Abstracts from Reports

able interest to the public, in particular to those who health bulletin on the nutritive are in charge of catering in institutions and schools. Value OF INDIAN FOODS AND THE PLAN- Stress is laid on the value of what are called the ' foods. NING OF SATISFACTORY DIETS protective' Human beings, and particularly children, says the cannot thrive at their best on a Improving India's foods bulletin, diet largely composed of cereals, such as rice, millet, etc., and analysis of some 200 common Indian p foods, insufficiently supplemented by other foods. To make p. eiaced a by summary of modern ideas about diet, is the deficiencies of such a must consume ' good diet, they m the Health on jt, ,en Bulletin The Nutritive Value of fair quantities of foods like milk, green vegetables, Foods and the of Diets' ,lan. Planning Satisfactory eggs, fruits, etc. These are sometimes known as the lssued ' * Tnk by the Director, Nutrition Research protective' foods, since they are rich in proteins, laboratories, Coonoor. vitamins and mineral salts, and protect the body against is a of the move to the Publication part popularize the ills which result when the diet is largely based on ni'trition researches. In the years as milled rice. Cod-liver of n Ur?s! early less nutritious foods, such oil, work the was to thp ?1^10.11 first objective get together which is very rich in vitamins A and D, may be classed data on which work could be ' SS10?tific practical as a most valuable protective' food. homes of the This material has arc defective because sirm G u people. In general, diets in India they keen ' collected by the workers at the Nutrition do not contain protective' foods in sufficient and now 10tn +^ar Laboratories, is being made available abundance. The aim in public health nutrition work in the ' public. and well-balanced' diets must be to a general planning jCoun!; given of calorie requirements and increase intake of ' foods. The classes in standuards protective' jn , suitable for the various age and sex groups the community which are particularly likely to suffer a are Vitr, ? suggested. Next, protein, fat, and various if their diet is defective are infants and growing and minerals are with em i11111-8 dealt with, special children and expectant and nursing mothers. S1? on Mai ? ^be minimum requirements of each. Even a little milk, we are told, is better than none. ?r? , and effect of on nutritive value which is are cooking The value of skimmed milk, considerably also discussed. but contains most of its cheaper than whole milk, _ an from the section on valuable is Information is given Walnut *nterest*ng excerpt elements, emphasized. V in tabular statements about protein, fat, carbohydrate, and and j A-. Well-balanced diet is essential if growth and fibre, calcium, phosphorus, iron, vitamins, are to A are added with data about the child -ment ta^e P*ace normally. badly-fed appendices biological often its of the of various and the avail- an J i13. small for its age and thin; 'weight value proteins foods, will be It will fall sick of iron in certain foodstuffs. easM gbt' below average. ability " ailments in school There of course, many kinds of health child frequency of minor are, public .n can be reduced by improving the diet. A nutrition work besides the planning of adequate diets. Cer: ' a a of enthusiasm for work The task of the nutrition worker is often to make an ? aPathy, lack of pep', u The cod-liver play, js characteristic of the malnourished. special {e.g., milk, _ oil, various ate .additions of the skin is a sensitive index of faulty feeding; vitamin-rich preparations) to an unsatisfactory diet a U or with a rather than to the whole diet afresh. Infant tin dry s^n' a skin covered papular erup- plan feed- w?[{' suggests faulty feeding. Eveiybody knows that a ing is a special subject demanding special knowledge eii-ted animal exhibits a certain glossiness and silkiness and training. But in all branches of practical dietetics is not seen in the fundamental principles involved are the and an i~a 'g?ocl coat'?which poorly-fed same, a well-fed human being has a an understanding of them is essential for successful ? jumals. Similarly ?ssy skin and a glow of health. Bright clear eyes are work in this field. ^2 a sign of satisfactory feeding. It is not only the poor, whose choice in the matter ue who are j-i section on the planning of diets describes the of food is extremely limited, ignorant and "fierences between 'ill-balanced' and 'well-balanced' in * The word is used here in a di+, and the methods to be followed improving 'protective' much wider ^ is out a 'well-balanced' sense than usual; proteins, as are not diet Pointed that really ' ' such, usually Wl11 more than included amongst foods. Inri- usually cost a good deal ordinary protective We do not think naian can be himself used it diets of poor quality, and how diets that Dr. Aykroyd in this verv wide without great increase in cost is described. sense.?Editor, /. M. G. rp?ProvedAne to details given are, therefore, likely be of consider- 324 THE INDIAN MEDICAL GAZETTE [May, 1937

prejudiced about diet. Plenty of people in India and indicating a child-bearing period five years shorter than elsewhere, who could afford themselves to consume and the European one. could feed their children on an excellent diet, do not Of the total births, 17.5 per mille were male, 16.1 in fact do so. One can readily find, among children of female. The excess of males over females born is a the more prosperous classes, cases of serious malnutrition constant feature. Taking British India as a whole the and food-deficiency disease. number of males born per 100 females is 108. Amongst In drawing up the new diet schedule, or in assessing the provinces this figure is 129 in North-West Frontier the value of an existing schedule, it is essential to Province, 119 in Ajmer-Merwara, 113 in the know whether enough food is being provided. It might United Provinces, and 112 in the Punjab. The other be thought that it is easy enough to discover food provincial figures vary near ? about the British India deficiency, for such deficiency must cause hunger. But mean except that the figure for Burma is 104. experience has shown that human beings can adapt The birth rates for the whole of British India in themselves, at a low level of vitality and with their rural and urban areas were the same, namely 34 per powers impaired, to an insufficient ration, and scarcely mille, but amongst the provinces the rural rate con- realize that they are under-fed. The nutrition worker, tinued to exceed the urban in the Punjab (+6 per in setting up standards of food requirements, ignores mille), Bihar and Orissa ( +13 per mille), Bengal this remarkable faculty of the body to adapt itself to (+8 per mille), Bombay (+2 per mille), and Madras semi-starvation. His standard of food intake implies (+15 per mille). In other provinces it was lower. full satisfaction, enough to enable human beings to lead The high rural rates in Bihar and Orissa and Bengal an energetic life at a reasonably high level of working are mainly due to the fact that a large proportion of capacity. the rural population who have migrated to urban Dr. Aykroyd, Director of the Nutrition Research centres return to their rural homes for child birth. Laboratories, states in an introduction that the purpose The birth rates for the chief communities, which are of the bulletin is to summarize available knowledge available for ten provinces, were as follows:? about the nutritive value of Indian foodstuffs for the Hindus Mohammedans Christians benefit of medical public-health workers, practitioners, North-West Frontier superintendents of residential institutions and others Province .. 28 31 31 interested in practical dietetics. Delhi .. 37 43 21 By its wealth of details the bulletin is a rich source United Provinces .. 37 37 10 of educational and propaganda material for those Bihar and Orissa .. 34 33 21 whose task it is to try and improve the health and Bengal .. 28 29 20 well-being of the people, both young and old. Central Provinces .. 40 41 19

Public Health Commissioner. Madras .. 36 38 33 Coorg .. 26 19 20 ANNUAL REPORT OF THE PUBLIC HEALTH Burma .. 17 28 23 COMMISSIONER WITH THE GOVERNMENT Ajmer-Merwara .. 35 34 7 OF INDIA FOR THE YEAR 1934 As usual, the birth rate exceeded the death rate iD every the difference recorded Public health in India province, largest being in the Punjab (+ 12 per mille), Madras (+ 11 per In an area of the mid-year 890,000 square miles, mille), Assam (+ 11 per mille), North-West Frontier estimated was 276 million with a population nearly Province (+10 per mille), Bombay (+10 per mille), of 310 mile. Births the year density per square during United Provinces (+9 per mille), and Burma (+9 per numbered nearly 9| million, and deaths a little over mille). 61 million, the rates per mille being 34 and 35 respec- tively, with the infantile mortality figure per 1,000 live Deaths births at 187. Compared with 1933 and quinquennial mean, the The year no unusual features in presented markedly death rate of 24.9 mille increased 3 per regard to health conditions. The death rate is higher per by roughly mille and 1 per These than it was last and so is the infantile mortality by mille, respectively. figures year, reflect the relative unhealthiness of the while the birth rate is lower. But such fluctua- year, partic- rate, in Bihar and the Central Provinces and tions in the recorded deaths must be expected from ularly Orissa, the United Provinces, where the rates exceeded those the present system of registration and too much stress for 1933 13 per 10 per and 8 per mille, Bhould not be laid on them. by mille, mille, respectively. Slightly higher mortality wasi returned Live births also in Madras, Burma and Ajmer-Merwara. Female The crude birth rate during the year was 33.7 per mortality exceeded male mortality in the Central Prov- mille of the total estimated population as against 35.5 inces (+ 3 per mille), Bihar and Orissa (+ 2 per mille), per mille in 1933 and 35 per mille the quinquennial and in North-West Frontier Province, United Provinces, mean. Including still-births, the rate was 34.3. Live Madras, and Burma (each + 1 per mille). But taking births registered during the year were 4 per cent less India as a whole, the male mortality was greater than than the figure of 1933. Compared with 1933, the the female, the respective figures being 25.1 and 24.6. Punjab recorded a decrease of a little over less than Mortality from the principal epidemic diseases increased were 100,000 births or of 10 per cent, the United Provinces during this year. Deaths from cholera, which nearly 120,000 or 7 per cent, Bihar and Orissa 79,000 nearly 200,000, have been nearly three times what they were is or 6 per cent, and Madras 70,000 or 4 per cent. In in 1933. Plague mortality which was 80,000 Delhi, Bengal, Bombay, Assam and Ajmer-Merwara almost double, but deaths from smallpox numbering there were slight decreases. Small increases occurred about 84,000 is low. The other principal causes of in North-West Frontier Province, the Central Provinces, death show comparatively little change. But in the Burma and Coorg. main the figures are higher, particularly under the Birth rate calculated on the basis of the estimated heading fevers, while the deaths recorded, numbering number of women of child-bearing age, taken as 15 to about 4 million, show an increase of over 400,000 over 40 years, was 167 per mille for the whole of British the figure for the previous year. India. Of the provincial figures, that for the Punjab, Health conditions for the rural population were namely 215, is the highest. The Central Provinces is specially unfavourable owing to the greater prevalence second with 209, and Delhi third with 197. The figures of fevers and cholera among them. The death rates for the other major provinces are as follows: North- exceeded those for urban areas by 9 per mille in Delhi, West Frontier Province 156, United Provinces 179, 8 per mille each in Bihar and Orissa and Madras, Bihar and Orissa 157, Bengal 139, Bombay 172, Madras 7 per mille in the Punjab, 4 per mille in Ajmer- 163, Assam 153, and Burma 144. The period of 15 to 40 Merwara, 3 per mille in North-West Frontier Province, years is possibly pitched too high, particularly for the 2 per mille each in Bengal and Assam, and 1 per mille southern half of India, but it is probably correct in in the Central Provinces, while for British India as a May, 1937] ABSTRACTS FROM REPORTS 325

and maternal whole the rates were 24.9 for rural areas and 24.4 for deficiencies, malaria, pre-natal weakness bad urban areas. and neglect, housing, high birth rate, lack of medi- and of the The was as cal aid ignorance bringing up of infants are death rate for the age period, 15 to 40, usual stated to be the main contributory factors. In higher among females than among males, ant Bombay the city debility, malformation and premature birth and cause is ascribable to the greater risk or death to diseases appear to be for the which women are child-bearing ages, respiratory responsible the exposed during number of deaths. rates being 10.7 for males and 12.4 for females. largest The recorded still-births for British India were 19.9 Considering deaths by communities, the rates the jor per mille of live births. This figure as also the whole of British India are 28 for Hindus, 24.2 oi figures cannot, however, be regarded as accu- Mohammedans and 17.5 for Christians. The provincial provincial as to defective many still-births figures are as follows:? rate, owing registration are included in the infantile mortality returns. The Hindus Mohammedans Christians infantile mortality figures for the different classes of North-West Frontier population are recorded in seven provinces only and 1. are below. It will be noticed that a uniform low Province .. 15 21 given if death rate among Christians continued to be Punjab .. 29 27 reported Delhi ..33 25 10 from these provinces:? United Provinces ..26 29 5 Hindus Mohammedans Christians Bihar ? ana Orissa .. 27 23 17 North-West Frontier .. 24 14 Bengal 23 Province .. 181 132 77 ? ? Central .. 32 Provinces 34 Punjab .. 194 183 165 Bombay .. 28 17 14 Delhi ..237 171 145 Madras .. 22 19 34 Bihar and Orissa .. 155 136 138 .. 22 27 Coorg Madras .. 209 183 127 Assam .. 18 20 18 .. 187 218 75 ? Coorg Burma .. 21 15 14 Ajmer-Merwara .. 231 258 102 Ajmer-Merwara ..31 27 3 The rural and urban infantile death rates for British Infantile mortality India were 183 and 218 per mille of live births. The ? ^be year 1934 was comparatively unhealthy for the urban mortality of infants in the Punjab has declined ut population in India. The recorded deaths, nearly steadily during the last three years. The urban V^M were 9 cent more than in 1933 and mortality were- particularly high in Ajmer- 10 00,000, per figures^ per cent higher than the mean; 187 Merwara where it exceeded the rural rate by 149 per out of quinquennial every 1,000 born are reported to have died. mille, and in the United Provinces and Bombay where . be persistent be ascribed it was by 96 and 63 per mille, The ui high mortality of infants may higher respectively. part to not of births but rural death rates were higher than urban in ?t defective registration only Coorg, infant deaths the inclusion of Delhi, Assam, Burma, and the Punjab, the persistently and through still-births, partly to the tendency of the more illiterate of the low urban rate in Coorg being due to the presence Population to underestimate the age of the diseased of a large number of plantation labourers who leave infant. their families at home. The provinces chiefly contributing to the increased Of the total registered deaths in British India, 42 per Mortality were the United Provinces cent as against 45 in 1933 occurred among children ?Bihar (+39 per cent), and Orissa (+ 11 per the Central Provinces under 5 years of age, and 6 per cent among those 26 cent), VX per cent), Burma (+14 per cent), and Ajmer- aged 5 to 10 years. In other words, nearly half of all iV-lerwara (+14 per cent). Minor increases also those who died were children under 10 years of age. ^Urred in Bombay and Madras Presidencies and in The percentage, however, shows a drop of 2 from the previous year's figure, which was 50. The wastage of infant -life calculated in live births How India compares with other countries the v?s highest in the Central Provinces, Ajmer- Burma, and Delhi. In these one Natural! Infantile r>ivijV^ra,uid in provinces Birth Death every four or five of recorded births failed death rate rate per rate per nf the first year of whilst the per per 1,000 ^Urv*ve life, percentage mille mille deaths of one week and above was high in Bengal, mille births tadras, Coorg, and Assam, that in Burma was high among infants aged 1 to 6 months, probably due in Part India .. 33.7 24.9 187 to the local custom of feeding at too British partial and 14.8 11.8 3.0 59 young an age with rice by the mother. England s in pre-masticated Wales. previous years, the steady fall in mortality accom- panies Scotland .. 18.0 12.9 5.1 78 the monthly increase in age of infants from l _to .. 16.0 12.2 3.8 82 months. These figures suggest that besides defective Belgium Czechoslovakia .. 18.8 13.2 5.6 126 !ftration> skilled maternity or midwifery service is Denmark .. 17.8 10.4 7.4 64 adequately or poorly provided, specially in the rural France .. 16.1 15.1 1.0 69 "acts, and that the indigenous dai as she is much .. 18.0 10.9 7.1 66 cheaper is still in demand. The uniformly low Germany popular .. 21.4 14.4 7.0 150 rate to Hungary ^s among Christians lends support this view, ea^bthe .. 23.2 13.1 10.1 99 majority of Hindus and Muslims still follow Italy Netherlands .. 20.7 8.4 12.3 43 methods. ^Primitive . 9.8 , the ,. 14.8 5.0 poor nutrition of the mother, over-crowding, a Norway uigh .. 28.4 16.6 7.8 ! birth rate and maternal mortality rate, Portugal high Roumania .. 32.4 20.7 11.7 ; 182 "equent and the of respiratory prematurity, prevalence .. 26.2 15.9 10.3 113 ^?ases? malaria and syphilis, combined Spain with convulsions, Sweden ?? 13.7 11.2 2.5 47 widespread of infant management, all ignorance Switzerland .. 16.2 11.3 4.9 I 46 contribute to the loss of infant life in India, h great Canada ?? 20.4 9.4 11.0 72 ft rate, as also infantile death rate, is high among Zealand .. 16.5 8.5 8.0 to them New 32 of6 classes owing to the inaccessibility 23.5 efficient South Africa 9.7 13.8 62 medical service. . , ,, , (White). are available for some provinces to show the ?uieffigures U. S. A. ?? 17.1 11.0 6.1 60 causes of jnfantiie In Delhi, for mortality. ?? 30.0 18.1 11.9 125 febrile and diseases were Japan ^stance, respiratory ?? 40.0 26.6 13.4 166 for the number of deaths In the Egypt ^sponsibleral largest Provinces debilitating influences, dietetic errors 326 THE INDIAN MEDICAL GAZETTE [May, 1937

These figures show that the only countries with A beginning has, however, been made in a number of which there can be any comparison with British India areas. Rural health units are now being established on the point of birth rate are Japan, Egypt and and are likely to be of great assistance, both as Roumania. In the death rate again it is only Egypt experimental stations for trying out schemes of village which is worse than India. So far as infantile mortality improvement and as demonstration and educational is concerned, the only countries having rates at all centres. with those of India are Roumania, Hungary, comparable Aerial navigation and yellow fever Egypt, Portugal, Czechoslovakia, and Japan. A potential danger to the public health of India i3 Can India support an increased population? the possibility of yellow fever coming in. And this has become acute as a result of the recent In the for 1933 it was stated that by 1941, at danger report of aerial communication between a conservative estimate, the population of India will development rapid India and the main endemic home of probably considerably exceed the figure of 400 millions. Africa, yellow which is now a few distant in time This is considered once again and the conclusion arrived fever, only days from an infected on a at is that the figure of 400 millions mentioned, in India; person embarking plane in Africa can now arrive in India in the infective last year's report is likely to be near the mark. stage ' of the disease. Should fever to be The question, therefore, arises Can increased popula- yellow happen tion be balanced by increased good production?' In introduced into India, the disease would be so appalling that well the a dealing with this question, there are several points to it may cripple country for generation. All the bear in mind. Agricultural research is continuously the necessary factors for the rapid spread of disease if the virus be introduced are and it is showing the way to increased yields. There are areas present, essential that measures should under wheat yielding 14 maunds to the acre which precautionary forthwith be taken. These consist in and could be made to yield double that amount. In the freeing the cities, the seaboard of present state of our knowledge, it is not safe, therefore, particularly towns, the stegomyia and in faci- positively to assert food production cannot keep pace mosquito establishing adequate quarantine ?lities for isolation of cases and with the increase in population. Although there is suspected their contacts in at the of in evidence of widespread under-nutrition in India, there mosquito-proof buildings airport entry Karachi. measures have already is nothing to show that the ryot is worse fed now Fortunately quarantine been taken at Karachi and are in than he was in earlier days. Rather is it probable progress. that the absorption of food-stuffs has over a period of (To be continued in the next issue) years risen in proportion to the population. Another factor which has a bearing on the population question THE SIXTEENTH ANNUAL REPORT OF THE is the relation of the birth and death rates. To those BLIND RELIEF ASSOCIATION, BIJAPUR, 1935 who believe that improved economic conditions or a The association was started in rise in the standard of living will be followed by a the year 1920 and owes its existence to the solid and enthusiasm drop in the birth rate there is some evidence that support of the of District. It is the first economic conditions are improving, while for those who people Bijapur association of its kind in the Karnatak hold that sooner or later increasing density will, by philanthropic and was established for the and cure of means which have not yet been satisfactorily prevention blindness in the District of and funds demonstrated, lower fertility, there may be some con- primarily Bijapur, solation in the undoubted fact that density permitting, in the surrounding Districts and States also. population From the incidence of blindness it is increasing in India. One other important factor in in the Karnatak can be that whatever be the cause of blindness connection with the birth rate is the age of marriage. judged no less than 30 to 40 cent of these cases are There is a considerable volume of opinion among those per remediable and an number For this qualified to judge that the age of females at marriage equal preventible. we have been on is this rise will tend to reduce fertility and purpose carrying propaganda work rising; the therefore lower the birth rate. amongst village population by lectures and magic lantern demonstrations on and village If food production keeps pace with population personal hygiene and are out cases of diseases such increase, a critical situation may be avoided. But India sanitation, hunting as and measles which are to rise needs more than this. A higher standard of living, smallpox likely give to serious eye afflictions. with all that this brings in the way of improved health Week Shows and and Child- and welfare, is a pressing need. This can only be Baby Village Maternity Welfare Centres should have a for the secured, in a predominantly agricultural country, by a place eye, where can be made to on considerable increase in food or a attempts impress the minds production pronounced o? the the drop in the annual increment of population. public importance of eyes, their susceptibility to infections, and the possibility of preventing such Nutrition infections, if care is exercised at the proper time. This principle has been specially observed in this district by But whatever the solution of the may be population the introduction of a special stall at these shows in no one will that our problem India, deny large exhibiting the various common eye ailments, explain- annual increase in that attention population requires ing their common causes by various charts, pamphlets, should be to a extent than has hitherto directed greater posters and also arranging a small exhibition of the been the case on the of nutrition. important subject common remedies and precautionary measures, which A out in the great deal of research has been carried could easily be practised by the public and thus the nutrition research laboratories of the Indian Research onset of eye afflictions and their sequelae averted. Fund the of this Association at Coonoor, and results Preventive work has been carried out by this associa- research to Over require to be made known the public. tion through its field workers in the villages of the and above this there is need for an into investigation district for the last 17 years. This has done immense the state of nutrition and habits of the dietary people good to thousands of poor patients. The association on which our information is deficient. lamentably offers certain special facilities to the poor and deserving patients. Among such facilities may be mentioned Rural hygiene journey charges to and from the civil hospital, supply of Sanitary improvement in rural areas, where the vast of food and clothing during their stay and a pair majority of the people of India live, is one other spectacles for those operated on, in addition to the outstanding need of the country. In these areas, free medical and surgical treatment. In spite of a" educationally, socially and materially backward as the such facilities, patients very often keep away f?r people are, compared with those in urban areas, general want of proper education, ignorance and superstition- sanitation is still in a primitive condition. Medical Occasions are not infrequent when they have to be relief for the most part is grossly inadequate and persuaded to undergo treatment. maternity and child-welfare works are almost completely There were eleven field workers, one for each of the lacking. eight. Talukas, viz, Bijapur, Indi, Sindgi, Bagewadi. May, 1937] SERVICE NOTES 327

Muddebihal, Bagalkot, Hungund and Badami, one for "ilgi Petha, and one has been entirely working in the municipal area of Bijapur. A special field worker has been maintained at Akalkot. The field workers have been specially trained at the civil hospital in washing the eyes and the management of common diseases. They are in a position to recognize any serious affliction requiring operative treatment and are instructed to send such cases to the nearest dispensary or camping place ?f the touring medical officer or the civil hospital, according to the seriousness of the complaint and the treatment required for them. Each field worker is given charge of a number of villages. He tours these villages by rotation, finds out cases for treatment by house to house visits, treats them and gives them medicines for further treatment during his absence. On his rounds, if he comes across cases of blindness which are not curable, he takes them on his register which enables us to collect proper statistics about the incidence of blindness in this district. He also inspects births for ophthalmia neonatorum. On an average he can visit two to three villages in a day. The field workers are supplied with ponie3 and they carry with them a box which contains solutions of boric acid, silver nitrate, sodium chloride, argyrol and mercury and dionine some cotton-wool, a bowl and a ointments, kidney tray. They maintain a record of their work in special registers supplied to them. The total number ?f cases treated by them during the year was 22,991. Birth inspection is an important portion of preventive work. The total number of birth inspections done by tile field workers during the year was 24,889 and the 'nspection was repeated in the case of 34,682. A separate record of births examined within ten days of blrth is also kept and the number of children so examined was 3,726. The examination was repeated within 10 days in the case of 632. The number of treatments done in the course of these examinations of children under one year of age for ophthalmia neo- natorum was ten and for other diseases 6,142. The number of cases of eye diseases among children under five years of age detected and treated was 6,036. Amongst these five were cases which required surgical ?fiterference and had to be sent to the civil hospital. . Ht is evident from this abstract that this association is carrying on valuable work and its example might be oilowed with advantage in almost any other part of *ndia.]