DIET IN INDIAN MILITARY HOSPITALS. By Surgeon-Major Herbert
Greene, A.M.D.
I shall in this paper confine myself to the consideration of diet in European Hospitals alone, for to treat exhaustively the very important and question of diet
complex
in Native Hospitals as well, would require lengthened space, and more special knowledge than I have at my disposal. I may be allowed, however, to remark enpassant that the latter subject is a one, and that the ?
sooner
burning
official attention is directed to it the better for the
sepoy.
It will be allowed, I think, by most medical men that, everything considered, diet plays a part in the treatment of disease which is second to none. The importance of drugs is no doubt great, though it has been the fashion of late in some quarters to deny their efficacy : but, without a properly regulated diet?the term of course including
meat, drink and alcohol?drugs alone would, as a general rule, be of little avail. An army in the field, though armed to the teeth, is nearly useless without an efficient Commissariat: and in like manner, without the foundation of a proper diet, the artillery of medicine becomes valueless. It
follows, therefore,
should be
as
suitable
that the diet of the sick soldier the resources of the country
as
where he is quartered permit; and whether this is so or not in India is the question which I now propose for solution. The original Diet Table of our Military Hospitals, as at present in operation, was drawn up in 1858 by the Hon.
Sidney Herbert's Committee, and was admitted 011 all hands to be most admirably suited to the requirements
of Home service.
It cannot, however, have been the intention of the compilers that it should also be introduced into India; for such an able body of men can scarcely have contemplated framing a scale of diet which should be indifferently applicable to countries where the conditions of life are so diametrically opposed to each other as in England and Hindustan. This Diet Table?very slightly modified except in one respect?is nevertheless now in force in this country, having been adopted in 1865. The exception I mean is the entire omission of all that
came
under the denomin-
ation of fresh vegetables. Onions, it is true, have been added to some of the diets, but, valuable addition though they be, they by no means supply the place of the fresh green food which is obtainable in most stations in India, and which would be obtainable in more at the expense of a small amount of labour and skill. Is then this Diet Table, which was drawn up for a temperate climate, suitable to India ? I think not. The question, as it appears to me, does not admit of a doubt. If this be granted, it is next necessary to euquire how the defects may best be remedied. I have heard an Engineer say that, when constructing a new road to a hill station in India, the best plan is to follow as nearly as may be the rude paths which the inhabitants have used from time immemorial. understand the effect which the varying seasons produce on the locality to be traversed, for theirs
native
They best
November 1,
DIET IN MILITARY
1878.]
HOSPITALS,?BY
S.-M. HERBERT
GREENE,A.M.D. 299
I would propose, therefore, that the following articles is a knowledge bought by experience : and though their tracks are undoubtedly susceptible of vast improvement, should be added to the Diet Table, in such quantities as still the general direction they take is nearly always experience may prescribe :? Grain of the country, to be made into chuppaties with correct. This following in the footsteps of natives may or may not be serviceable in ; dhall and rice for curry; curry powder; fresh ghee I but have no engineering,
vegetables; oil, vinegar. A diet composed of these materials, supplemented by else might be at least, admit the former. I do not tea or cofEee with milk, and whatever in cases invaluable I desirable think, prove would, mean that we should servilely copy the food of natives, thought for we can improve its quality and quantity as we do where, while the system required to be supported, the their paths ; but there are, I contend, certain broad prin- existence of what used formerly to be called sub-acute of doubt whatever of its utility as regards diet latter is generally admitted now,
manner
clothing. The but few, in practice and
ciples involved in it which
we do wrong to ignore, and keep in view when considering the question of rations, and a fortiori diet. These principles are fairly exemplified in the Gaol ration in this presidency. It is, or was till lately, as
which
we
follows 24 5 8
?
ever
:?
oz.
?
should
Prisoners with hard labor. Grain of the country. Dhall, five times a week.
Vegetables. food,
5
?
Animal
1
?
Oil.
twice
8 dr. Curry stuff. Salt. ? Prisoners not
a
week.
6 19
oz.
on
hard labor.
Grain of the country.
3 ? Dhall. 6 ? Vegetable. 8 dr. Oil. 1 ? Curry stuff. 6 Salt* ? The ordinary food of coolies is, I take it, never more, and seldom so much, as the hard labour scale, and yet what an amount of work they will accomplish on it. It is needless to multiply instances, for every one must be of their powers of endurance; but for the sake of an example I will cite the case of the carriers at Mount Aboo in Rajpootana. They are little men, and weigh on an average, I should say, not more than seven or eight stone. Yet each man?or woman either?thinks nothing aware
carrying load of at least forty pounds from the foot of the hill to the summit, a distance of about three miles, and an ascent of over three thousand feet. Four of them will also carry up a heavy European and a chair in a little over an hour, and keep up an animated conversation the whole time. There is, therefore, evidently no lack of muscle-producconsume ; but as it also ing material in the food of
a
they
possesses the merit of being non-inflammatory, there can, I think, be no question of its fitness to be included in a modified form among hospital diets. *
The
Rice Or Atta
Ship Ration for Native Troops is lb.
oz..
...
1
0)
Salt
...
1
4'
...
0
4
as
follows lb.
oz.
...
0
1
...
0
2
...
0
0J
...
0
OJ
0
4
0
Turmeric
...
0
0J
Sugar Chunam Kath
Onions
...
0
0J
Oil per week
0 0
0J 0J
Eating tobacco... Smoking ,, ...
0
0| li
Water
...
l
gallon.
Dhall
Garlic
...
Chillies
...
Black
...
0
0?
...
0
1
Ghee
Pepper
...
inflammation of
an
internal organ rendered
a
meat diet
inexpedient. I
that the highest authorities are opposed of native food by Europeans on account of its bulk, and the large quantites of condiments required with it ; the latter, in their opinion, being likely to am
to the
aware
adoption
cause gastric catarrh and hepatic congestion. This objection, as far as I am aware, is purely theoretical, for the question has never been settled by the sole test of these matters, a sufficient experience. The evidence, as it exists at present, is indeed, if anything, in favor of the view I am advocating ; for Friedel seems to have proved conclusively that in China at all events European meateaters are far more liable to digestive and hepatic disease than are their congeners, who depend principally on vegetable food. But granting for a moment the efficiency of the present Diet Table on paper, what is its worth in reality ? To solve this problem it will be necessary to examine the ingredients in detail. Tea, Sugar, Sago, Arrowroot, Salt, Rice, Barley.
These articles may, I think, be said to be of as good in India as at home. The tea is, if anything, better ; and half an ounce is allowed per diet instead of
quality a
quarter.
Milk. It is not necessary to insist on the fact that ordinary Indian cow's milk is a very inferior article, and not to be compared as regards nutritive qualities to English milk. On examining the Diet Tables for Home and Indian Hospitals, however, I find that exactly the same amount is allowed in both for all the diets except tea and milk. In tea diet 3 ounces more are given in India, and in milk diet 14 ounces less. This is evidently wrong, for if the quality is inferior the quantity ought to be increased. surgeon in charge of af hospital knows the there is in India in getting the milk, such as it is, pure and free from adulteration. The utmost care is necessary, for though the animals are driven daily to hospital to be milked, their owners are such adepts in chicaneiy that it is almost impossible to preAs a remedy I would sugvent their nefarious practices. gest that Government should maintain a dairy at every station. If skilfully managed it could be made to pay; residents and married officers and soldiers for
Every difficulty
private only be too glad to support it; and the cows being properly fed would yield milk of a quality which is unattainable so long as they are permitted, as at present, to feed on the garbage in the nullahs round bazar3. would
THE INDIAN MEDICAL GAZETTE.
3Q0
foul feeder than a half-st arved Indian of ordure comes amiss to it, and so despecies is its appetite that it ofttimes prefers offal to
There is
no more
cow : no
praved
wholesome food. Bread. Bread in India is, as a rule, bad. The flour it is made from is inferior: the apparatus used is defective: and the yeast or leaven by no means of the first class. Bak-
easily acquired, and, judging by results, Indian bakers must be densely ignorant of even its first principles. A good wholesome English quartern loaf is worth a dozen of the little cakes they produce in this country, which turn sour in a day, and are scarcely more satisfying to a hungry man than saw dust. Failing good bread, I think chuppatie3 carefully made would be infinitely more useful from a nutritive point of view ; and as a matter of taste much to be preferred. As regards this item then, there can be no doubt that the Indian diet is inferior to the English. ing is
art not
an
Beef.
Everyone will admit at once that the Indian substitute is longo intervallo inferior to the " Roast Beef of Old England," and the adapters of the Diet Table seem to have been partially sensible of this, for though they make no change in full diet, they allow 4 ounces more in Beef tea. Even this, however, does not bring them to the same level; for the cattle intended for killing are so badly fed that are neither well grown nor well nourished, and their flesh consequently loses from 50 to 70 per cent in
they
cooking. Mutton.
apply to the mutton as at present to hospitals There is no reason, however, that supplied this should be so, for sheep in this country, if properly fed and looked after, furnish excellent meat, in no whit inferior to the average met with in butchers' shops at home. It would surely be feasible to establish sheep farms in every station for the supply of mutton to the troops. The cost of the ration would be slightly enhancThe
same
remarks
ed, but the benefit would be incalculable.
As long as adhere to an English scale of diet in India, it is, I think, incumbent on us to take steps to prevent the supply being inferior to the model.
we
Fowls. These too can be procured in India as good as at home, if only a little care be taken to feed them. The hospital however, drawn as it is from the bazars, is very
supply,
indifferent; and the eight diet
tity
in
no means
by England.
are
the
ounces
allowed of the
equivalent
on
chicken
same
quan-
Butter. The compound called butter supplied to hospitals in India is a snare and a delusion. It is no more the equivalent of honest English butter than would be the stuff used for lubricating railway wheels. It emanates, of course, from the bazar, where the mysteries of its
manufacture are shrouded in obscurity ; and as an aliment I consider it entirely valueless. This also is remediable,
[November 1,
for buffaloes' milk butter indeed.
properly
churned
yields
1878;
very fair
Fish. Fish diet is practically unknown in India, for, except at a very few stations, there is none to be procured. Eggs. Two Indian eggs
are
English.
scarcely equal
in size to
one
Potatoes. stations the potatoes are quite as good as in England, and, with more care in their cultivation, I think they could be successfully grown all over the country. If then my analysis be correct, and the inferiority of At
some
the Indian milk, bread,
beef, mutton, fowls, and butter supplied to hospitals, be admitted, it follows that the same quantities, or nearly the same quantities, as are used at home, cannot in this country afford the nourishment which the sick soldier requires: or, in other that words, English diet will no more bear converting as
at par than does the rupee.
When it is considered, too, that even at home the of fat in the regulation diet is insufficient, the lamentable deficiency of that essential pabulum in our Indian scale becomes very apparent. It is difficult to indicate a remedy for this, but perhaps if bacon were added to some of the diets it might have the desired effect. It is an ordinary article of consumption in all private houses, and the soldier in barracks, as is well known, indulges in it, or in some other oily food, whenever his finances admit of it. amount
Regarding the other ingredients of hospital diets I only two remarks to make: (1) Champagne is seldom supplied of good quality. What is sold in the bazars is proverbially bad, and its administration does infinitely more harm than good ; and yet I believe this is generally the source from which hospital champagne is drawn : (2) Water. I am not aware that means of cooling water A draught of are ever supplied where there is no ice. and when a man all at is abominable times, water tepid is sick becomes positively nauseous. The best way of cooling water that I know is to expose it to a current of air in Bassorah jars or coojas. These cost little, and should I think be supplied to all Hospitals, a current of air can always be obtained by means of a thermanhave
tidote. There
still remains one very important point conwith Hospital diets which requires a few words. The cooks employed are very badly paid and not sufficiently numerous. A competent man, to dress the varied diets of twenty sick men and women cannot be nected
obtained for Rs. 7
a
month,
that the inferior food is made Deesa, 29th July, 1878.
and the consequence is by indifferent cooking.
worse
should have man in hospital in India first the or a biscuit coffee and of tea thing in the a cup for himself, and it is can He nothing buy morning. hardly fair to deprive him, because he happens to be of what he has been accustomed to in barracks. 5?Every
sick,
Greene, A.M.D.
I shall in this paper confine myself to the consideration of diet in European Hospitals alone, for to treat exhaustively the very important and question of diet
complex
in Native Hospitals as well, would require lengthened space, and more special knowledge than I have at my disposal. I may be allowed, however, to remark enpassant that the latter subject is a one, and that the ?
sooner
burning
official attention is directed to it the better for the
sepoy.
It will be allowed, I think, by most medical men that, everything considered, diet plays a part in the treatment of disease which is second to none. The importance of drugs is no doubt great, though it has been the fashion of late in some quarters to deny their efficacy : but, without a properly regulated diet?the term of course including
meat, drink and alcohol?drugs alone would, as a general rule, be of little avail. An army in the field, though armed to the teeth, is nearly useless without an efficient Commissariat: and in like manner, without the foundation of a proper diet, the artillery of medicine becomes valueless. It
follows, therefore,
should be
as
suitable
that the diet of the sick soldier the resources of the country
as
where he is quartered permit; and whether this is so or not in India is the question which I now propose for solution. The original Diet Table of our Military Hospitals, as at present in operation, was drawn up in 1858 by the Hon.
Sidney Herbert's Committee, and was admitted 011 all hands to be most admirably suited to the requirements
of Home service.
It cannot, however, have been the intention of the compilers that it should also be introduced into India; for such an able body of men can scarcely have contemplated framing a scale of diet which should be indifferently applicable to countries where the conditions of life are so diametrically opposed to each other as in England and Hindustan. This Diet Table?very slightly modified except in one respect?is nevertheless now in force in this country, having been adopted in 1865. The exception I mean is the entire omission of all that
came
under the denomin-
ation of fresh vegetables. Onions, it is true, have been added to some of the diets, but, valuable addition though they be, they by no means supply the place of the fresh green food which is obtainable in most stations in India, and which would be obtainable in more at the expense of a small amount of labour and skill. Is then this Diet Table, which was drawn up for a temperate climate, suitable to India ? I think not. The question, as it appears to me, does not admit of a doubt. If this be granted, it is next necessary to euquire how the defects may best be remedied. I have heard an Engineer say that, when constructing a new road to a hill station in India, the best plan is to follow as nearly as may be the rude paths which the inhabitants have used from time immemorial. understand the effect which the varying seasons produce on the locality to be traversed, for theirs
native
They best
November 1,
DIET IN MILITARY
1878.]
HOSPITALS,?BY
S.-M. HERBERT
GREENE,A.M.D. 299
I would propose, therefore, that the following articles is a knowledge bought by experience : and though their tracks are undoubtedly susceptible of vast improvement, should be added to the Diet Table, in such quantities as still the general direction they take is nearly always experience may prescribe :? Grain of the country, to be made into chuppaties with correct. This following in the footsteps of natives may or may not be serviceable in ; dhall and rice for curry; curry powder; fresh ghee I but have no engineering,
vegetables; oil, vinegar. A diet composed of these materials, supplemented by else might be at least, admit the former. I do not tea or cofEee with milk, and whatever in cases invaluable I desirable think, prove would, mean that we should servilely copy the food of natives, thought for we can improve its quality and quantity as we do where, while the system required to be supported, the their paths ; but there are, I contend, certain broad prin- existence of what used formerly to be called sub-acute of doubt whatever of its utility as regards diet latter is generally admitted now,
manner
clothing. The but few, in practice and
ciples involved in it which
we do wrong to ignore, and keep in view when considering the question of rations, and a fortiori diet. These principles are fairly exemplified in the Gaol ration in this presidency. It is, or was till lately, as
which
we
follows 24 5 8
?
ever
:?
oz.
?
should
Prisoners with hard labor. Grain of the country. Dhall, five times a week.
Vegetables. food,
5
?
Animal
1
?
Oil.
twice
8 dr. Curry stuff. Salt. ? Prisoners not
a
week.
6 19
oz.
on
hard labor.
Grain of the country.
3 ? Dhall. 6 ? Vegetable. 8 dr. Oil. 1 ? Curry stuff. 6 Salt* ? The ordinary food of coolies is, I take it, never more, and seldom so much, as the hard labour scale, and yet what an amount of work they will accomplish on it. It is needless to multiply instances, for every one must be of their powers of endurance; but for the sake of an example I will cite the case of the carriers at Mount Aboo in Rajpootana. They are little men, and weigh on an average, I should say, not more than seven or eight stone. Yet each man?or woman either?thinks nothing aware
carrying load of at least forty pounds from the foot of the hill to the summit, a distance of about three miles, and an ascent of over three thousand feet. Four of them will also carry up a heavy European and a chair in a little over an hour, and keep up an animated conversation the whole time. There is, therefore, evidently no lack of muscle-producconsume ; but as it also ing material in the food of
a
they
possesses the merit of being non-inflammatory, there can, I think, be no question of its fitness to be included in a modified form among hospital diets. *
The
Rice Or Atta
Ship Ration for Native Troops is lb.
oz..
...
1
0)
Salt
...
1
4'
...
0
4
as
follows lb.
oz.
...
0
1
...
0
2
...
0
0J
...
0
OJ
0
4
0
Turmeric
...
0
0J
Sugar Chunam Kath
Onions
...
0
0J
Oil per week
0 0
0J 0J
Eating tobacco... Smoking ,, ...
0
0| li
Water
...
l
gallon.
Dhall
Garlic
...
Chillies
...
Black
...
0
0?
...
0
1
Ghee
Pepper
...
inflammation of
an
internal organ rendered
a
meat diet
inexpedient. I
that the highest authorities are opposed of native food by Europeans on account of its bulk, and the large quantites of condiments required with it ; the latter, in their opinion, being likely to am
to the
aware
adoption
cause gastric catarrh and hepatic congestion. This objection, as far as I am aware, is purely theoretical, for the question has never been settled by the sole test of these matters, a sufficient experience. The evidence, as it exists at present, is indeed, if anything, in favor of the view I am advocating ; for Friedel seems to have proved conclusively that in China at all events European meateaters are far more liable to digestive and hepatic disease than are their congeners, who depend principally on vegetable food. But granting for a moment the efficiency of the present Diet Table on paper, what is its worth in reality ? To solve this problem it will be necessary to examine the ingredients in detail. Tea, Sugar, Sago, Arrowroot, Salt, Rice, Barley.
These articles may, I think, be said to be of as good in India as at home. The tea is, if anything, better ; and half an ounce is allowed per diet instead of
quality a
quarter.
Milk. It is not necessary to insist on the fact that ordinary Indian cow's milk is a very inferior article, and not to be compared as regards nutritive qualities to English milk. On examining the Diet Tables for Home and Indian Hospitals, however, I find that exactly the same amount is allowed in both for all the diets except tea and milk. In tea diet 3 ounces more are given in India, and in milk diet 14 ounces less. This is evidently wrong, for if the quality is inferior the quantity ought to be increased. surgeon in charge of af hospital knows the there is in India in getting the milk, such as it is, pure and free from adulteration. The utmost care is necessary, for though the animals are driven daily to hospital to be milked, their owners are such adepts in chicaneiy that it is almost impossible to preAs a remedy I would sugvent their nefarious practices. gest that Government should maintain a dairy at every station. If skilfully managed it could be made to pay; residents and married officers and soldiers for
Every difficulty
private only be too glad to support it; and the cows being properly fed would yield milk of a quality which is unattainable so long as they are permitted, as at present, to feed on the garbage in the nullahs round bazar3. would
THE INDIAN MEDICAL GAZETTE.
3Q0
foul feeder than a half-st arved Indian of ordure comes amiss to it, and so despecies is its appetite that it ofttimes prefers offal to
There is
no more
cow : no
praved
wholesome food. Bread. Bread in India is, as a rule, bad. The flour it is made from is inferior: the apparatus used is defective: and the yeast or leaven by no means of the first class. Bak-
easily acquired, and, judging by results, Indian bakers must be densely ignorant of even its first principles. A good wholesome English quartern loaf is worth a dozen of the little cakes they produce in this country, which turn sour in a day, and are scarcely more satisfying to a hungry man than saw dust. Failing good bread, I think chuppatie3 carefully made would be infinitely more useful from a nutritive point of view ; and as a matter of taste much to be preferred. As regards this item then, there can be no doubt that the Indian diet is inferior to the English. ing is
art not
an
Beef.
Everyone will admit at once that the Indian substitute is longo intervallo inferior to the " Roast Beef of Old England," and the adapters of the Diet Table seem to have been partially sensible of this, for though they make no change in full diet, they allow 4 ounces more in Beef tea. Even this, however, does not bring them to the same level; for the cattle intended for killing are so badly fed that are neither well grown nor well nourished, and their flesh consequently loses from 50 to 70 per cent in
they
cooking. Mutton.
apply to the mutton as at present to hospitals There is no reason, however, that supplied this should be so, for sheep in this country, if properly fed and looked after, furnish excellent meat, in no whit inferior to the average met with in butchers' shops at home. It would surely be feasible to establish sheep farms in every station for the supply of mutton to the troops. The cost of the ration would be slightly enhancThe
same
remarks
ed, but the benefit would be incalculable.
As long as adhere to an English scale of diet in India, it is, I think, incumbent on us to take steps to prevent the supply being inferior to the model.
we
Fowls. These too can be procured in India as good as at home, if only a little care be taken to feed them. The hospital however, drawn as it is from the bazars, is very
supply,
indifferent; and the eight diet
tity
in
no means
by England.
are
the
ounces
allowed of the
equivalent
on
chicken
same
quan-
Butter. The compound called butter supplied to hospitals in India is a snare and a delusion. It is no more the equivalent of honest English butter than would be the stuff used for lubricating railway wheels. It emanates, of course, from the bazar, where the mysteries of its
manufacture are shrouded in obscurity ; and as an aliment I consider it entirely valueless. This also is remediable,
[November 1,
for buffaloes' milk butter indeed.
properly
churned
yields
1878;
very fair
Fish. Fish diet is practically unknown in India, for, except at a very few stations, there is none to be procured. Eggs. Two Indian eggs
are
English.
scarcely equal
in size to
one
Potatoes. stations the potatoes are quite as good as in England, and, with more care in their cultivation, I think they could be successfully grown all over the country. If then my analysis be correct, and the inferiority of At
some
the Indian milk, bread,
beef, mutton, fowls, and butter supplied to hospitals, be admitted, it follows that the same quantities, or nearly the same quantities, as are used at home, cannot in this country afford the nourishment which the sick soldier requires: or, in other that words, English diet will no more bear converting as
at par than does the rupee.
When it is considered, too, that even at home the of fat in the regulation diet is insufficient, the lamentable deficiency of that essential pabulum in our Indian scale becomes very apparent. It is difficult to indicate a remedy for this, but perhaps if bacon were added to some of the diets it might have the desired effect. It is an ordinary article of consumption in all private houses, and the soldier in barracks, as is well known, indulges in it, or in some other oily food, whenever his finances admit of it. amount
Regarding the other ingredients of hospital diets I only two remarks to make: (1) Champagne is seldom supplied of good quality. What is sold in the bazars is proverbially bad, and its administration does infinitely more harm than good ; and yet I believe this is generally the source from which hospital champagne is drawn : (2) Water. I am not aware that means of cooling water A draught of are ever supplied where there is no ice. and when a man all at is abominable times, water tepid is sick becomes positively nauseous. The best way of cooling water that I know is to expose it to a current of air in Bassorah jars or coojas. These cost little, and should I think be supplied to all Hospitals, a current of air can always be obtained by means of a thermanhave
tidote. There
still remains one very important point conwith Hospital diets which requires a few words. The cooks employed are very badly paid and not sufficiently numerous. A competent man, to dress the varied diets of twenty sick men and women cannot be nected
obtained for Rs. 7
a
month,
that the inferior food is made Deesa, 29th July, 1878.
and the consequence is by indifferent cooking.
worse
should have man in hospital in India first the or a biscuit coffee and of tea thing in the a cup for himself, and it is can He nothing buy morning. hardly fair to deprive him, because he happens to be of what he has been accustomed to in barracks. 5?Every
sick,
