing population. Now the
agrarian economy of India is considerably more antiquated
and defective than was that of England in the time of Mai thus.
But to assume that Indian agriculture cannot be brought up to
a level of efficiency high enough to provide for a population
that is not increasing at a disproportionate rate, is either to
deny the possibility of normal progress in India or to condemn
the economic policy of our rulers as inadequate and reaction-
ary. It is undeniable that the pivot of that policy of the Govern-
ment has been centred rather upon the requirements of a
commercial nation than upon the basic needs of the Indian
peoples. That is why no rational reconstruction of agricultural
industry has yet been undertaken and no substantial progress
is made towards abating the risk of the pressure of population
upon the means of subsistence.

Be that as it may, every effort should now be concentrated
on reorganizing the semi-feudal land system with its tendency
to the progressive fragmentation of holdings and the increasing
concentration of enormous tracts of land in the hands of a
few who use it not to increase the food supply of the popula-
tion but for reaping a harvest of rent and various forms of
illegal exactions (nazar). Revenue farming, which first de-
veloped during the Moghul rule, has been stabilized under
organized capitalist economy. We have no space here for dis-
cussions upon what fundamental alterations in the economic
system are necessary before agricultural practice in India can
be benefited by the application of technological knowledge.
We would only point out that agrarian reform in India is
overdue and that the time for piecemeal adjustments has
lapsed. The incompetence of our agriculture is largely due to
our inability to adapt it to the changing circumstances of a
scientific and experimental age. The nation's food supply thus
remains in the hands of those who have neither access to tech-
nical and material equipment nor the guidance of the 'directed
economy 5 of a government particularly concerned with the
health and nutrition of the people. It is in this state of affairs
that the Malthusian spectre looms so large on the horizon and
disturbs some of our sociologists.

The argument that an increase in the food supply and an

274

NUTRITION AND AGRICULTURE

improvement in the health and social conditions of the people
would merely tend still further to increase the population, may
be dismissed in a few words. This argument, based on Mai thus,
has not in fact been confirmed by experience. Thus, during the
first three decades of the twentieth century the food supply of
England and Europe generally has increased, yet the rate of
increase of the population in all European countries except the
U.S.S.R. has been rapidly decreasing. An improvement in the
social conditions and standards of living of the people, more-
over, far from having a tendency to increase the birth-rate,
would seem to have the opposite effect: people do not wish to
endanger their standard of living or that of their children by
having large families. For example, it is found that the birth-
rate among the Brahmins of Madras city is practically equal
to the birth-rate among the Europeans; but the rate is nearly
double among the lowest group in the social scale. The further
emancipation of women and the spread of education, particu-
larly with the discovery of methods of contraception, a know-
ledge of which it should be the policy of enlightened education
to spread, especially in India where infant and maternal mor-
tality is so high, would have the effect of still further decreasing
the size of the family: educated parents, wishing to ensure the
education of their children, will not have any more children
than they can afford to educate.

To sum up: while admitting that, if the food supply remains
at its present level, there is a danger that in the near future the
population will catch up with it, we deny first that the rate of
increase in population is in itself alarming, and second that
there is any reason why the food supply should not be very
greatly increased. We see the solution of the population prob-
lem in India not in any direct attempts to limit the population,
but in a reorientation of the agricultural policy supported by
a corresponding reorganization of other branches of economic
structure, and in a general improvement of the standard of
living of the people.

Nutrition and Agriculture

The underlying problems of nutrition have obviously a close
relationship with those of agriculture and animal husbandry.
One of the main features of agriculture in India is that the

275

FACING THE PROBLEMS IN INDIA

crops grown are principally those that supply the staple food-
stuffs, mostly cereals and pulse, of the bulk of the population.
And yet it seems paradoxical that there should be so much
chronic starvation and widespread malnutrition in the country.

Let it be frankly stated that until recently agriculture in
India has never been seriously thought of as a vital industry.
It pays the tax on land, which is the main source of revenue
for the Government; it exports certain raw materials for Euro-
pean industries and helps to balance the finance of a debtor
country; it supplies cotton, jute, oilseed, tea and other raw
materials to build up industries in India and abroad; but it
does not provide the tillers of soil, and those who depend on
them, with adequate and proper nutrition; nor, indeed, does
it help them to mitigate the poverty which is the basic cause of
malnutrition.

The nature of the problems which to-day confront Indian
agriculture is rendered complicated by our social, economic,
and political circumstances. They have not allowed the prudent
use of our natural resources. The soil shows signs of exhaustion,
and consequently some of our most urgent agricultural prob-
lems centre round the improvement of soil conditions. Defi-
ciencies of essential plant foods such as nitrogen, phosphorus,
and lime, soil acidity, soil erosion, inefficient methods of tillage,
lack of a system of proper rotation suitable to the respective
zones, improper utilization of irrigation facilities, the reckless
waste of farmyard manure these are problems which must be
faced in order to enable Indian agriculture technically to
meet the requirements of health and nutrition of our people.
The deplorable state of animal husbandry offers a formidable
obstacle to the improvement of Indian diets. Cattle are ill-fed
because the quality of the grass is inferior; men are under-
nourished because milk supply is inadequate.

Since Indian agriculture is in a backward state and since the
state of nutrition of the bulk of the Indian population is far below
the normal requirements, the problems implied in the pro-
posal of 'marrying agriculture and health 5 the phrase used
by Mr. S. M. Bruce of Australia at the Assembly of the League
of Nations in 1935 have a special significance for India. It
means that agricultural policy, research, and administration
must be based primarily upon the dietary requirements of the

276

NUTRITION AND AGRICULTURE

people; it means that the State must take adequate measures
not only to explore the food resources of the country, but to
control their distribution in the interest of the consumer; and
it means that no time should be lost in effecting a reorientation
of agricultural industry if the nutrition and health of a very
large proportion of the Indian peoples are to make a substan-
tial improvement.

The initial step towards the solution of this depressing state
of nutrition in India would be to increase the productivity of
the soil. Our land could yield at least twice or three times as
much human food as it does at present. While in some of the
Western countries it was considered expedient to adopt mea-
sures to decrease production, the need of India is to enhance
agricultural productivity by removing the barriers which stand
in the way of assimilating the advances of scientific research in
agricultural economy. The application of the sciences of
chemistry, genetics, pest control, and mechanics, together with
the development of modern transport, can ensure abundance
of food supply. The epigram poverty in the midst of plenty
is not at the moment applicable to India, since the level of her
agricultural production is far below its potentialities. It is truly
said that 'India is a rich country inhabited by a poor people'.

What is required is to release the means of production and
distribution from the grip of an economic system operating in
India under the combined forces of feudalism and capitalism.
That there can be no real solution of the problem of nutrition
within that system is clear from what we witness in the advanced
countries of the West. Although the nature and magnitude of
undernourishment and malnutrition there differ from the con-
ditions obtaining in India, the fact that the crisis of under-
consumption of essential foodstuffs is so widespread among a
great part of their peoples should be a lesson for India.

In most of the advanced countries of the West the application
of science and technology to the different spheres of social and
economic life has been progressively successful and has brought
about bountiful harvests in their fields and factories. And yet
there do exist striking deficiencies in the diet of a considerable
proportion of the peoples. Does this not force us to conclude
that man has been unable to use the accumulated knowledge
of science to his real advantage? Does it not raise the funda-

s 277

FACING THE PROBLEMS IN INDIA

mental question of the disharmony between the application of
science and the economic structure? In the sphere of produc-
tion, science has been successful in overcoming to a large
extent the physical limitations of man's environment. He is
now able to make the desert blossom or to reclaim waterlogged
areas. Or, when he is faced with severe conditions of drought,
he is able to mitigate its influence by using deep-rooted crops.
By an understanding of the correct balance between the pro-
portions of essential fertilizing constituents, he is able to create
favourable soil conditions for crop production. The science of
plant breeding has shown him what encouraging results, both
in regard to yield and quality, may be obtained in practical
agriculture. It is recorded that in the middle of the thirteenth
century, the average yield of wheat in Oxfordshire was no more
than 5 bushels per acre; but to-day, experiments with high-
yielding varieties of wheat at Cambridge show that it is pos-
sible to obtain under normal working conditions a yield of 60
bushels per acre as compared with an average of 32 for the
United Kingdom. As a result of five years' research, Dutch
plant-breeders have produced a strain of sugar cane which has
raised the yield of this crop in Java to six tons to the acre.
Perhaps Professor Vavilov, the director of the Bureau of
Applied Botany in the U.S.S.R. was not unduly optimistic when
he declared that the world as a whole could support twenty-five
times the present population if the application of science to
agricultural practice was unhampered by the illogical politico-
economic systems which to-day control agricultural production.
In the work of land reclamation either in a dry zone or in
a waterlogged area, the achievements should dissipate the
pessimistic view. The success of dry farming in Utah, to cite
an instance, is a fact of outstanding importance in the annals
of the application of science to agriculture. The large-scale
operation as observed by Lord Bledisloe 83 'in conserving soil
moisture by the systematic cultivation of alternate crops of
wheat and lucerne, in arid areas with an annual rainfall not
exceeding six inches, and in de-alkinizing salt-poisoned land,
rendering it available for market-garden crops and fruit, has
received all too small public recognition, but it has neverthe-
less, taken in conjunction with wheat research in Canada,
contributed materially to the growing consciousness that the

278

X. Successful dry farming in Bombay Presidency: the crop grown is

millet.
By kind permission of Sir John Russell, F.R.S.

XI. The adjoining land where dry farming is not adopted.
By kind pet mission of Sir John Russell, F.R.S.

NUTRITION AND AGRICULTURE

world can continue to increase its population at the present
rate for at least another century without any risk of food
shortage'.

With regard to the protection of crops against pests and
parasites, the use of fungicide and insecticide, the methods of
inducing hyper-parasitization and the genetic selection of
varieties for immunity have already achieved good results in
minimizing the loss of crops. It is now possible to eliminate as
much as 25 per cent loss of crops from pests by adopting
recognized methods of control. But proposals are made for
allowing crops to be damaged by pests in order to reduce the
food supply! Professor Fernald, an American entomologist,
writes: 'Still more recently the value of controlling insects
injuring crops of which an excess has been raised, leaving a
surplus which cannot be disposed of, has been discussed and
the proposal made that attacks of insects on such crops should
be allowed to proceed unrestrained to reduce or entirely pre-
vent any surplus.' This is an instance of c the frustration of
science'.

In animal husbandry the progress has not been slow. The
knowledge of feeding and breeding livestock has transformed
the entire character of husbandry in the advanced countries.
There pasturage is improved by selection of nutritive fodder
crops; the health of the livestock is guarded by the supply of
mineral and other deficiencies in foodstuffs; and the basis of
milk and meat production is regulated by scientific management.

All these improvements in various aspects of agriculture
have taken place in less than a generation and the trend of
agricultural research holds out a further revolution in agricul-
tural practice. But it used to be said', laments Sir Daniel
Hall, 'that the greatest public benefactor was the man who
could make two blades of grass grow where one grew before.
Not so to-day, when nations are considering agreements to
restrict output and even destroying the products of the soil.'
Science and enterprise have performed the miracle of the
loaves and fishes, but they do not seem to feed the multitude.

We are not concerned here with the diagnosis of the factors
which offer obstacles to the realization of the benefits science
holds out to mankind, specially in providing him with an
adequate subsistence. The truth is, and we must admit it, that

279

FACING THE PROBLEMS IN INDIA
the growth of agricultural production does not bear a har-
monious relationship with the means and methods of distribu-
tion. It is being realized that the existing economic system,
revolving as it does around the magnet of profit-making, leads
to the frustration of all efforts of scientific workers, and pro-
duces interminable confusion. Attention must therefore be
directed to replacing the laisser-faire economy by organized
economic planning.

Reorientation of Indian Agriculture

The foremost and dominant consideration in any scheme for
economic planning in India must be given to agriculture. We
may state categorically that in formulating agricultural policy,
the Government have not borne in mind the importance of
relating it to the nutritional requirements of the people. Inves-
tigations into the quality of the cereals, pulse, and other staple
foodstuffs of home consumption have been undertaken in a
haphazard fashion. No serious attention has been given to the
varieties of millet which enter into the dietaries of millions,
and nothing has been done for the improvement of pulse which
are, as we have seen, important as sources of vegetable protein.

No single item of foodstuff could be more suitable for India
than whole wheat flour. It is liked by all Indian communities
although the average consumption per head is only about 23-5
kilograms as against 1 30 in Europe. But there is every indica-
tion of its increased consumption. Once India had a large
export trade in wheat, but to-day her market is being thrown
open to wheat and milled flour from Australia and other parts
of the Empire. Is this not an instance of subordinating India's
interests to those of the Empire? What explanation can there
be for the lack of initiative on the part of the Indian Govern-
ments in increasing the output of wheat or in extending its
cultivation? In other wheat-growing countries, the State policy
is to give direct assistance for the purpose of stimulating its
production. In Great Britain, for instance, the production of
this cereal has increased to 1,800,000 tons since the passing of
the Wheat Act. While the development of animal husbandry,
the cultivation of fruits and vegetables, the organization of
milk supply and the marketing of foodstuffs are matters which

280

REORIENTATION OF INDIAN AGRICULTURE

have been left to their fate, official activity in India is directed,
in the main, to the problems affecting jute, cotton, oilseeds,
and other raw materials required for the export trade.

We cannot enter upon an analysis of the circumstances
under which it has come to pass that agriculture in India barely
'feeds its man'. The framework of this basic industry is medie-
val and characteristic of feudal economy, and within such a
structure, the scope of progress is obviously limited. Only by
adopting a constructive agricultural policy can we hope to
overcome the handicaps which hinder the development of
agriculture in India.

The first obvious step towards planned agriculture in India
would be to adopt deliberate measures for increased food pro-
duction.* e ln considering the problem of nutrition in the East,'
Aykroyd says, 'primary emphasis must be placed on quantity,'
because a large proportion of the population has hardly more
than one poor meal a day. Our agricultural policy must aim
at ensuring not only an adequate food supply, but the right
kind of food in order to correct the widespread dietary de-
ficiencies of our people. During the last few decades there has
been no increase in the acreage under food crops, while that
under non-food crops shows an upward tendency. The basis of
our crop production is haphazard and uneconomic, and we
have not as yet troubled to develop a system of reliable statistics
which would be of assistance in regulating crop production
with a view to initiating a comprehensive food policy. Condi-
tions precedent to the formulation and adoption of such a
policy are twofold, namely, a proper soil survey and a cropping
system based upon agrobiological factors. The first would
involve mapping the entire regions of our arable fields showing-
such details (e.g. topography, rainfall, underground water,
etc.) as are required for scientific direction of agricultural pro-
duction; and the second would lead to the maintenance of
Nature's equilibrium in respect of the soil and the crop. A
planned food policy based upon the interrelated knowledge of
all factors of crop production would give far wider scope for
the application of agricultural science to farming in India.
Land now devoted to inferior cereals, for example, may well
be adapted to more nutritive staples. In view of the limited
* See Appendix VI.

FACING THE PROBLEMS IN INDIA

possibility of increasing the areas under food crops, the capacity
of our arable land for producing the requisite quantity and
quality for home consumption should be fully exploited. In
those areas where this cannot be done without increasing the
per-unit cost of production, a form of subsidy may be intro-
duced with advantage.

Secondly, it is becoming increasingly evident that deliberate
measures are overdue for arresting the alarming process of soil
impoverishment through cropping, erosion, and ill-planned
agriculture. Conditions under which crops are grown deter-
mine to a great extent their nutritive value; in other words,
foods vary in composition according to the variations of the
soil conditions. If, for example, soil is deficient in phosphorus,
the crops grown therein contain a low percentage of this ele-
ment. McCarrison 84 found that rice grown on puddled fields
had a nutritive value approximately 33 per cent less than the
same rice grown under comparatively dry conditions. Lowland
rice contains a low content of vitamin B. Again, land receiving
farmyard manure yields wheat and other cereals of greater
nutritive value and of higher vitamin potency than those
grown in fields treated with chemical fertilizers. Tretiakov in
Russia increased the protein of spring wheat from 13-48 to
16-13 P er cent an d the phosphorus of winter wheat from 0-77
to 1-22 per cent by fertilizing with farmyard manure.* Tests
for determining the influence of manurial treatment on the
baking quality of English wheat show that the nitrogen content
of the cereal increases consistently in proportion to the supply
of nitrogenous manures.

It is this correlation between soil conditions and the value of
food in certain essential nutrients that constitutes one of the
fundamentals of agricultural science. If we neglect to maintain
the natural fertility of soil, we expose ourselves not merely to
a serious economic loss consequent upon its impoverishment,
but to alarming deficiencies in the nutritive substances of our
staple foods. The maintenance of soil fertility, what the Danes
define as the attempt to preserve the joy of the soiP, is there-
fore a problem closely related to that of food supply both in
regard to its quantity and quality. It has been rightly said that
'the soil book-keeping of India shows a chronic deficit'. Our
* Communicated to the author by a Polish agricultural expert.
282

XII. The wasteful practice of using dung for fuel removes one of the

possible means of restoring soil fertility.
By kind permission of Sir John Russell, F.R.S.

XIII. Sowing seeds with a country drill.
By kind permission of Indian State Railways Magazine.

REORIENTATION OF INDIAN AGRICULTURE
land could yield at least twice or three times as much foodstuff
as it does at present provided the vicious circle in which
agricultural industry has become entangled is broken, and the
obvious handicaps to the application of the resources of modern
scientific and technical research are removed.

The problem of soil fertility must be an integral part of
planned agriculture. Under the prevailing conditions of farm-
ing our soil is not adequately replenished by farm wastes and
manures. The dung is wasted, as we have seen, as fuel; and
with the export of oilseeds and oilcakes we export valuable plant
food which should be restored to the soil. A large proportion of
our arable land is poor in humus content and with its dis-
appearance the natural life of the soil receives a serious setback.
That in India the process of soil exhaustion has almost reached
a stage known as 'dead level' is indicated by the yield of staple
crops, which, in many instances, is practically constant. The
standards of efficiency of production may be judged by the fact
that India has the lowest out-turn per- acre even in normal
years. Some of our Western experts propose the introduction of
chemical fertilizers in our agricultural practice; but the possi-
bility of their extended use is indeed meagre. Apart from the
consideration that they are expensive and do not really rehabi-
litate the soil, their application tends to diminish the nutritive
value of crops. Commenting upon the form of intensive agri-
culture which encourages the use of chemical fertilizers, Carrel 85
observes: 'Mass production has modified the composition of
wheat, eggs, milk, fruit, and butter, although these articles have
retained their familiar appearance. Chemical fertilizers, by
increasing the abundance of crops without replacing all the
exhausted elements of the soil, have indirectly contributed to
change the nutritive value of cereal grains and of vegetables.*

Thus the problem of the fertility of our soils resolves into the
single consideration of the proper and adequate utilization of
farmyard manure. The saving of this invaluable plant nutrient,
now largely used as fuel, the use of compost prepared from
various waste products, and a judicious system of green-
manuring these positive measures for improving our ill-
nourished land demand a nation-wide crusade.

Thirdly, investigations on plant genetics should be systema-
tized and directed to the improvement of the existing varieties

283

FACING THE PROBLEMS IN INDIA

and to the introduction of new ones. The reorientation of
Indian agriculture to the nutritional requirements of the
people would necessitate setting up in each province a special
institute of applied botany whose function would be to study
every aspect of the foodstuffs drawn from the plant kingdom.
Here, at long last, our neglected fruits and vegetables would
be studied. The improvement of the seeds and the varieties of
those vegetables, pulse, and fruits whose dietary values are
comparatively high would be the chief concern of the institute.
Through such an institute we may at last succeed in organiz-
ing the distribution of tested seeds.

Indeed, researches on plant genetics and plant ecology hold
out a promise of development to which no modern State can
be indifferent. In the U.S.S.R. the Department of Applied
Botany, which receives an annual endowment of 300,000,
collected over 20,000 specimens of peas, beans, and lentils with
a view to selecting strains of greater nutritive values than those
grown in the Russian soil. Over a thousand workers are en-
gaged in the study of plants of economic importance, and
researches are being pursued with the object of doubling the
number of chromosomes in plant-cells and so of evolving larger
sizes of cereals, pulse, and root-vegetables. Cabbage, which is a
favouriteleafy vegetable of the people, receives special attention
by a separate section of the Department of Applied Botany.
The Russian geneticists are also working on strains of quick-
maturing potatoes so that they may be grown even in those
regions which otherwise are unsuitable for the crop.

Lastly, the problem of marketing agricultural produce can-
not be left out of consideration in any scheme for 'directed
agriculture'. It is not, however, merely a question of providing
better facilities, or of controlling the prices of commodities.
The chief problem of the exploitation of our peasantry lies in
the middlemen to whom the primary producers are obliged to
sell crops at a price about 25 per cent lower than the usual
market-rate and in the deliberate increase of paper money
thrown on the buying market by the banking cum commercial
organizations. During the harvesting seasons, the cash reserves
of the banks are heavily drawn upon and the agents of trading
concerns traverse the countryside with ready cash for buying
agricultural produce.

284

INTRODUCTION OF NEW FOOD CROPS

The quantity of foodstuffs which the cultivator sells or keeps
for his own consumption cannot be accurately estimated; but
the imperious necessity of meeting his liabilities in cash pay-
ments in the harvesting seasons contends with his desire to
ensure food supply for himself and his family. In the struggle
between the cash demands of the creditors and the stomach of
the peasants, the organized interests gain the victory and a
great part of the peasantry is left without adequate sustenance
even in a normal season of harvests. And he cannot, after
meeting the demands of his landlord, moneylender, commis-
sion agents, shopkeeper, and a host of other parasitic interests,
provide himself with the cash required for the food of his family.

Recently the Government in India have directed their
attention to the investigation of our under-developed market-
ing systems. The outcome of this enquiry may at least result in
identifying the sources of the incredible waste involved at
almost every stage of distribution. As every form of waste
inflates the cost of distribution and enhances the prices of
commodities, we hope that the existing disparity between
production and consumption may to a certain extent be
lessened by deliberate weeding out of a number of parasitic
interests which so disastrously affect the market. Ultimate
success in the task of organizing agricultural marketing is to
be measured by the impetus it offers to production.

Introduction of New Food Crops

Co-ordinated investigations of plant genetics and plant
ecology may lead to another important aspect of the relation-
ship between nutrition and agriculture, namely the introduc-
tion of new food crops. It is estimated that there are approxi-
mately half a million species of plants in the world but only a
few hundred of these are cultivated. The discovery and intro-
duction of a new source of food may have far-reaching conse-
quences in social economy, as was the case with the introduc-
tion of potatoes in the latter part of the sixteenth century in
England;* or of banana in recent years. There are other

* Potatoes were indigenous to South America and were imported into
Europe about A.D. 1580. Sir Walter Ralegh was the first to grow potatoes,
on his estate near Cork.

285

FACING THE PROBLEMS IN INDIA

instances of the successful introduction of foreign plants into
European agriculture and they have often made desirable
changes in the diet of the people. The introduction of green
salads by Catherine of Aragon, wife of Henry VIII, undoub-
tedly improved the monotony of English fare. The Mediter-
ranean countries are indebted to the Portuguese for intro-
ducing the cultivation of oranges.

One of the essential steps towards the reorientation of agri-
culture in India then is to explore the possibilities of introdu-
cing new food crops. We shall here mention two plants which
have already attracted much attention as sources of human
nutrition.

Of the new crops which may be successfully introduced into
Indian agriculture, the soya bean (Glydne hispida) is of excep-
tional importance owing to its nutritive value. It is a legu-
minous plant known to have been grown from the earliest
times in China, Japan, and Java, where the soya bean is an
important item in the people's diet. It is rich in good proteins
and contains as much as 4-8 per cent of inorganic constituents,
mostly phosphates and calcium. In i oo grams of soya bean
there are, on an average, 38 gm. proteins, 28 gm. carbohydrates,
and 1 8 gm. fat; and its fuel value is calculated at about 430.
Its low starch content makes it a suitable item in the dietary
of diabetic and dyspeptic patients. Of the vitamins it is rich in
both fat-soluble A and water-soluble B; the latter is, as we
have seen, an essential food-factor especially for those who
consume polished rice.

The beans are soaked in plain or salted water tor about
twelve hours and then roasted or boiled. Sprouted beans are
used as a fresh vegetable and in Chinese cookery it enters into
various dishes. The flour made from this valuable legume con-
tains approximately 40 per cent protein, 20 per cent fat, and
26 per cent carbohydrates and 6 per cent inorganic constitu-
ents. Among its other uses, the preparation of milk from soya
bean deserves our attention. Dried soya beans (especially
yellow varieties), are soaked for a few hours and then crushed
into a pulp. This is then boiled with water for about thirty
minutes, and the liquid, passed through a fine sieve, is the 'soya
bean' milk which is so extensively used in China. Its chemical

286

INTRODUCTION OF NEW FOOD CROPS

and physical properties are somewhat similar to those of cow's
milk and it may be used as a good substitute for infant feeding.
Soya-bean milk is also recommended for the treatment of
digestive disturbances. The precipitated proteins of the milk
form a popular article of food known as bean curd (teou fu)
out of which the Chinese prepare different varieties of cheese.
It is interesting to compare the compositions of vegetable
casein prepared from soya bean and peanut.

TABLE XIX*
Percentage Composition of Vegetable Casein

Soya Bean Peanut

Moisture 1 1 -43 ' 6-14

Ash 2-08 1-37

Fat 0-91 0-47

Total nitrogen 12-25 13*05

Casein nitrogen 78-15 83-26

Ever since the problem of nutrition for industrial and agri-
cultural workers engaged the attention of Europe and America,
an attempt has been made to popularize the soya bean and its
flour. Berezeller of the Vienna Physiological Institute sug-
gested a recipe for the preparation of bread with soya-bean
flour and calculated that its use would save five and a half
million pounds annually to the Austrian nation. The United
States Army dietician found that a mixture of 80 per cent
wheat flour and 20 per cent soya-bean flour yields an excellent
bread of good flavour. During the War the bread for the French
Army was largely made from soya-bean flour. The Italian
Government have recently instructed their health officers to
induce the people to use a certain amount of this new flour in
the manufacture of polenta and bread. Soya-bean bread has
been introduced into the dietary of patients in many European
sanitoria for the treatment of tuberculosis.

Soya-bean flour properly mixed with cereals such as rice,
wheat, or jowar, would considerably increase the protein con-
tent of the usual vegetarian diet in India. This has been
attempted in the Presidency of Bombay with imported soya
beans; but, although its nutritive value was demonstrated, its
introduction as an article of diet met with little or no success.

* From the Chemical Department of Nankai University, Tientsin.

287

FACING THE PROBLEMS IN INDIA

Perhaps the trouble lay in the process of milling, which ought
to be so devised that the strong flavour of the soya bean is
removed.

In view of the urgent need for the supply of inexpensive
nutrients in India, this leguminous crop must claim more
attention than it has so far received from the departments of
Agriculture and Public Health. The extension of its cultivation
offers no formidable difficulties; for it grows in almost all types
of soil; it is a hardy plant and resists alike drought, excessive
humidity and even light frosts. Its flowers are self-pollenated
and consequently its introduction in a new region is com-
pletely advantageous. Its yield is better than the other legumi-
nous crops grown in India, as is indicated by the results
obtained in field trials in Gujrat and Sind. Determined efforts
should now be made throughout India to interest the cultivator
in this crop.

The autonomous Indian provinces now can help considerably
both in the cultivation and use of soya bean by introducing soya
flour into the diet of prisons, reformatories, orphanages, and
other public institutions. Numerous charitable organizations
which undertake to feed the poor may be able to provide
sufficient of the essential nutrients at a reasonable cost by
popularizing the soya bean. In this matter the leaders of Hindu
orthodox communities should exert their influence upon the
priests of the temples where large-scale social feeding is a
common practice.

Another plant whose cultivation may be extended in India
both as a nutritious leafy vegetable and a forage is lucerne
(medicago sativa). Though a native of the temperate regions
of Western Asia and the north-western part of Persia, it has
been successfully introduced in no less than thirty countries*
It is a hardy plant with a long root system and thrives well in
deep and well-drained soil. Under irrigation the crop can be
introduced in semi-arid regions where the scarcity of fodder is
chronic.

Its popularity in the West has been due chiefly to its value as
forage. The Moors gave it a name, alfalfa, which means the
best fodder, and introduced its cultivation into Spain. From
there the crop spread throughout Europe and America. The
discovery of its use for human consumption led to research into

288

HORTICULTURE

the food values of lucerne. It is fairly rich in proteins of a high
biological value, especially in the fresh young leaves of the
plant; and if the crop is grown in a proper soil, it contains
nearly three times as much calcium as milk and twice as much
iron as spinach. As regards vitamins, they are relatively abun-
dant in the young plant. Levy and Fox have shown 86 that it is
'an exceptionally rich source of vitamin G'. It is estimated that
the fresh uncooked lucerne leaves contain five times as much
vitamin G as the same weight of orange juice.

Horticulture: Production of Fruits and Vegetables

We have already pointed out that in taking deliberate steps
towards increased food production in India, considerable
attention must be given to the production of protective food-
stuffs. In our study of Indian dietaries, we have indicated how
inadequate is the supply of fruits and vegetables, two chief
sources of essential nutrients, particularly for a country where
the greater part of the population is by habit vegetarian.

Now horticulture is that branch of farming which is devoted
to the cultivation of fruits and vegetables; but it has not so far
entered into any general scheme of agricultural development
in India. Our fruit-growers and market-gardeners receive no
substantial direction from the State in regard to seed selection,
cultivation, or marketing of produce. In the West, the slogans
'Eat more fruit 3 or 'Drink more milk 5 are followed by various
enterprises for the production and distribution of fruits and
milk, for the fruit-growers and dairymen are so organized that
they can successfully arrest the attention of the State. Various
measures such as tariffs, subsidies, efficient transport facilities
are adopted to give the required impetus to production in
dairies, vegetable gardens, and orchards.

The supply of fruits and vegetables may be considerably
increased by initiating a 'kitchen-garden movement 3 for the
benefit of those who are unable to purchase them in the open
market. Such a movement originated in the first instance in the
United States under the leadership of Grace Dodge, and had
a phenomenal success in popularizing the use of fruits and
vegetables for home consumption.

A movement somewhat analogous to the provision of allot-

289

FACING THE PROBLEMS IN INDIA

ments in Great Britain has lately been started in Italy with a
view to encouraging the production of vegetables and small
fruits. In some industrial areas, each worker is given a plot of
land to cultivate, but he is not allowed to sell its produce. It is
estimated that there are over two million 'family kitchen-gar-
dens 3 in Italy in the management of which the State Depart-
ment of Agriculture renders every assistance. The new agra-
rian reforms in Central and Eastern Europe recognize the
necessity of creating such holdings as would provide a small
garden to landless labourers and poorer agriculturists and
encourage some form of collective action among them, especi-
ally in the interests of those who are unable to overcome diffi-
culties in adopting the advanced technique of crop produc-
tion.

A similar movement is long overdue in India and the initia-
tive must come from landlords in the permanent settlement, and
from the State in the Rywatari* areas. For a period of years
the garden plots should be given free of rent and their cultiva-
tion should be supervised by appropriate agents. In countries
where conditions somewhat similar to those obtaining in India
prevail, efforts are being made to introduce some form of group
cultivation. While the collective cultivation of soil to the extent
it has succeeded in the Soviet Union may take time to achieve
in India, it should be possible to adapt the practice in the
first instance to the production of milk, vegetables, and fruits.
At the initial stage, individual ownership may not be elimi-
nated but efforts should be directed to show how collectivist
methods of cultivation and farm management serve the interests
of the group more effectively than those of single and isolated
holders. Immediate fruition of such developments may be
delayed but we should remember that in the tradition of using
the common pasture, woodlands, and watersheds, etc., our
peasantry has an instinctive appreciation of collective economy.

It is not impossible to adopt an organized plan of establish-
ing a number of large vegetable gardens and orchards in
selected areas in India. The types of soil not remunerative
under a cereal crop may well be brought under the cultivation
of suitable fruits and vegetables; or the areas under opium and

* The system of land tenure under which the revenue is paid by the
cultivator direct to the Government.

290

ANIMAL HUSBANDRY

hemp if the use of these narcotics is greatly reduced maybe
made available for this purpose. The importance of adequate
provision for fruits and vegetables is so vital for the proper
nutrition of our people that I have no hesitation in suggesting
that even the production of tea, coffee, and other non-essential
articles of food should be discouraged if suitable lands are not
available for the cultivation of 'protective' foodstuffs and for
increasing milk production.

Animal Husbandry: Production of Milk and
Milk-Products

Animal husbandry in India is faced not with the problem of
raising meat but with that of increasing milk production
sufficiently to meet the needs of a non-flesh-eating people. The
condition of dairy farming has therefore a special bearing upon
the nutritional requirements of all communities in India. The
nature of agricultural economy, the insecurity of land-tenure
for herdsmen, shortage of grazing land, poor quality of fodders,
haphazard breeding, prevalence of disease, conditions of trans-
port and marketing of milk and milk-products all these render
the problem of dairying in India extremely complex. Neverthe-
less, they can no longer be ignored if we are to provide even
minimum standard diets for the people of India.

Indian herdsmen are, as a rule, capable and consider the
cow a 'sacred' animal.* Its domestication led to the develop-
ment of agricultural pursuits and provided nourishment. To
the Aryan-speaking settlers in India, cattle became a symbol of
wealth, and they sought to create a social tradition by institu-
ting certain picturesque rituals, designed to raise this animal
in the estimation of the people, thus ensuring its care and
maintenance. 'O, Mother cow, you are like my own Mother;
you feed me with milk; be always full of milk so that we may
live in health: and may disease, illness and discomforts be far
from you 5 with these words even to-day the cow is greeted by
the daughters of Hindu houses.

'Happily for the Hindus,' observes Sir Monier Williams, c the
cow which supplies them with their only animal food milk

* The Babylonians showed their high regard for the cow by addressing
her as 'the mother of the moon*.

291

FACING THE PROBLEMS IN INDIA

and butter and the ox which helps to till their ground were
declared sacred at an early period. Had it not been so, this
useful animal might have been exterminated in times of famine/

But in housing and feeding this object of veneration, our
dairymen are now driven to adopt measures which are posi-
tively harmful to the animal and render the task of milk pro-
duction under hygienic conditions almost impossible. Cows
are kept tied in wretched hovels and fed with scanty fodder.
In the wet season they may obtain additional nourishment by
grazing, but in the dry season they starve and lose weight; and
the recurring period of starvation during their early years
seriously undermines their stamina.

The development of pasturage is one of the essential con-
ditions for any substantial improvement of the cattle in India.
The pastures are generally poor in nitrogen and deficient in
mineral elements, in consequence of which milk production
remains low and the progressive deterioration of breeds goes
on unhampered. What results can we possibly expect from
selective breeding with our ill-fed or starved cattle? By adop-
ting a better system of feeding and by improving the pastures,
the military dairy farms in India have herds of Indian cattle
yielding as much as 5,000 pounds of milk in a lactation.

In the first place our immediate task for the improvement of
animal husbandry is to determine how the nutritive value of
pastures can be improved and what methods may be adopted
to offset the widespread mineral deficiencies which lead to
malnutrition and disease of cattle. We have already noted that
there exists a close relationship between the state of nutrition
of milch cows and the nutritive content of the milk. What is
more, in some dairy countries, the nutritive value of ensilage
has been so much improved that the cost of production of
butter-fat is reduced by nearly 30 per cent. The adoption of
a system of rotation which includes a leguminous fodder crop
may,, as recommended by the Royal Commission on Agricul-
ture in India, be helpful towards the solution of our fodder
problem. And we would be rendering a real service to mother
cow if, instead of aggravating the Hindu-Moslem conflict in
defence of her sacredness, both the communities co-operate in
popularizing appropriate methods of storage of fodder in
rural areas.

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ANIMAL HUSBANDRY

Secondly, in view of the fact that the consumption of milk
arid milk-products is far below what is desirable, and that the
conditions of their production are fraught with grave risks of
contamination and pollution, the informed public opinion of
the country should not remain content until some definite steps
are taken to organize the dairy industry as an integral part of
agricultural economy in India. The state of our milk supply
and of the dairy industry reflects nothing but discredit on a
civilized government. The initiative for evolving a satisfactory
system must now come from the peoples and their representa-
tives in the legislatures. We do not underestimate the difficul-
ties inherent in the problem, but they are by no means insuper-
able. What is necessary is the preparedness to formulate a bold
policy and the will to carry it out.

In planning the development of our dairy industry, it is
essential that regions adapted to dairy farming should be
properly surveyed in all their aspects. Each of these regions
may then be divided into a number of 'dairy districts' and each
of these may be organized on co-operative lines so that the
industry may be freed from the grip of outside interests. The
security of land tenure for our dairy farmers, the reservation
of grazing land, the development of collective economy in
milk production and distribution and of mixed farming would
lay the foundation of progress of dairying in India. While
adopting scientific technique in the methods of production and
distribution of dairy products, our aim should be to avoid a
large-scale factory system. The difficulties arising from the lack
of communications and transport facilities, or from the cir-
cumstances which make it impossible to employ scientific
technique, should concern those who are now responsible for
the welfare of the people.

But it should be realized that no positive advance in the
development of the dairy industry is possible without building
up high-yielding herds of milch cattle and that by increasing
the yield of Indian cattle we may succeed to a great extent in
reducing the cost of milk production. It is necessary that every
step leading to the improvement of indigenous strains of cattle
should now be taken and that the provision of financial assis-
tance for the purpose should be adequate. We cannot suggest
a single measure which would contribute more to the solution

T 293

FACING THE PROBLEMS IN INDIA

of nutritional problems in India than the improvement of the
milk-producing stock of the country.

Development of Indian Fisheries

We have already referred to fish as a source of animal pro-
teins. The extent to which the protein deficiency in the normal
diets of the people may be satisfied by the development of
fisheries is shown by Japan. As soon as it was demonstrated
that fish was one of the easiest and cheapest means of providing
good proteins in a densely populated country, where the poverty
of the masses would ordinarily limit them to a dietary utterly
deficient in necessary proteinous foodstuffs, the Japanese Gov-
ernment lost no time in exploiting this abundant resource which
undoubtedly serves to maintain the nutritional balance of the
millions in Japan to-day. This consumption of sea products is
the chief reason why Japan's imports of land-produced food-
stuffs are so comparatively small in spite of the congestion of
population. The total value of annual catches in Japan proper is
about 250 million yens,* of which 64 per cent is by coastwise
fishery, 25 per cent by deep sea fishery, 8 per cent by inland
fisheries, and 3 per cent by trawling. From a single motor fish-
ing boat in 1 906, the number now exceeds 50,000. The Japanese
thus extend their fishing operations to distant seas and have
steadily increased their share of the world's total sea fishery
production until in 1933 it reached the level of over 35 per
cent. Leaving 10 per cent for export, they consumed over 25
per cent of all the sea products taken throughout the world;
and with these Japan has built up an extensive industry.

The irregularities in the supply of fish are partially met by
canning which has led to the popularity of crabs, lobsters,
shrimps, and other kinds of fish so abundant in certain sea-
sons but so susceptible to rapid deterioration unless promptly
preserved. The tough and muscular fish (e.g. the skate) are
made into a kind of loaf called 'Kamaboka'. Fisheries yield a
very useful fertilizer made of dried fish refuse and non-edible
fish, which is extensively used in the garden-farms of Japan.
By all these means, the fishing industries of the country are
well organized and the interests of fishermen are protected by
* i yen=24'58d.
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DEVELOPMENT OF INDIAN FISHERIES

efficient trade associations. There are over 4,000 fishery guilds
with an aggregate membership of nearly 550,000.

Italy, ever since the advent of the Fascist regime, has suc-
ceeded in organizing the fishing industry on a comprehensive
scale. The 'grain campaign' initiated by the Government,
reduced the acreage under pasture and depressed meat pro-
duction; but the increased dependence of the country upon
imports for the supply of meat was not desirable. Consequently
the Government turned their attention to fisheries. Measures
to protect the interests of fishermen engaged in the industry
on a small scale by marketing regulations were taken in nearly
600 centres, and the efficiency of operating in high seas was
achieved by organizing corporations which now control over
1,300 motor-ships.

In contrast with the achievements of these two sovereign
States where the need of cheap proteinous foods is so urgent,
the backward and disorganized condition of fisheries in India
illustrates what little concern has been shown by her rulers for
developing the food resources of the people. In the province of
Bengal where the people have no prejudice against fish and
subsist, as we have seen, on a diet dangerously deficient in
proteins, the Government took no initiative in the matter of
organizing fisheries, although the Japanese had been operating
nearly fifty trawlers in the Bay of Bengal. Thirty years ago a
special officer was appointed in Bengal to investigate the prob-
lem of inland fisheries in the province and at a later period the
Government of Bengal and Madras established departments
of fisheries, but on the recommendations of the Retrenchment
Committee the department in Bengal was abolished. Their
record of achievement was disappointing. In Madras, through
the efforts of the Department, a considerable advance has been
made in the manufacture of fish oil and fish manure (guano)
but no substantial development can be recorded either in the
methods of fishing or in the condition of the fishermen. While
artificial fecundation and hatching enriched fisheries in other
countries, these methods do not appear to have had any suc-
cess under conditions obtaining in Bengal and Madras. No
attempts were made to pursue initial experiments and investi-
gations such as are conducted in the countries where fisheries
are regarded as an integral part of national food economy.

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FACING THE PROBLEMS IN INDIA
Even without adopting artificial fecundation, it is possible to
enrich Indian fisheries by exercising a strict control over the
practices of obstructing the watercourses and thus interfering
with the migration offish to their spawning grounds. It would
also be necessary to prevent free spill of rivers, canals, and tidal
creeks. It is known that 'weirs and bunds affect fisheries by
preventing the ascent of breeding fish to their spawning
grounds 5 ; but in laying out most of the irrigation works in India
the interests of the fishing industry have been ignored.

The report of an enquiry into the fisheries of Bengal in 1908
states: 'In Europe and America, as well as in Japan, there are
very stringent fishery laws having for their object the protec-
tion and preservation of fish, the securing of facilities for the
passage offish to their spawning and feeding grounds, and the
increase of control over fisheries in a various way. Even a
sparsely peopled country like Canada has found it necessary
to protect its fresh-water fisheries by direct legislative enact-
ments and by Orders in Council having the force of law. In
Canada and the United States especially, the combined effects
of artificial propagation and judicious protection are apparent
in the abundant supply of fresh-water fish which after satisfy-
ing local wants allows of large exports being made to other
lands. But Bengal presents a very different picture. In spite of
a magnificent system and of enormous water surfaces spread
over the country, fish is becoming scarcer every day, a result,
among other causes, of want of protective legislation. 5 The
report goes on to suggest certain laws to facilitate the migration
of fish to and from the breeding-places and recommends that
special provision should be made for the control of the main
channels and rivers throughout the Province.

*A general extension offish culture 5 , wrote Sir K. G. Gupta
in his official report, 'is to be welcomed not only on its own
account as adding to the food supply of the people but also
because it will materially help to prevent the dissemination of
malaria as the carp greedily devours mosquito larvae. . . .'
Certain varieties of fish found in Indian rivers, canals, and
tanks are known to be most efficient larvicides. The experi-
ments in breeding and supplying these fish to local bodies for
introduction into tanks and cesspools infected with mosquito
larvae have already shown satisfactory results.

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DEVELOPMENT OF INDIAN FISHERIES

That the potential resources of fisheries in India are vast and
capable of great development is now a recognized fact; but in
all problems relating to research on edible species, provision
of hatcheries in selected areas, organization for the training of
fishermen and, finally, marketing, the initiative for their solu-
tion must of necessity come from the Government. They
should face the problem with that firm resolve that charac-
terizes a nation fully conscious of its nutritional deficiencies.
But so long as the laisser-faire policy in matters that concern
vitally the health and well-being of the people persists, so long
as public opinion does not wake up to the realities of the
situation, and so long as vested interests either of the Govern-
ment as in Burma, or of the propertied classes, as in the areas
under Permanent Settlements, are allowed to dominate the
situation, there can be no hope of any improvement in fishery.

Public opinion in those parts of India where a large portion
of the people has no objection to the use of fish, should be
aroused in favour of such practical measures as are necessary
for the development of fisheries. The fact that fisheries and the
fish trade are mostly in the hands of special castes has no doubt
added to our difficulties in reconditioning the industry; but
these difficulties must be boldly faced. A number of co-opera-
tive societies have been started among fisherfolk but they are
neither adequate nor efficient for the purpose of overcoming
the hostility of vested interests. The educational work among
them has been equally disappointing.

One method of approach to the problem of Indian fisheries
is to attract industrial enterprise. There is no reason why
Indian fish products, such as dried and salted fish, and fish-
liver oil should not find a wider place in the world market.
Hilsa eggs (Clupea ilasah) may be added to the list of caviars;
the liver oil of some of our common fish may be found as rich
in vitamin as the cod or halibut oil of commerce; and lastly,
the internal and external markets for dried and salted fish are
capable of greater expansion.

Finally, we must urge upon the Federal and Provincial
Governments of India the imperative necessity of developing
both coast and river fisheries.

FACING THE PROBLEMS IN INDIA

Research, Training, and Propaganda

For the purposes of correct definition and adequate under-
standing of the problem of human nutrition, the essential steps
must be taken in the direction of research and training in
order to furnish a broad basis for effective propaganda and
action. Educational institutions in most of the advanced coun-
tries take an active part, as we have seen, both in research
and in the spread of knowledge in regard to nutritional require-
ments at different ages; and these are associated with various
voluntary organizations. In India there are no such facilities
for co-ordinated activities at present; but if any significant
measure of success is to be assured, it is of the utmost impor-
tance that at every stage of the educational system this problem
should receive adequate and earnest attention.

Impressed with the urgent need of research and training in
matters closely related to human nutrition the Royal Com-
mission on Agriculture in India recommended, ten years ago,
the establishment of a Central Institute; but the Government
of India took no steps in this direction and left the situation as
the Commission found it. In the Pasteur Institute at Coonoor,
which owes its inception to the generous donation of an
American, Lieut.-Colonel (now Sir) Robert McCarrison, was
then carrying on his pioneer investigations into various Indian
diets in their relation to health and disease. Those members of
the Commission who visited his laboratories and were able to
grasp the far-reaching significance of the experiments con-
ducted there realized that the facilities provided by the Indian
Research Fund Association were utterly inadequate and that
work of such importance should be closely co-ordinated with
agricultural research. The fund is administered by the Public
Health Commissioner with the Central Government and out
of about ^90,000 annually spent on the promotion of medical
research a sum varying between 6,000 and 7,500 is made
available to nutritional research. An additional block grant of
11,250 has recently been ear-marked for widening the scope
of nutritional investigations in India.

About three years ago when the subject of human nutrition
engaged the attention of the League of Nations, the Govern-

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RESEARCH, TRAINING, AND PROPAGANDA
ment of India appointed Dr. W. R. Aykroyd as the Director
of the Research Laboratories at Coonoor and an Advisory
Committee came into existence in 1936 for the purpose of
securing collaboration of medical practitioners, economists,
agricultural experts, and other interests in planning nutritional
research and propaganda in India.

The other institution directly concerned in the study of
human nutrition is the Department of Bio-chemistry in the
All-India Institute of Public Health recently established in
Calcutta. Both these institutions are now co-operating in a
special enquiry into the nutritive value of some 300 common
Indian foodstuffs, and already valuable data regarding their
energy-bearing and biological values, vitamin content, and in-
organic constituents have been accumulated.

It is, of course, realized that food investigations should
include not only the determination of nutritive values, but the
manifold aspects of production of foodstuffs. They should be
carried out in co-operation with the various social and indus-
trial organizations and should above all closely follow the tests
of the physiology of nutrition. In India a close investigation
into the physiology of nutrition is necessary as the basis of
exact research if we wish to ascertain correctly the state of
nutrition of the masses. Our knowledge of the basal metabolism
of various racial and occupational groups is inadequate and
carefully planned investigations should be undertaken in co-
operation with the universities, medical and other appropriate
institutions.

A French scientist of international fame once suggested to
me that India offered a unique opportunity for investigating
the problem of low metabolism, because there chronic under-
nourishment was common and the habit of fasting frequent.
Thorough investigations of a large number of people with a
low intake of food may throw open a new field of research in
the physiology of nutrition, and it is to be hoped that such an
inquiry may be undertaken by an international committee
under the auspices of the Health Organization of the League
of Nations.

We are indebted to Dr. Aykroyd for initiating detailed
inquiries into Indian dietaries. About seventeen diets resemb-
ling that of the various communities have been tested both by

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FACING THE PROBLEMS IN INDIA
chemical analysis and feeding experiments with rats. Based
upon the results obtained, investigations are being carried out
to ascertain the quality and quantity of diets supplied to a
number of residential institutions for school children in South
India. It is hoped that work of this nature will be extended to
other parts of India and will lead to comprehensive dietary
surveys of different communities and classes. The scheme of
training field workers for the purpose, recently adopted by the
Coonoor Institute, would be helpful in organizing diet-surveys
on a sound footing. These surveys should not only enable us to
make a proper assessment of the relative nutritive values of the
dietaries but should reveal many other essential facts to
which the problem of 'applied' nutrition is related. It should
be possible, for instance, to suggest how the agricultural con-
ditions of a locality may be adjusted to the nutritive require-
ments of the people and what special measures are necessary
to correct serious nutritional deficiencies. In order to obtain
a fair index of the dietary conditions prevailing in a given
community it is necessary to study a number of social and
economic factors governing its life and labour. And with the
advance of experience in conducting dietary surveys by skilled
nvestigators, it would be possible to evolve systems both
for the collection of data and for their critical classifica-
tion.

The type of dietary survey we suggest should include all
possible details of the working-class standard of living. To say
that a poor diet is a result of poverty is not very helpful.
Poverty must be analysed,' observes Aykroyd. The business of
these surveys should therefore consist of analyses of the system
under which poverty multiplies and assumes such a dangerous
proportion in India. We shall then have reliable evidence con-
cerning the problem of nutrition and poverty. In Great Britain,
Dr. M'Gonigle 87 has shown that a direct correlation exists
between wages and death-rate. Families with an income be-
tween 255, and 355. a week die, for example, at the rate of 25-96
per thousand, and between 653. and 755. a week, the rate falls
to 13-51; but when the income rises above 755. a week the
death-rate is 1 1-52 per thousand. Similar facts in regard to the
wastage of human life in India as a result of poverty are
necessary to arouse public opinion and to bring about a

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RESEARCH, TRAINING, AND PROPAGANDA

nation-wide campaign for establishing a legal minimum wage
to which we have already referred.

In selecting staffs for research work, care should be taken to
engage men with a broad scientific and social outlook. The
field of nutrition has constantly been handicapped', writes
Mellanby, 88 'because much of the work has been in the hands
of narrow specialists bio-chemists with little or no biological
or medical knowledge, and medical men with little or no
fundamental bio-chemical or physiological training. By any-
body with a wider grasp of physiological, bio-chemical, patho-
logical and clinical subjects, a rich harvest will be gathered.'
They must also be fully aware of the peculiar circumstances of
the country to which the results of their research have to be
applied. It is the application of the well-established results
derived from nutritional research to actual practice which is
of special importance. The basic needs for optimum health are
generally known but the difficulty lies in adjusting them to
economic and social circumstances. Indeed those who are
concerned with the problem of well-balanced diets for the
masses in India would require a great deal of skill in suggesting
how, as Aykroyd puts it, sixpence could be made to do the
work of a shilling.

But in a country where dietary customs have often a religious
bias by which certain foodstuffs are prohibited and others
included, where the people are ignorant of the actual food
values of the various foodstuffs easily available to them, where
both agriculture and animal husbandry are in a primitive
stage of development and where the need of corporate action
is so urgent it is obvious that there is great scope for education
and propaganda to furnish the driving power that is required
to stimulate the minds of the people to creative efforts.

Our primary and secondary schools do not possess any of the
essential features for successful nutritional education. Our
teachers are untrained even in the rudiments of knowledge of
the relation between health and nutrition; our school environ-
ment is as a rule depressing and unhygienic; funds available
for initiating any planned scheme for health education are
meagre, and there are social difficulties in dealing with prob-
lems that touch upon habits and customs deeply rooted in
communal traditions. But it is imperative that Indian political

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FACING THE PROBLEMS IN INDIA

leaders should face the problem with courage, and initiate
methods which in all civilized countries are regarded as essen-
tial for the making of a healthy nation.

Our Provincial Ministries should now concentrate their
efforts upon the training of teachers. In all Indian normal
schools and other institutions for the training of teachers, the
course of studies should include a broad outline of the prin-
ciples of dietetics and health. The course should be compulsory
and its subject-matter should be selected in consultation with
the Ministry of Health in the Province. It should be neither
'bookish 5 in character nor of an advanced technical level. On
the one hand, it is not enough for the teacher to know that
milk is an ideal food for growth, that it contains c good' protein
as well as some of the essential mineral substances such as
calcium and phosphorus, and that it supplies certain vitamins.
On the other hand, no attempt should be made to teach all the
complexities, for example, of the amino-acid contents of food-
stuffs. Methods of keeping records of the weighing and measur-
ing of pupils, technique of explaining the charts, capacity of
following such directions as may be given to him by the
Ministry of Health, and certain basic knowledge in regard to
the management of school gardens should form a part of the
curriculum.

For the diffusion of knowledge relating to health and nutri-
tion among the people, we have in Chapter Four offered a few
suggestions based upon the fundamental need of reviving the
corporate institutions in India. The effectiveness of propa-
ganda designed to ameliorate the conditions of life of the people
lies in removing such functional disabilities and insidious
influences- as have impeded the growth of initiative and respon-
sibility among local bodies. Once we succeed in arresting the
disintegration of these nuclei of our indigenous social organiza-
tion, the task of reaching the masses will be easy. We shall then
find the people willing to take their share in financing such
measures as are required for the improvement of health,
physique, and nutrition. It may then be possible to devise a
system of local taxation by which the communities themselves
would be trained in the spirit of self-help. An Indian author has
truly observed: The supreme need of public finance in India
under a system of responsible government is for the people to

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RESEARCH, TRAINING, AND PROPAGANDA

learn the difficult lesson of self-taxation for the public good.
They will never be disciplined in this, so long as taxes are
imposed only from above and expended for dimly understood
and distant provincial and national purposes. They can be
effectively schooled in this discipline only through intensive
development of local autonomy, including the right of impos-
ing local rates and duties and expending them for the better-
ment of their own immediate surroundings.' 89

Side by side with active collaboration in the research activi-
ties of the central institutes, the provinces should initiate and
pursue investigations in their own respective spheres through
their universities and other appropriate bodies. An integral
part of economic studies in each province should consist of diet
surveys in selected groups from each community. It should be
possible, for example, to take one or more groups in a given
area, making specific arrangements to ensure that they have
a well-balanced diet for a period of at least a year. Records of
such experiments may be effective from the point of view both
of research and propaganda. For the correction of any defici-
encies and the promotion of better health, the ultimate respon-
sibility now rests with the provinces, and their reliance upon
the Central Government is neither feasible nor desirable. In
each province there should be a central authority Food
Council concerned exclusively with all questions pertaining
to health and nutrition. Its function should not be merely
advisory and it should be empowered to initiate such plans as
may be warranted by the special circumstances in particular
areas. It should rest with this body to supplement and extend
activities of various official and voluntary organizations and
also to provide interrelating links between public health ser-
vice, education, agriculture, industry, and rural reconstruc-
tion; it should be empowered to supervise institutional feeding,
to inspect factories and shops where foodstuffs are preserved,
and to assist the Public Health Department in enforcing pure
food acts; as it should not be impracticable for the proposed
provincial food council to establish a number of food-stores
where the public may obtain food supplies of good quality at
a reasonable price.

It is not sufficient to bid governments and politicians to seek
means and methods of combating physical ill-health among the

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FACING THE PROBLEMS IN INDIA
masses of the population. It is essential to our purpose that
voluntary organizations should do their part in full measure.
The movement for spreading the knowledge of the proper kind
of food among the masses can succeed only in so far as it draws
within its orbit a band of public-spirited workers. They must
be in touch with the people and should be able to advise how
their meagre incomes may be economized so that they may
consume more milk, fruits, vegetables, and wheat. They should
keep a vigilant watch over the flood of useless commodities,
such as Japanese goods, cheap utensils, foreign toys, patent
medicines of all sorts, gramophones, etc., which find their way
to our village markets and fairs. They should impress upon the
masses that any unnecessary expenditure is an antisocial act
so long as they have to struggle with undernourishment and
malnutrition, and that the stress of their conditions of life
demands strict economy. The other advantage of voluntary
organizations is that through them the public would be kept
informed of the actual state of nutrition and the slow and pon-
derous parliamentary machinery would not be allowed to rest
until positive measures are adopted for facing the problem in
India.

Then there is the problem of making the necessary financial
provision for carrying out all those measures that are necessary
to mitigate the ravages of the spectre of malnutrition. With all
goodwill and sympathy, the Provincial Legislatures may not be
able to find adequate finance for the purpose of taking initia-
tive in raising the general low level of health and nutrition. It is
not enough to start Provincial Autonomy with its budgets 9 just
balanced and to place the deficit provinces on a bare subsis-
tence level' by subventions from the Central Government. Most
of the provinces would need a substantial programme of
capital expenditure for offering increased facilities for the
improvement and expansion of the departments concerned
with the welfare of the Indian masses. Personally I am not
hopeful of any relief through a reduction in the expenditure on
the regular services, defence, maintenance of law and order,
courts and general administration. The system of bureaucracy
which holds India under its grip does not make for economy.

The reorganization of agriculture alone would need ample
resources and the readjustment of economic factors in relation

304

RESEARCH, TRAINING, AND PROPAGANDA

to farming must of necessity involve a considerable financial
strain upon the State. As Sir John Orr put it, the marriage of
health and agriculture could not take place 'without the gold
wedding ring 5 . The task of mitigating the suffering and econo-
mic loss caused by dietary deficiencies and of building a
healthy race has to be undertaken on a comprehensive scale
and demands an intensive mobilization of 'men, money, and
munition'.

The outstanding responsibility of our public men belonging
to all sections of the Indian communities is, therefore, to lend
their support to any proposal even though it may involve a
certain amount of financial sacrifice on their part. Every pos-
sible avenue must be explored for the purpose of financing
research, organization, determined campaigns and ameliora-
tive measures in regard to health and nutrition; but the prob-
lem of additional taxation has to be viewed with great caution,
bearing in mind that the present system is not equitably
adjusted in relation to the interests of the consumer. His burden
is already excessive; and this being so, it should be the guiding
principle of any measure enacted for the purpose of revenue to
give our indigent population every possible relief, and to look
to those who have been and are benefited by 'prosperous*
India for increased taxation. In this connection, the official
attitude, as revealed by Sir James Grigg, the Finance Member,
in a recent address before the Indian merchants in Bombay i
of interest. Referring to the urgent need of reassessing Indian
tariffs, he observed: 'The objects of this examination are, so far
as the Revenue Tariff is concerned, first, to see whether the
tariff is fully efficient as a revenue-producing instrument, and
secondly, to see whether it can be simplified in the interests of
the commercial community. I pass over a third object, namely,
the interests of the consumer, whom it is usually considered
bad form to mention in commercial circles, because to do
anything substantial for him, would as I have several times
said in the Assembly cost more money than is likely to be
available in the immediate future. 9

But now that the supreme responsibility of changing the
direction of the financial policy of the Government rests with
us, we must remember die mass of people who are under-
nourished and live in circumstances of extreme poverty. It is

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FACING THE PROBLEMS IN INDIA

for us to find adequate financial resources for the development
of services which are of direct benefit to the masses without
increasing their burden. India, however, as Layton points out
in the Report of the Indian Statutory Commission, is 'a coun-
try in which there are large accumulations of wealth on which
the burden of Government rests very lightly'. Those who are
now at the helm of public affairs in India must also realize that
e the economic preservation of a people 5 , to quote Engels, 'is
based on the principle that every generation pays back fully
and with interest the capital spent upon it for education and
vocational training. This is effected by its upbringing of a new
generation. Upon this generative foundation rests the secret of
every human economy, and the essence of true national wealth.*

We have attempted in this volume to summarize the know-
ledge which we possess of the relation of food and health, and
have adduced sufficient evidence to show that ill-health among
the greater part of the population in India is due to both
quantitative and qualitative dietary deficiencies. The slow
increase in the total production of food and the backward state
of agriculture involve a grave danger of widespread physical
deterioration specially among the growing generation. There
are two avenues which we must explore if any appreciable
advance is to be made in the standards of living for our people
as a whole; one is the co-ordination of all efforts towards
increased productivity; the other an organized campaign for
the elimination of waste of every form which characterizes our
economic and social life. ^

One of the effective means of^pproaching the problem is of
course the application of science to our material needs. In
building up our own State in India, nothing is of more impor-
tance than serious attempts to incorporate scientific ideas in its
administration and constructive activities. No modern State
can progress without encouraging a wider and wider applica-
tion of science to life.

Owing to the vastness of the country, and to the heterogeneous
conditions of living of its diverse peoples, the task is not easy.
The situation has become so entangled in the peculiar circum-
stances of our social and economic life that the problem of
improving the health and nutrition of the people may even

306

RESEARCH, TRAINING, AND PROPAGANDA
appear insoluble. But it is our firm conviction that concerted
action of all concerned in the improvement of the health and
well-being of the nation cannot but lessen the gravity of the
situation. It may also create a sense of responsibility among the
people themselves. Once the masses become courageous enough
to challenge the circumstances which bring them to the pitch
of misery; once their conditions waken the privileged classes to
the realization of the sinister forces which allow the state of
health, nutrition, physique, and happiness of the bulk of the
people to come to such a pass; and once the balance sheet of
social economy is presented without ambiguities once such
awakening comes about, the Governments of the country will
not be slow in adopting progressive measures. With us in India
it is not merely a question of livelihood; nor do we estimate the
health of our people only at its economic value. The deplorable
consequences of ill-health and undernourishment lie in arrest-
ing the growth of man as a full personality. To quote the words
of Carlyle, 'It is not to die, or even to die of hunger, that
makes a man wretched; many men have died; all men must
die the last exit of us all is in a fire-chariot of pain. But it is
to live miserable we know not why; to work sore and yet gain
nothing; to be heart-worn, weary, yet isolated, unrelated, girt
in with a cold universal laissez-faire?

37

APPENDICES

L Maternal Mortality in Some Other Countries of the
World.

II. Birth and Death Rates in British India (1901-34).

III. Milk Production and Consumption in India.

IV. Principal Food Crops of India.

V. Statistics of Excise Revenue in British India.
VI. An Approximate Estimate of Food Production in India.

VII. Diagram showing an insufficient and ill-balanced diet,
with an adequate and well-balanced diet. (By kind
permission of the Nutrition Research Laboratories, I.R.F.A.,
Coonoor.)

VIII. Nutritive Values of Diets in Common Use in the Five
Main Divisions of India. (jB^ kind permission of tfie
Royal Society of Arts.)

39

APPENDIX I

Maternal Mortality in Some Other Countries of the World
(compiled from different sources)

C om t r Maternal Mortality

J per 1,000 births

Holland 2-4

France 2-5

Sweden 2 '6

Denmark 27

Norway 27 .

Italy 2 -9

Japan 3-0

England and Wales 4*1

Switzerland 4-5

New Zealand 47

Irish Free State 4*8

Australia 5*9

Scotland 6*3

United States of America 8*5

(According to Sir John Megaw of the Indian Medical Service
the figure for India exceeds 24 per 1,000 births. The Public Health
Commissioner in his latest annual report says that the rate of
maternal mortality is 24-5 per 1,000 live births.)

APPENDIX II

Birth and Death Rates in British India (1901-34)

p , Birth-rate Death-rate

wa permille per milk

1901-10 38 34

1911-20 37 34

1921-30 35 26

1931 35 25

1932 34 22

1933 34 22

1934 337 24-8

t|L

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cp co ^ i op d co r^ r-*op g> coco co

o. S"?-9
ob r* coco

d coco m r- o

in d cb coihf^cb 6 o>

co co o Th in

d cri ^ *- cr^cp o 9 T
ob6d4j*o)h6 coo

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o
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coco t^

^cp n co "ncp

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co in

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co

r^ coco op co r*

in 6 4t* 6 co co d
co co cooo d co o

CO *- >- - >-4

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r^ - co mco

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co co d coco o d co **

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-*oooooo ooooo^o

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co or cp co co

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co

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316

APPENDIX VII

ILL- BALANCED DIET

GREEN - LEAFY

VEGETABLES

OSOZS

2,600 CALORIES.CORRESPONDING TO AVERAGE ADULT INTAKE PER DAY

WELL-BALANCED DIET

GREEN-LEAFY

VEGETABLES

4OZ5

FRUITS
20ZS

2600 CALORIES, CORRESPONDING TO AVERAGE ADULT INTAKE PER DAY

NUTRITION RESEARCH LABORATORIES. I.R.F.A.
COONOOR

jfl.r j: JUi> JLJJL./X v j

NUTRITIVE VALUES OF DIETS IN COMMON

Rclatiuc. oalucs of
the National Diets
of India.

Leprosy

Gastric and Duodened Ulcer

USE IN THE
FIVE MAIN

DIVISIONS OF
INDIA.AS

DETERMINED
BY FEEDING

EXPERIMENTS
ON RATS,

COMPARED WITH

THE FREQUENCY

DISTRIBUTION

OF CERTAIN

DISEASES PER

1000 OF SICK

PERSONS IN

THESE

DIVISIONS.

Pulmonary Tuberculosis.

Bcri-Beri

Diarrhoea and Dysentery

318

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5. TERROINE, E. F.: Report on the Protein Component of the

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6. BURNET, ET., AND AvKRpYD, W. R.: 'Nutrition and Public

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7. MCCARRISON, SIR ROBERT: 'Nutrition and National

Health 5 (Cantor Lectures of the Royal Society of
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8. DIAMARD: Quoted in The Chemistry of Food and Nutrition by

H. C. Sherman.

9. CATHCART, E. P. : The Influence of Fat and Carbohydrate

on the Nitrogen Distribution in the Urine 3 . Bioch. Jour.,
vol. XVI, 1922.

10. SHERMAN, H. C.: The Chemistry of Food and Nutrition, 1933.

11. ORR, SIR JOHN, AND LEITCH: Iodine in Nutrition (Med.

Res. Coun. Special Rept. No. 123, 1929).

12. MCCARRISON, SIR ROBERT: 'Problems of Nutrition in

India 5 , Nutri. Abs., vol. II, 1932.

13. THE INTERNATIONAL LABOUR OFFICE: Workers' Nutrition

and Social Policy (1936).

14. NEWMAN, SIR GEORGE: Report of the Chief Medical Offi-

cer, Board of Education, Great Britain (1908-18).

15. EMERSON, W.: Nutrition and Growth in Children (1923).

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1 6. BURNET, ET., AND AYKROYD, W. R.: Nutrition and Public

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17. BENEDICT, F. G.: Human Vitality and Efficiency under Prolonged

Restricted Diet (Carnegie Inst. of Washington, 1919).
17^. AYKROYD, W. R.: Vitamins and Other Dietary Essentials

1 8. GRAY, C. E.: The Food of Japan (League of Nations C.H.

681, 1928).

19. BALFOUR, MARGARET: 'Early Infant Mortality in India

with Special Reference to Premature Birth 5 , Ind. Med.
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20. MELLANBY, E., AND GREEN, H. N.: c Rat Technique for

Demonstrating Interfering Effect of Cereals on Bone
Calcification', Bioch. Jour., vol. XXII, 1928.

21. OSBORNE, T. B., AND MENDEL, L. B.: The Relation of

Growth to the Chemical Constituents of the Diet 3 ,
Jour. BioL Ghent., vol. XV, 1913.

22. JEANS AND ZENTMIRE: 'A Clinical Method for Determining

Moderate Degrees of Vitamin A Deficiency', Jour. Am.
Med. Ass., vol. CII, 1934.

23. McCARRisoN, SIR ROBERT: 'Further Researches on Stone',

Ind. Jour. Med. Res., voL XVIII, 1931.

24. FUJIMAKI: Report of the Imperial Institute for the Study

of Nutrition (1921).

25. MAURER AND LOH SENG TASK 'The Effect of Partial De-

pletion of Vitamin B Complex upon Learning Ability
in Rats', Jour, of Nutri., vol. IV, 1931.

26. WILLS, D. C., AND TALPADE, L.: 'Survey of Dietetic

Conditions of Women in Bombay', Ind. Jour. Med. Res.,
vol. XVIII, 1930.

27. EVANS AND LEPKOVSKY: 'Effects of Variations in the Diet

upon the Vitamin B Requirement', Jour. Nutri. vol. II,

1929

28. PIRQUET, E.: 'Rickets in Vienna', Med. Res. Com., vol.

LVII.

29. WILSON, D. C.: 'Rickets among Indian Children of School

Age', Ind. Jour. Med. Res., vol. XVIII, 1930.

30. WILSON, D. C., AND SURIE, ELLA: 'Dietary Factors in the

Aetiology of Osteomalacia', Ind. Jour. Med. Res., vol.
XVII, 1930.

320

LIST OF REFERENCES

31. SCOTT, A. C.: 'A Contribution to the Study of Osteo-

malacia in India', Ind. Jour. Med. Res., vol. IV, 1916.

32. MELLANBY, M.: 'Diet and the Teeth', Med. Res. Coun.

Kept 140, 153, 191.

33. WILSON, D. C., AND SURIE, ELLA: 'A Preliminary Note on

the Incidence of Rickets and Dental Caries among School-
children in India', Ind. Jour. Med. Res., vol. XVII, 1930.

34. BRIDGES, M. A.: Dietetics for the Clinician (1935).

35. SHERMAN, H. C.: 'Some Quantitative Aspects of the

Mineral Metabolism', Nutri. Abs., vol. I, 1932.

36. CHIEF MEDICAL OFFICER: Annual Report of the Ministry

of Health, Great Britain, 1933.

37. STRAUSS AND CASTLE: The Etiology and Treatment of

Anaemia in Pregnancy 5 , Amer. Jour. Med. Sci., 1932.

38. STOTT, H., AND OTHERS: 'The Distribution and Cause of

Endemic Goitre in the United Provinces', Ind. Jour.
Med. Res., 1931.

380. McCARRisoN, SIR ROBERT: The Problem of Endemic
Goitre', Bri. Med. Jour., 1937.

39. EWART: 'Study of the Relation between Economics and

Tuberculosis', Proc. Roy. Soc. M., 1923.

40. CUNNINGHAM, J. : 'Dysentery in East Bengal', Ind. Med.

Gaz., vol. LVIII, 1923.

41. READ, MARGARET: Indian Peasant Uprooted (1933).

42. DAS, SIR KEDARNATH, AND MAHALANOBIS, P. C.: A Pre-

liminary Note on the Rates of Maternal Deaths and Still-
births in Calcutta (Sankhya, 1933).

43. WILLS, L., AND MEHTA, M. M.: 'Studies in Pernicious

Anaemia of Pregnancy', Ind. Jour. Med. Res., vol. XVIII,
1930.

44. BALFOUR, MARGARET: 'Maternity Conditions and Anaemia

in the Assam Tea-gardens', Jour. Ass. Med. W. /., 1933.

45. THEOBALD, G. W.: 'The Aetiology and Prevention of the

Toxaemias of Pregnancy', Bri. Med. Jour., 1933.

46. AYKROYD, W. R., AND RAJAGOPAL, K.: 'The State of

Nutrition of Schoolchildren in South India', Ind. Jour.
Med. Res., vol. XXIV, 1936.

47. MCCARRISON, SIR ROBERT: 'A Good Diet and a Bad one:

An Experimental Contrast 3 , Ind. Jour. Med. Res., vol.
XIV, 1927.

321

LIST OF REFERENCES

48. WILSON, D. G.: 'Osteomalacia in the Kangra District 5 ,

Ind. Med. Res., vol. XVIII, 1931.

49. BALFOUR, MARGARET: 'Diseases of Pregnancy and Labour

in India, with a Special Reference to Community',
Trans. F.E.A.T.M., Seventh Congress, 1929.

50. VAUGHAN, K. : The Purdah System and its Effect on Motherhood

(1928).

51. WILSON, D. C.: 'Osteomalacia Studies', Ind. Jour. Med. Res.,

vol. XVIII, 1931.

52. WRIGHT, LT.-COL. R. E.: 'An Account of Keratomalacia',

quoted by Aykroyd in Human Nutrition and Diet (1937).

53. AYKROYD, W. R., AND KRISHNAN, S.: 'Stomatitis Due to

Vitamin Deficiency', Ind. Jour. Med. Res., vol. XXIV,
1936.

54. MCCARRISON, SIR ROBERT, AND RANGANATHAN, S.: 'Re-

searches on "Stone" ',/wrf. Jour. Med. Res.,vol. XIX, 1931.

55. MEGAW, SIR JOHN: 'Diet as a Possible Factor in the Causa-

tion of Stone in the Bladder in the Punjab 5 , Ind. Med.
Gaz., 1933.

56. 'Ascorbic Acid in Bengal Milk 5 , Lancet, 1935.

57. SCHWARTZE: 'Destruction of Vitamin C in the Boiling of

Milk 5 , Jour. ofNutri., 1930.

58. ABT. AND FEINGOLD: 'The Use of Buttermilk and Milk

Derivatives in the Concentration of Infant Food 3 , Arch,
fed., 1930.

59. SEYMOUR-JONES: 'Forms of Milk Available', Food Industries,

1930.

60. HESS, A. E.: 'The Therapeutic Value of Egg-yoik in

Rickets', Jour. Am. Med. Ass., vol. LXXXI, 1923.

61. RANGANATHAN, S.: 'Effect of Storage on Vitamin C Poten-

cy of Foodstuffs', Ind. Jour. Med. Res., vol. XXIII, 1936.

62. CHOPRA, R. N., AND ROY, A. C.: 'A Proteolytic Enzyme

in Cucumber', Ind. Jour. Med. Res., vol. XXI, 1933.

63. JOHNSTON, J. H.: 'Place of the Banana in Diet of Children',

Jour. Am. Diet., vol. Ill, 1928.

64. DE, N. K.: 'The Possible Use of Red-Palm Oil in Supple-

menting the Vitamin A Activity of Common Vegetable
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65. HALDANE, J. B. S.: The Inequality of Man and Other Essays

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LIST OF REFERENCES

66. MILLER, R. J., AND HIS ASSOCIATES: 'Influence of Tea,

Coffee, and Cocoa upon Digestion', Am. Jour. PhysioL,
1920.

67. BRAY: Proceedings of the Royal Society of Medicine,

I930-

68. WEN-CHAO MA: The Use of Soya-Bean Lecithin in Curing

Opium Habit 5 , Trans. F.E.A.T.M., gth Congress, 1934.

69. AYKROYD, W. R., AND KRISHMAN, S.: The State of Nutri-

tion of Schoolchildren in Three Towns of South India',
Ind. Jour. Med. Res., vol. XXIV, 1937.

70. AYKROYD, W. R., AND KRISHMAN, S.: 'State of Nutrition of

Schoolchildren in Residential Hostels in South India',
Ind. Jour. Med. Res., vol. XXIV, 1937.

71. CHOWDHURY ROY, A. C.: Enquiry into the Standard of Living

of Jute Mill Workers of Bengal (1929).

72. CATHCART, E. P., AND MURRAY, A. M. T.: 'Studies in

Nutrition', Report Med. Res. Coun., No. 165, 1932.

73. BALFOUR, MARGARET: 'The Maternity Conditions of

Women Mill Workers', Ind. Med. Gaz., May 1930.

74. ORR, SIR John: Food, Health, and Income (1936).

75. BURNET, Ex., AND AYKROYD, W. R.: 'Nutrition and Public

Health 3 , Quart. Bull. Health Org. (League of Nations),
vol. IV, 1935.

76. LEAGUE OF NATIONS: 'Nutrition in Various Countries', The

Problem of Nutrition, vol. Ill (1936).

77. LEAGUE OF NATIONS: Problem of Nutrition, vol. I (1936).

78. LEAGUE OF NATIONS: 'Statistics of Food Production, Con-

sumption, and Prices', The Problem of Nutrition., vol.
IV (1936).

79. LEAGUE OF NATIONS: Final Report, The Problem of Nutrition

80. INTERNATIONAL LABOUR OFFICE: Workers' Nutrition and

Social Policy (1936).

81. CLARK, L., AND BRINTON: Men., Medicine, and Food in the

U.S.S.R. (1936).

82. AYKROYD, W. R.: Human Nutrition and Diet (1937).

83. BLEDISLOE, LORD: Science and the Farmer (1935).

84. McCARRisoN, SIR ROBERT: 'Influence of Irrigation on the

Nutritive Value of Rice', Ind. Jour. Med. Res., 1928.

85. CARREL ALEXIS: Man the Unknown (1935).

323

LIST OF REFERENCES

86. LEVY AND Fox: 'Antiscorbutic Value of Lucerne 5 , Bic

Chemical Jour.y 1935.

87. M'GONIGLE, G. d M.: Poverty and Public Health (1936).

88. MELLANBY, E.: Nutrition and Diseases, 1934.

89. AN INDIAN STUDENT OF POLITICAL SCIENCE: The Key i

Freedom and Security in India (1933).

3*4

INDEX

\berdeen, anaemia in, 109; Rowett
Research Institute, 245

ibortion, 98

\bt, 169

\cton, Major, 134

igriculture, application of science
to, 278-9; disequilibrium be-
tween agricultural and industrial
production, 1 7-1 8, 2 0-2 1 . See also
under various countries; and under
animal husbandry, etc.

\hmad, B., 183 n.

Ahmedabad, textile workers' family
budgets, 221

Akikuyu, the, 65, 245

alcohol, 191-6

alcohol neuritis, 192

All-India Conference of Medical
Research Workers, resolution of,
118

All-India Women's Conference,
resolution of, 132

allotments, 289-90

almorlds, 57

alum, 1 68

American Child Health Associa-
tion, assessment of malnutrition,

85

anaemia. See under deficiency dis-
eases

angular stomatitis, among children
in south India, 131, 215

animal calorimeter, 38-9; hus-
bandry, 29 1-4; nutrition, 16, 279

animal products in diets, 43-4, 48,
56, 75, 144, 209-12

animo-acids, 42-3, 44, 47, 60, 61,
72-3, 163, 174, 181, 210

aniseed, 190

apples, 54

ascorbic acid, 54

asparagus, 176

Assam, maternal mortality, 129

Astor, Lord, 240

atta, 1 80

Atwater, 62, 67, 68

Austria, food relief measures, 264

Aykroyd, W. R., on agricultural
policy, 281; diet proportions, 69;
energy requirements, 63; health
of schoolchildren, 131, 212-13,
215; hunger, 87; Indian dietary
standards, 233-4, 299-300, 301;
milk to schoolchildren, 257; pel-
lagra, I43;osteomalacia, i05;un-
milled rice, 137; vitamins, 51-52

Aykroyd, W, R., and Burnet, Et,
anaemia, 109; assessment of
malnutrition, 85-6; calorie re-
quirements, 67; dental caries,
105; diet, 75, 250; factory meals
in U.S.SJL, 251; fat and carbo-
hydrates in diet, 68; food preser-
vation, 55; protein, 64-5; Report
on Nutrition and Public Health, 238-
239; thermodynamic principles,
49; vitamins, 70-1

Bacon, Sir F., 37, 78

Balfour, Margaret, 129, 139, 223,

230

bananas, 53, 54
barley, 98, 100, 193
basal metabolism, definition and

determining factors of, 39-41, 62
Baumann, 109

325

INDEX

beans, 36, 176, 181
bean-sprouts, 177
beef, 47, 125, 174
beer, 192
beetrootj 176

Belgium, blindness in, 142 n.
Benedict, F. G., 39
Bentley, Dr., 125
Berezeller, 287

beri-beri: infantile beri-beri, 253;
and rice, 93 and n., 135 sqq., 181,
247; symptoms, 97-8; and toddy,
194; and vitamins, 51 n. t 73, 96
Berlin Conference, 1932. See Vita-
min Standardization, Second
Conference on
Bernard, C., quoted, 35
Berzelius, 57
Bihar: health of schoolchildren,

131; infant mortality, 126
biscuits, 183-4
Shot's spots, in India, 131
Bledisloe, Lord, 278
blindness, 142 and n.
Bloch, C. E., 94
body tissues, 56, 72-3, 74, 107
Bombay: clinical observations in,
96; family budgets, 219, 221,
223; housing conditions, 122; in-
fant mortality, 126; rickets, 104;
Textile Labour Union, 218
Bradfield, Major-General, 117
bran, 180-1
Bray, 194
Brazil: burning of coffee, ai; kera-

tomalacia, 95
bread, 58, 93, 97, 183-4
Bridges, M., quoted, 107
Bright's disease, 210
brinjal, 178
Brinton, N. See Clark, V., and Brin-

ton, N.

Bruce, S. M., 239, 276
Burnet, Et. : dropsy in Sierra Leone,
134. See also Aykroyd, W. R., and
Burnet, Et.
Burton, R., Anatomy of Melancholy,

36

butter, 56, 58, 128, 142; composi-
tion of, 167; vitamin A content,
53; vitamin D content, 55

buttermilk, 169

Buttes, H., treatise on foodstuffs, 36

cabbage, 36, 54, 100, 110, 176

caffeine, 191

calcium: consequences of deficiency
of, 107-8, 1 10, 138-9, 140; daily
requirements, 70; dental caries,
105; in eggs, 171; in fish, 172;
formation of bones and teeth, 57;
incidence of stone, 143-4; in milk
and cheese, 75, 163, 165, 169; in
millet, 1 80; pyorrhoea, 106; and
vitamin D, 103-4; m water, no;
in whey, 1 70

Calcutta: All-India Institute of
Hygiene and Public Health, 30,
148, 154, 299; Eden Hospital,
128; infant mortality, 126; Medi-
cal College, 145; School of Tropi-
cal Medicine and Hygiene, 147,
148; Students' Welfare Com-
mittee, 215

calories: human requirements of,
39 and n., 40-1, 46, 62 sqq., 69,
72, 73, 233, 250; place in nutri-
tion, 64; theory of, 16

Cambridge, nutritional research,

245

cane sugar, 170

canning, 55, 173, 294

carbohydrates, 48-9; action of curd
on, 1 68; caloric value, 72; de-
ficiency in, 90-1; chemical radi-
cals, 60- 1 ; and deficiency of
calcium, 108; dietary standards,
68, 69; foods containing excess of,
155; in milk, 162, 163; supply of
energy, 74

carcinoma, 95, 190

Carlyle, T., quoted, 307

carotene, 53, 70 ., 138, 188

Carrel, A., 283

carrots, 36, 96, 1 10, 176, 177-8; vita-
min A content, 53; vitamin B, 54

326

INDEX

Cartier, J., 100

Casale, 98

casein, 168, 170, 181, 287

Castle, 109

Cathart, E., 64, 220

cattle, number reduced in Den-
mark, 21

celery, 176

cereals, 53, 55, 75, 159, 178-81

Charaka, 77

Cheadle, 102

cheese, 36, 54, 56, 57, 58, 128; cal-
cium content, 75; consumption in
India, 169; Indian imports and
exports, 167

Chile, reduction of sheep in, 21

chillies, 54, 190

China: beri-beri, 97; osteomalacia,
105

Chopra, Lieut-Col., 195; and
alcohol, 193-4; cause of dropsy,
134; and cucumber, 178; and
koknar, 195

Chossat, 102

Chowdbury, A. C., 218

chutney, 190

cinnamon, 190

cirrhosis of the liver, 192

citric acid, 168

citrous fruits, 54, 1845

Clark, V., and Brinton, N., health
conditions in U.S.S.R., 250, 251,
255, 262-3

clove's, 59, 190

cocaine, 196

coco-nut, 186-7, J 88, 193

cod-liver oil: composition of, 58;
and cure for keratomalacia, 95;
dental caries, 106; in diet, 56;
iodine content, 59; and retinal
defects, 142; and rickets, 102,
104; and vitamin A, 53, 55

coffee: burnt in Brazil, 21; con-
sumption in India, 191

Coimbatore, infantile mortality in,
127

coleworts, 36

condensed milk. See milk, condensed

conservation of energy, 38, 40

constipation, 96

Cook, Capt., 100

cooking, 80; in India, 203-5

Coonoor, Research laboratories,
298-9; diet research, 30, 300;
investigation into amaranthus
and drumstick leaves, 176; nutri-
tive value of peas, 181; red palm
oil, 1 88; work of Sir R. McCarri-
son at, 149, 230, 298

coriander, 59, 190

cotton, ploughed under in U.S.A.,
21

cotton seed, 168

country spirit, 192-3

Cowgill, 70

crab, 59

cream, 167

cucumbers, 36, 178

Cunningham, J., 121

curd, 1 68

dahi. See curd

Danzig, goitre in, 109 n.

Darling, M., 24

Das, J. L., 214 n.

dates> 53, 58, 185, 193

Deccan plateau, diet characteris-
tics of the, 207-8

deficiency diseases: beginning of
research in, 50; diet and dis-
ease, 77-9; discovery of vita-
mins, 73; and malnutrition,
77-88, 89-110; possibility of
abolition, m; prevalent dur-
ing and after Great War, 1 9
Various diseases: anaemia: hook-
worm infection, 124; infantile
anaemia, 126; iron deficiency,
108-9, 2 53i pernicious anae-
mia, 128; pregnant anaemia,
I2 9 !39> 253; angular stoma-
titis, 131, 215; beri-beri, see
beri-beri; carcinoma, 95, 190;
dental caries: among school-
children, 256; in Central Pro-
vinces, 131; deficiency in vita-

327

INDEX

deficiency diseases, contd.

min D, 252; and mineral
deficiency, 105-6, 140; in
North-West Frontier Province,
141; dropsy, 98, 134-5; gastro-
intestinal disorders, 133-4, 170;
goitre, 109-10; hemeralopia,
92, 95; keratomalacia: dis-
covery of vitamins, 73; in
India, 141; and skin condition,
143; and vitamin A deficiency,
94-5, 247; malaria: in India,
115; and price of foodstuffs,
78; in south-east Russia, 19-
20; oedema, nutritional, 19;
osteomalacia: calcium defici-
ency, 107; during Great War,
19; during pregnancy, 139,
253; vitamin D deficiency, 104-
105, 138-40; pellagra, 98-9,
143; phrynoderma, 131, 215;
pyorrhoea, 106, 140; rickets: in
Central Provinces, 131; and
cod-liver oil, 55; and con-
densed milk, 1 70; during Great
War, 15; excess of fat, 155; and
hypoplasia of the teeth, 106;
excess of iron, 59; in school-
children, 131, 256; vitamin D
deficiency, 101-4, 138-9, 252;
vitamins, 73; and yolk of eggs,
172; scurvy: among children,
253; citrous fruits, 100, 184;
history and cure of, 100; vita-
min deficiency, 52, 93, 101,
249; stone, 36; vitamin and
mineral deficiency, 143-4; tu-
berculosis: in India, 115-16,
117-18; relation to poverty
and malnutrition, 116-17, 2 53>
xer ophthalmia, 215. See also
under various countries, e.g. India

de la Warr, Lord, 239

delirium tremens, 192

Denmark, destruction of cattle, 2 1

dental caries. See under deficiency
diseases

diabetes, in India, 118-19

Diamard, 59

diet: composed of animal or vege-
table products, 43-4, 48, 209-12;
criteria for assessing, 74-5. See
also under food; nutrition; mal-
nutrition

dietary standards, 49-50, 61-71,
73> 233-4; table of > 68

dietary surveys, 300

'digestive utilization' of foods, 45

Dodge, G., 289

dropsy, 98, 134-5

Drummond, Prof., 51 n.

Dubini, 124

dysentery, 121

eclampsia, in India, 129

eggs: 171-2; biological value in

combination, 48; in diet, 128;

and osteomalacia, 140; protein

value, 42, 44; and rickets, 102;

vitamin content, 53, 54
egg yolk: mineral content, 57, 58;

vitamin content, 55, 96
Egypt, blindness, 142 n.
Eijkman, 50, 93
Elyot, Sir T., 36
Emersori, W., 84
Engels, F., 306

England. See under Great Britain
ergosterol, 103
Ewart, 116-17

famine, in eastern Europe, i$

Far-Eastern Association of Tropi-
cal Medicine, and milled rice,
136-7

fats: 187 sqq.; in butter, 167;
calorie value, 69, 72; deficiency
in, 91; and energy, 48-9, 66, 68,
74; excess of, no, 155; in milk,
162; and vitamin A, 53; and
vitamin D, 55

fatty acids, chemical formula of,
60, 61; excess of, no

Federated Malay States, govern-
ment control over rice, 137

Feingold, 169

328

INDEX

fenugreek, 190
Fernald ? Prof., 279
Feuerbach, 36

figs, 36, 57

Fischer, 42

fish: 172-4; in diet, 128; iodine con-
tent, 59, 172; oils, 173, 1 88; phos-
phorus content, 57; vitamin
content, 58, 96; vitamin B2 con-
tent, 54

fisheries, 172-4, 294-7

flour: energy content, 72; human
requirements, 45-6; value in
combination, 47-8

food: adulteration of, 18, 227; in
India, 1503; combinations, 47
48; demand following Industrial
Revolution, 16-17; destruction
during world depression, 21;
'energy-bearing' and protective*
foods, 58, 59-61, 75, 81, 129;
'infant foods' in India, 1 55 and n.;
oxidation of, 38; processing, 16
17; profiteering, 17; scarcity dur-
ing and after Great War, 19;
structural formula of food con-
stituents, 60- 1 ; 'supplementing',
47-8, 212; synthetic production,
19. See also under diet; nutrition;
malnutrition, etc.; and under
various countries

food standards. See under dietary
standards

Fox* L., 289

France: nutritional research, 254-
255; nutrition of schoolchildren,
260-1

Frapoli, 98

Friedleben, 102

Frolich, 100

fructose, 184, 187

fruits, 54, 58, 184-6

Fujirnaki, Dr., 95, 247

Funk, C., 51 n.

Gaekwar of Baroda, 114
game, in India, 174
Gandhi, M., 119 rc., 123

Gangetic delta, diet characteristics

of, 205-6
garlic, 176-7
gastric ulcer, 190
gastro-intestinal disorders, in India,

l M-k 170

Gebhart, J. G., 260-1
gelatine, 42
Germany: malnutrition during and

after Great War, 86; synthetic

methods of food production, 19
ghee, 53, 144, 166, 167-8
ginger, 59, 190
glucose, 48, 72, 184, 187
goat's flesh, 174
goitre, 109-10
Goldenberger, Dr., 99
gourd, 36, 178
grain: destroyed in Kansas and

Nebraska, 21; and vitamin Bi,

54

grapefruit, 54

grapes, 184

Gray, G. E., 90

Great Britain: Advisory Commit-
tee on Nutrition, 56, 68, 69, 74,
150, 244; blindness, 142 n.;
Education (Provision of Meals)
Act, 1906, 258-9; expectation of
life, 127; herrings dumped into
sea, 21 ; malnutrition, 236-7;
Market Supply Commission, 245;
Medical Research Council, 88,
243-4; milk in schools, 259-60;
Milk Nutrition Committee, 244;
Ministry of Health, nutritional
activities, 243-4; National Asso-
ciation for the Prevention of
Tuberculosis, 117; nutritional
research, 243-6; nutrition of
adults, 263; nutrition for mothers
and infants, 153, 254; nutrition
of schoolchildren, 256, 257-60;
population, 273; public health
services, 144; relation between
wages and death-rate, 300; tu-
berculosis, incidence of, 116-17

Green, H. N., 94

329

INDEX

Green-Armytage, Lieut-Col, 129-

130

Grigg, SirJ., 305
Grijns, 50, 93

groundnut, 168, 181, 183-4, 188
Gupta, Sir K. G., 296
gur, 159, 186-7
Gurkhas, immunity from osteo-

malacia and rickets, 139

haemorrhage, 98

Hailey, Lord, 270

Haldane,J. B. S., 189-90

halibut, liver oil, 53

HaU, Sir D., 279

Hamsun, K., 87

hare flesh, 36

Hawkins, 100

heat, loss by evaporation, 70

helminthic infections, in beef, 125

and n.

hemeralopia, 92, 95
hemp, 196

herrings, 56; dumped into sea, 21
Hess, A. E., 70, 102, 172
hexoses, 60

Himalaya regions, goitre, 1 10
Himsworth, H. P., 118-19 n -
Hindhede, 43
Hindus: concepts of diet, 197-200;

prohibition of beef, 36
Hippocrates, 92, 100
Hofmeister, 42
Hoist, 100,
honey, 58, 187
hookworm, in India, 124-5
Hopkins, Sir F. G., 27, 51
horticulture, 289-91
Huldchinsky, 102
Huntly, 102

India: Age of Consent Committee,

130

agriculture and dairying, etc.:
agricultural research, 25-6;
allotments, 290; animal hus-
bandry, 29 1-4; cropping system
necessary, 281-2, 292; dairy

India, contd.

industry, 166, 292-4; dairy
products, imports and exports,
167; horticulture, 289-91; lu-
cerne, 288-9; marketing prob-
lem, 284-5; new food crops,
285-9; ownership of land, 23-
24, 25, 229; pasture improve-
ment, 292; plant genetics,
283-4; reorientation required,
29-3> 3*-2 215-16, 274, 276
sqq., 280-9; Royal Commis-
sion on Agriculture, 24, 292,
298; rural economy, 23 sqq.,
274, 275 sqq.; soil fertility,
281-3; soil productivity, 24,
32, 273-5, 276-7; soya bean,
286-8; wheat trade, 280
deficiency diseases, etc.: anaemia:
hookworm infection, 124; in-
fantile anaemia, 126; preg-
nancy anaemia, 109, 128, 129;
angular stomatitis, 131, 215;
beri-beri, 97, 135-7; Bitot's
spots, 131; blindness, 142; car-
cinoma, 190; dental caries,
131, 140-1; diabetes, 118-19;
dropsy, 134-5; dysentery, 121;
eclampsia, 129; eye diseases,
141-3; gastric ulcer, 190;
gastro-intestinal disorders, 1 33-
134, 170; hookworm, 124-5;
influenza, 115; keratomalacia,
141, 143; lathyrism, 138 ^ma-
laria, ii5;ostcomalacia, 104-5,
138-41; pellagra, 143; phryno-
derma, 131, 215; phthisis, 116;
pyorrhoea, 140; rickets, 138-9,
155, 170; skin diseases, 143;
still-birth, 98; stomatitis, 143;
stone, 143-4; tetany, 129;
toadskin, 143; tuberculosis,
115-16, 117-18; xerophthal-
mia, 215

diet, foodstuffs, etc.: alcohol and
drugs, 191-6; cooking, 203-5;
dietary habits: 201-8; east and
west coast diet characteristics,

330

INDEX

India, contd.

208; Hindu concepts, 197-200;
industrial worker, 218-28; in-
fant foods, 155 and w.; McCar-
rison's dietary standard, 69;
Moslem concepts, 200-1; pea-
santry and plantation labour,
228-34; schoolchildren, 212-
217; diet survey, 30; dietary
surveys, 300; fish, 172-4; food
adulteration, 150-3; food pro-
duction, increase necessary,
281-3; foodstuffs (see also under
names of various foodstuffs); milk:
imports and exports, 167; milk
powder, 170-1; milk supply,
151* 155, 1^3-71, 217; varia-
tion in, 163, 164; rice, pro-
posed government control over,
136-7; salt tax, 189-90; sugar
supply, 186-7; tea > 190-1; tea
drinking, 170; foods of vege-
table origin, 174-86; vege-
tarianism, 209-12; water sup-
ply, 1 20- 1

domination of British Imperial-
ism, 24-5

drugs, 195-6

early marriage, 130

export of opium, 195

Famine Commission (1880), 25

fisheries, 173-4, 2 95~7

Government of India Act: 7,979,

'49; *935, *49> 189

Harijans, 119 and n.

health, etc.: Central Advisory of
Health, 149; expectation of life,
127; former state of health,
113-14; health education, 156-
161, 228; health of middle and
lower classes, 119; health of
schoolchildren, 131-2; health
of upper classes, 118-19; infant
mortality, 125-7; low resis-
tance to infection, 115, 116,
11 8, 159; maternal condition
and mortality, 128-31; ma-
ternity and child welfare, 153-

India, contd.

155; public health services:
difficulties facing, 144-6, 149-
150; history of, 146 sqq.; need
for co-ordinated policy, 114-
115, 149-61; organization of,
147-50; sanitary conditions,
121-5; standard of health,
113-61

labour and labour conditions:
conditions of industrial em-
ployment, 24, 122-3, 218-28;
minimum wage, 226; Royal
Commission on labour, 122-3,
218, 222, 223; working con-
ditions of miners, 123; Linlith-
gow Commission, 123-4
nutrition, malnutrition, etc.: im-
portance of nutrition, 31-2,
113, 116-17, 269 sqq., 277;
indifference towards nutrition,
269 sqq.; interrelation of nutri-
tion and social structure, 28-9,
30, 32, 114-15, 269 sqq.; mal-
nutrition: 23, 26-8, 31-2,
87, 118, 126-7, 128-31, 131-2,
154-5, 212-17, 222; nutritional
reforms, financial aspect, 304-
306; nutritional research, 29-
30; nutrition research, training
and propaganda, 298-307;
overfeeding, 89, 119, 202-3
population problems, 272-5
Indian Medical Gazette, 136
Indian Research Fund Association,

147,298

Indian Statutory Commission, re-
port quoted, 306

industrial revolution: effect on
nutrition, 17-18; and increased
demand for food, 16-17
Indus valley, diet characteristics,

206-7

infant mortality, India, 125-7
International Allied Food Commis-
sion, 211

International Institute of Agricul-
ture, 239, 240, 241

331

INDEX

International Labour Office, 81;
Workers' Nutrition and Social Policy 3
quoted, 242

iodine, 59, 70, 166, 172; conse-
quences of deficiency, 109-10

iron: 57-8, 59, 70, 163, 171;
consequences of deficiency, 108-
109, 252

Italy: fishing industry, 295; food
relief measures, 264, 265; pella-
gra, 99

jaggery, 186-7, 194, 195

jam, 58

Japan: beri-beri, 97-8; blindness,

142 TZ.; expectation of life, 127;

fisheries, 294, 295; incidence of

goitre, 109; nutritional research,

246-8
Jean, 95

Jews, prohibition of pork, 36
Joule, J. P., 38

keratomalacia. See under deficiency

diseases
ketosis, 49
Kharkov Institute of Nutritional

Research, 176
khir, 170
kidneys, 53
Kossel, 42
Kramer, 100
Krishnan, S., 143, 215

lactic acid, 167, 168

lady's finger, 178

Lahore, rickets, 104

laisser-faire, abandonment of, 18, 2 1

lard, 1 88

lathyrism, in India, 138

Lavoisier, 38 and ., 49

Lay ton, Sir W., 306

League of Nations: nutritional
research, 238 sqq.; opium, 195;
Health Organization: and mal-
nutrition, 22; Permanent Com-
mittee on Biological Standardi-
zation, 70 .; Report of Technical

League of Nations, contd.

Commission, quoted, 62-3, 67-8,
240; Mixed Committee on Nutri-
tion, report of, 111-12, 132, 240
sqq.

lecithin, 196

leechi, 184

legumes, 159, 181-4

Leitch, 70

lemons, 54, 100, 171, 184, 185;
juice, 170

Lenin, 270

lentils, 58, 181, 182-3

lettuce, 54

Levy, EL, 289

Lewis, 70

Liebig, 41, 89

lime, no

lime juice, 100, 168

limes, 185

Lind, 100

LinlithgoWj Lord, 217

Linlithgow Commission. See under
India

linseed, 188

Lister, Joseph, 79

liver: analysis of, 58; and cure of
diseases, 92 and .; deficiency of,
102; in diet, 128; phosphorus
content, 57; vitamin A content,
53> 96; vitamin B content, 54;
vitamin D, 55

liver oil, 171, 188. See also cod-liver
oil

lobster, 59

Lombroso, in

London, nutritional anaemia in
East End, 109

lucerne, 288-9

Lunin, 50

Lusk, G., 49, 62, 69

McCarrison, Sir R.: food and nu-
trition, 35, 77, 78, 79, 81; gastro-
intestinal disorders, 133; goitre,
no; Indian diets, 27, 69, 207,
230-1; Indian nutrition problem,
3 2 J I 55> research work at Coo-

332

INDEX

McCarrison, Sir R., contd.
noor, 149, 230, 298; rice, 282;
stone formation, 95, 143-4; vita-
mins, 52, 96

McCay, 109, 228, 231 andn., 232

McCollum, 55, 65, 102

McGulloch, 89

Madras: infant mortality, 127; tex-
tile workers* family budgets, 222;
Women's Christian College, 40

Madsen, 43-4

Madura, 135-6; infant mortality,
127

Magendie, F., 41, 93

mahua, 168, 188, 193

maize, 98, 99, 103-4^

maize flour: biological value in
combination, 48; human nutri-
tional value, 46

malaria: in India, 115; and price of
foodstuffs, 78; in south-east Rus-
sia, 19-20

malnutrition, *anthropometric mea-
sure' for detecting, 84-5; conse-
quences of, 77 sqq., 86-8, 89-1 ro;
defined, 80 sqq.; during world
depression, 21; effect of Great
War on problem of, 19; effect on
children, 88; investigated by
League of Nations, 22; measures
against in nineteenth century,
1 8; methods of detecting, 83
sqq.; standards for assessing im-
proved, 20. See also under various
countries; and under food constituents,
e.g. proteins, fats, etc.

Malthus, 272 andn., 273, 274, 275

mango, 53, 184, 190

Manu, quoted, 209

Mann, C,, 244

manurial treatment, efficacy of,
282-3

margarine, 43, 56, 58, 188

marrow, 178

Masai, the, diet of, 65, 245

maternity and child welfare, 153
sqq.

Maurer, 96

meat: 174; biological value of pro-
teins, 47; value in diets, 42, 43-4,
57, 58; vitamin B, 54

Megaw, Sir J.: and alcohol, 192;
death in childbirth, 130; dental
caries, 140; diet and stone, 144;
malnutrition in India, 134, 206,
229; vitamin deficiency, 138

Mehta, M., 129

Mellanby, M. : rickets, 1 02, 1 03 ; staff
for nutritional research, 301 ; vita-
min A deficiency, 94, 103, 105-6

melons, 36

Mendel, L. B., 94

metabolism, basal. See basal meta-
bolism

M'Gonigle, Dr., 300

milk: 162-71, 291-4; buffalo milk,
165-6, 1 68; Burton's opinion of,
36; calcium content, 57, 69, 75;
in combination, 48; condensed,
101, 170; in diet, 127, 128, 139,
140, 142, 144; equivalents, table
of, 171 n.; goat's milk, 166;
human and cow's milk, 61; In-
dian imports and exports, 167;
iodine content, 59; nutritional
value, 244-5; pasteurization,
164-5; pellagra, 99; powder,
170-1; protein content, 42, 44,
47> 58, 212; rickets, 104; and
schoolchildren, 217, 257, 259;
skimmed, 169; supply in India.
See under India; variation in, 163,
164; vitamin content, 50-1, 53,

54> 55, 56, 58, 75> 96
milk sugar, 168, 170
millet, 1 80, 193
minerals, in diet, 56 sqq., 69, 73,

74, 162
mineral deficiency, consequences

of, 107-10

minimum wage, 226-7
Minto, Lord, 114
molasses, 193
Moscow: Clinic of Therapeutic

Dietetics, 251; National Institute

of Nutrition, 248

333

INDEX

Moslem concepts of diet, 200-1

mowha, 194

Mulder, G. J., 41-2

Murray, A. M. T., 1220

mustard, 188

mutton, 174

Mysore, maternal mortality, 128

neurasthenia, sexual, 106

Newman, Sir G., 78, 82-3, 107-8,
113, 128

New South Wales, adult nutritional
measures, 265-6

Niger, 188

night-blindness. See hemeralopia

nitrogen, in protein, 43 sqq., 47

nitrogenous equilibrium, 43, 45

N.W. Frontier Province, health of
schoolchildren, 131

Norway, diet of schoolchildren, 216

Nussbaum, J., 210

nuts, 54, 57, 58

nutrition: calorie factor, 64, 71;
criteria for assessing diet, 74-5,
80; defined, 35, 71; effect of
Industrial Revolution, 1 6, 17-18;
food standards, 49-50, 61-71, 73;
general relationship to society,
15, 22, 28, 31-2, in-12, 235
sqq.; history of, 35 sqq., 71-2;
incomplete knowledge of, 37, 49,
73; a science, 15; table of dietary-
standards, 68. See also malnutri-
tion; proteins; overfeeding; and
under various countries

nutritional research: adults, 263-8;
international, 238-43; mothers
and infants, 252-6; schoolchil-
dren, 256-63; selection of staff,
301

nutrition, animal. See animal nutri-
tion

nuts, 184-6

oatmeal, 103-4
oedema, nutritional, 19
oils, fish, 53, 55
olive oil, 58, 1 06

onions, 176

opium, 195-6

oranges, 21, 54, 56, 100, 101, 171,
184, 185

Orissa: health of schoolchildren,
131; infant mortality, 126

Orr, Sir J., 242, 245; inadequate
diet, 112, 117, 305; iodine re-
quirements, 70; malnutrition in
England, 236, 237, 259, 263;
tuberculosis, 117

Osborne, T. B., 94

O'Shaughnessy, Dr., 145

osteomalacia. See under deficiency
diseases

Ottawa Agreement, 2 1

ovalbumin: biological value in
combination, 47-8; and vitamin
B2, 54

overfeeding, 88-9, 119, 202-3

ovitellin, 42

oysters, 59

palm, 193, 195; sugar content, 186-
187

papaya, 178, 184

paprika, 54-5

parsley, 54

pasteurization, milk. See under milk

Peace Treaties, economic results of,
20

peanut, 54, 287

peas, 54, 58, 181

Pekelharing, 50

pellagra. See under deficiency dis-
eases

pepper, 59, 190, 194

Pettenkoffer, 38, 40

Pevsner, Prof., 251

phosphorus: consequences of de-
ficiency, 59, 103-4, *<>5, 106, 107,
108, no, 138-9, 143-4; dai *y
requirements of, 70; in eggs, 171;
in fish, 172; function of, 57; in
milk, 163, 1 66

phrynoderma, 131, 215

phthisis, in India, 116

pigs, number reduced in U.S.A., 2 1

334

INDEX

pineapple, 184

Pirquet, Prof., 84, 85, 103

plantain, 54, 185

Playfair, 68

Philippines, beri-beri in, 97

Pliny the Elder, 102

pneumonia, and deficiency of vita-
min A, 95

podina, 190

pomelo, 184, 185

poppyseed, 168

pork, Jewish prohibition of, 36

potatoes, 43, 54, 177, 185

poultry, 174

proteins: 41 sqq., 61, 171; biologi-
cal value of, 47-8, 72-3, 74;
consequences of deficiency in, 89,
91-2, 155; in egg, 171; human
requirements, 45 sqq.; in milk,
162, 163, 165; optimum intake,
44 sqq., 64 sqq.

prunes, 54, 58

pulses, 181 sqq.; vitamin content,

53 54

pumpkin, 178
purdah, 105, 139, 140
pyorrhoea, 106, 140
Pythagoras, 36

radiostol, 106

radish, 36, 54, 176

raisins, 58

Ralegh, Sir W., 285 n.

Ratlibone, E., 127

Read, M., 122-3

red palrn oil, 188

renal hypertrophy, 65

Report on the Physiological Bases of
Nutrition t 44

respiratory diseases, and infant
mortality, 126

rhubarb, 176

rice, 98, 159, 168, 179, 193, 196,
21 1 ; human nutritional value,
46-7, 179; polished, and vitamin
Bi, 54, 247; proposed govern-
ment control in India, 136-7;
and relation to disease, 50, 5 1 w.,

rice, contd.

93> 97> 134 sqq., 141, 247;
storage problems of, 138; varia-
tions in nutritional value, 282

rickets. See under deficiency diseases

Riga, school meals, 261-2

Rig-veda, quoted, 197

Rockefeller Foundation, 148

Rogers, Sir L., 116, 147

Ross, Sir R., 124, 131

Rournania, pellagra, 99

Rowntree, B. S., 226

Roy, A. G., 178

Rubner, 41, 62, 67, 68, 211

Russell, Col., 115-16

Russia. See under U.S.S.R.

Saiki, Dr., 246

salad, 56

salmon, 53, 59

salt, 59, 167, 168, 189-90

scurvy. See under deficiency diseases

sesame, 188

Seymour-Jones, 171 n.

sheep, number reduced in Chile, 2 1

Sherman, H. G., 69, 70, 96, 107

Sholapur, textile workers' family

budgets, 221
shrimp, 59

Siam, control of rice, 137
Sierra Leone, dropsy in, 134
Simpson, Sir J., 150
Singapore, government control over

rice, 137

skimmed milk. See milk, skimmed
Sorley, 122
soya bean, possibilities in India, 286

sqq.
Spain, oranges and vegetables

dumped into sea, 21
spinach, 36, 54, 57, 58, 175
sprouts, 176
squash, 178

starch, 48, 162, 177, 185
Steenbock, 103
sterility, human, 106
Stewart, Lieut-Col., 32
still-birth, 98

335

INDEX

stomatitis, 143

stone. See under deficiency diseases

Stott, H., 1 10

Strauss, 109

sucrose, 184, 187

sugar, 48, 58, 72, 162, 163, 177,
186-7, J 95J excess in blood, 1 19,
159; in fruits, 184, 185. See under
milk sugar, cane sugar, etc.

supplementing, 478, 212

Surie, E., 104, 106

Susruta, 77 and n.

Swiss Goitre Commission, no

Takaki, Baron, 97-8

Talpade, L., 96

tamarind, 168, 190, 194

tannic acid, 191

taro, 177

Tasi, L. S., 96

tea, 170, 190-1

tepari, 184

Terroine, E. F., protein component

of human diet, 44 sqq., 65 sqq.,

211,237

tetany, in India, 129
Theobald, G. W., 129
thermodynamic machine, body

considered as, 49, 71
thyroxine, 59
tinning. See canning
tissues. See body tissues
toadskin, 143
tobacco, ploughed under in U.S.A.,

21

toddy, 187, 193, 194
tomatoes, 53, 54, 56, 96, 171, 178
T.U.G., delegation to India, 225
treacle, 57, 106
Tretiakov, 282

Trichinopoly, infant^ mortality* 1 2 7
tuberculosis. See under deficiency

diseases
tumeric, 190
Tyszka, 67, 68 '

ulcer, gastric, 96

unemployment: and malnutrition,
21; relief measures, 22,^264

U.S.S.R.: adult nutrition, 266-7,
268; communal restaurants, 227,
251, 266-7; experiments on nu-
trition of schoolchildren, 213;
maize in diet, 99; malaria in,
19-20; nutritional research, 248-
252; nutrition of mothers and
infants, 2556; nutrition of school-
children f } 262-3; and provision of
adequate diet, 112; research on
plant genetics, 284; scurvy, 249

U.S.A. : agricultural restriction, 2 1 ;
blindness, 142 n.; food relief
measures, 264; nutrition for
mothers and infants, 255; pella-
gra in, 99

Upper Ganges valley, diet charac-
teristics, 206

Vasco da Gama, 100

Vaughan, K., 139

Vavilov, Prof, 278

vegetables, 289-91; in diet, 43-4,
48, 56, 57, 69, 75, 96, 128, 159;
dumped into sea by Spanish
government, 17; fats, 168; fruits
and nuts, 184-6; fruit vegetables,
178; green, 54, 55, 58, 139, 140;
leaf and flower vegetables, 1 75-6;
oils, 53, 54, 144, 188; poor in
vitamin A, 53; root, 54, 58; roots
and tubers, 177; seeds, 178-84;
stems and bulbs, 176-7*

vegetarianism, 20912

vetches, 138, 181

Vienna: nutritional research in, 20,
84, 103; osteomalacia, 105

vinegar, 100

vitamins: 50 sqq.; human require-
ments, 56, 69, 70-1, 73, 74, 75,
96, 162; vitamin A: 51, 52, 53,
163, 164, 169, 171, 1 88; conse-
quences of deficiency of, 94 sqq.,
* 10, 135, 138, 140, 141, 143, 155,
247; vitamin B, 52, 53-4, 56, 135,
1 66; consequences of deficiency
of, 96 sqq., 194; vitamin C, 54-5,
165, 170, 182-3, 184; conse-

336