Diet. Disease and Death in Colonial South India

Item

Title
Diet. Disease and Death in Colonial South India
Creator
V R Muraleedharan
Date
1998
extracted text
Diet. Disease and Death in Colonial South India
\

K Muralrrdharan

Reprinted Irom Economic and Political Urrkh. Vol XXIX Nos I and 2, January 1-8. 1994
Pagination as in original

a

Diet, Disease and Death in Colonial South India
V R Muraleedharan

There is an abundance of evidence to suggest that a large number of the people in colonial south India suffered
continuallyfrom a number ofdeficiency diseases. Their susceptibility to these diseases was a result of inadequate diets.
However, the nutrition-mortality link has not received adequate attention so far.
THE existing studies on mortality trends
ticular reference to the inter-war period? nial government from the late 1920s. The
-----purpose of this essay is primarily to present
in colonial India have very little to say on tIs_ »i_
the---------present* estimate _r
of .u
the—
minimum
the nature of relationship between nutri­ energy requirement applicable to the in­ the available material on the extent of
tion and mortality. In fact, even much less
ter-war period? (given Sukhatmc’s view malnutrition and the prevalence of dis­
has been said and written about the extent that energy requirement of an individual is eases caused by malnutrition in colonial
of malnutrition and its consequences on
dynamic over time, which is why an south India. It attempts to highlight cer­
the incidence and prevalence of diseases individual adapts himself to lower energy tain important studies carried out and the
in colonial India. While paucity of empiri­ intake): Is it possible to draw a single insights derived from them during the
cal data is an important reason for lack of upper limit and lower limit for the entire inter-war period, which formed an imporsuch studies, there has been no attempt Indian population, which differed in more tant phase in the development of nutrition
even to put together the available infor­ than one respect from one region to an- --------- T‘ It relies
’----------j1-- —
LscienceT-inj:India.
heavily
on *the
mation in this respect.
other?; What percentage and which age findings of the studies reported in various
It is important to note here that an analy­ group(s) of the population ‘ ‘remained just medical journals, and certain records of
sis of the nutrition-mortality link should above the lower limit’ ’? What percentage
the government of Madras. The details of
be preceded as far as possible by an em­ of the Indian population remained moder­ these studies arc presented in Sections II
pirical understanding of the extent of mal­ ately or severely malnourished during
and HI, while Section I briefly mentions
nutrition and its consequences with re­ normal times? In fact, controversy still
the prevailing views among the nutrition
spect to a given period and population. exists as to the exact relationship between
workers in India by the end of 1930s.
Such preliminary exercises have not yet nutrition and mortality, particularly in
Section IV concludes by raising few
been carried out to the extent it is possible determining the “threshold, critical mal­ more questions that we need to face in
with the available data, which as a result nutrition level’ ’, beyond which malnutri- order to have a better understanding of' th<ie
limit our underslanding of the demographic tion could cause mortality. Mortality mortality decline in inter-war period in
trends in colonial India. Consider for mechanisms are complex, as Livi-Bacci
colonial India.
example, Sumit Guha’s essay on ‘Mortal­ puts it: “while it cannot be claimed that
ity Decline in Early Twentieth Century nutrition-mortality link is the sole key to
I
India’,1 in which be questions Ira Klein’s the explanation of mortality, it cannot be
immunological hypothesis2 and puts for­ also be denied that, nutrition does play a
By the end of 1930s an enormous amount
ward an alternative explanation for the role in determining the level of mortality of information had been collected on the
decline in mortality rates during inter-war of the past’’6
value of diets and their relationships with
colonial India. He suggests that “the In­
These questions need to be answered the prevalence of diseases among the vari-------------------------------------------------------------------------------------------------------------------------------- r .t_--------------- ---------------- n_.:_t_
dian population in the second quarter of Jjefore one can accept Guha’s hypothesis ous sections
of the populations in British
the twentieth century lived longevbpcausp ■ to explain the mortality decline in the India. Although in many respects there
tbe weather gods enabled it to maintain a inter-war period. Guha merely states
were gaps in the knowledge of food habits
stable level of malnutrition rather than Sukhatme’s argument and considers it as a and" their influence on the health of the
alternatively plunge between adequate valid explanation for the inter-war phe- people, nutrition workers in India had by
nutrition and severe malnutrition as it was
nomenon without presenting the avail- late 1930s gained certain important indoing earlier.’ ’’.He supports his argument able, though limited, empirical data on the sights into the-physiological requirements
(a) by adopting the view that human be­ dietary habits of the various sections of of the human body under different cli­
ings can adjust to moderate variation in
the population. He spends considerable matic and environmental conditions. This
food intake (as argued by Sukhatme that space in order to cast doubt on Klein’s is evident from the following words of W
“the energy requirement of an individual argument that mortality declined during R Aykroyd, made in late 1941:
is not static but is dynamic over a wide,
inter-war period on account of changes in
Within the last 30 years science has reached
though limited range...’’),4 and (b) by obhost-parasite relations and the developdefinite conclusions as to what constitutes a
s<
’
* • •intake
• during
•
,_____
° the
:erving
that the food
inter- _____
ment of _________________
natural immunity
among
good diet for human beings. The principles
war period stabilised though the per capita people. But he does not provide any detail
of correct feeding are fairly well understood
----on
^ets of
Julian population in
food availability declined in the ~same
and ‘optimum’, dietary standards based on
period. Thus he says, “the bulk of the support of his argument.
these principles have been drawn up by
League of Nations Commissions and other
population managed to remain just above
The food intake and their value varied
authoritative organisations?
the lower limit of this range,
w . whereas considerably,’ and as a result the prevaearlier at least a significant minority had lence of diseases too" varied across the Yet, it was Aykroyd again who cautioned
periodically fallen below the lower limit.’ ’’ regions in British India. In fact, as Michael
the nutrition workers in India in 1938
A series of important issues and questions- Worboy shows, malnutrition was ‘dis­ thus:
arise in this context which have not been covered’as a problem of imperial impor­
Common sense must always be used in
considered by Guha’s abovementioned es­ tance to the colonial government only
drawing up new diet schedules, or in as­
say. Some of them are: what exactly is the during the inter-war years.’ In colonial
sessing the adequacy of existing ones...
range, in quantitative terms, that Guha India, the extent of malnutrition came to
Standards of calorie requirements are ap­
(and Sukhatme) is talking about with par- be recognised more acutely by the coloplicable only to reasonably large numbers^

Economic and Political Weekly

January 1_8, 1994

55
S ■

and not to individuals. The relation be­
tween calorie requirements and such fac­
tors as work, activity and climate must be
bom in mind.’
Two important but related issues re­
ceived more attention of the nutrition work­
ers (in fact all over the world) particularly
since the Great Depression of 1929-33.
One was the question of evolving a ‘bal­
anced diet’ and the other was the need to
understand the relationship between nu­
trition and infection, or to put it differ­
ently, the incidence of nutritional dis­
eases. And both these questions were seen
clearly as having a bearing on the eco­
nomic nature of the problem. The various
dietary surveys and the laboratory experi­
ments conducted in different parts of the
country during the 1920s and 1930s with
a view to understand the abovementioned
issues formed an important stage in the
evolution of nutrition science in India.
They proved rather conclusively that the
nutritional standards of the European coun­
tries would not be appropriate for the
people in the tropics; they also showed
that even within a society, individual re­
quirements vary. As Aykroyd put it in
1938:
But experience has shown that human be­
ings can adapt themselves, at a low level of
vitality and with their powers impaired, to
an insufficient ration, and scarcely realise
that they are under-fed. The nutrition
worker, in setting up standards of food
requirements, ignores the remarkable fac­
ulty of the body to adapt itself to semi­
starvation.10

This was an important insight’. But the
adaptive nature of man, as perceived by
the nutrition workers in India in 1930s, did
not discourage them from attempting to
set a balanced diet, though no one could
satisfactorily define it in quantitative
terms. Talking about an ideal dietary and
nutritional standards in India, an editorial
of Indian Medical Gazette in 1936 com­
mented thus:
The diet of a nation should be composed of
available foods based on scientific knowl­
edge of their values and they should not be
unduly manhandled eitherin the factory or
in the kitchen. The uieal in feeding of a
people should be to provide a ‘square
meal’ which in the language of modem
dietetics may be defined as one which is
well balanced from the point of bulk as
well as flavour and in the approximately
correct proportions of essential constitu­
ents.”
The same editorial, while commenting oh
the incidence of nutritional diseases, ob­
served that a considerable proportion of the
people may be suffering from a ‘wcll-balanced deficiency’ in diet and therefore were
not showing any sign of malnutrition. Often
it was lamented that,

56

i
I

there are innumerable American and excel­
lent English books on dietary, but most of
these, except for the teaching of general
principles, are of little use to the workers in
India. Ln the first place, the dietetic require­
ments ofthe people of Indiaare not the same,
either quantitatively or qualitatively, as those
in temperate and cold countries, and at­
tempts to draw up standard diets without
appreciating this fact would lead to both
waste and an unsuitable diet.12
Therefore, it was felt necessary to have
complete data on the value of the foodstuffs
available in India and prepare a balanced
diet The 1930s, as already indicated, wit­
nessed a growing and genuine interest in the
field of nutrition science, which as a result
produced vast, though not complete, data on
the composition of various foodstuffs in
India. However, the studies conducted were
not adequate considering the vast and di­
verse patterns of diets followed by different
communities in India.
The publication of Health Bulletin: The
Nutritive Value of Indian Foods and the
Planning of Satisfactory Diels in 1938 by
Aykroyd was essentially an attempt to present
* ‘our present knowledge of what constitutes
an adequate or optimum diet... based on an
enormous amount of research work on hu­
man beings and laboratory animals carried
out in many countries.”13
The Health Bulletin was meant to serve
as an authoritative guide book for plan­
ning a balanced diet. Its publication was
hailed and welcomed by many as it was an
attempt tocollate and synthesise the avail­
able information for the purpose of plan­
ning a balanced and affordable diet:
This brochure contains much... information
that v.111 be invaluable to those in India who
have to judge or plan diets, whether they be

medical men or otherwise. The general
principles are,dcalt with briefly and fig­
ures are given for the caloric requirements w
of the average Indian... there are many
gaps in our knowledge of the nutritive
values of Indian foodstuffs, but enough is
known to justify the compiling of this
‘health bulletin’. Its publication will do
away with one of the most serious handi­
caps under which the nutrition worker in
India has been labouring.14
This represented a crucial stage in the prac­
tical application of knowledge in the formu­
lation of public policy in colonial India. The
main difficulty encountered by the nutrition
worker was an economic one: how to devise
a well-balanced diet that could be afforded
by an average Indian? As B N Gangulee put
it in 1939:
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^^
ensured to the community as a whole. Oi^y
when an answer is provided to both these

Table 2: Relative Eh-ecis of Experimental
Diets on Rats
Diets

Mean BodyWeights
(Grams)

Body-Weight
Gain in Per­
centage

235
230
225
200
185
180
155

60
58
54
40
35
33
23

Sikh
Pathan
Mahratta
Gurkha
Kanarese
Bengalee
Madrassi

Source: Gangulee, p 230, see note 15.

Table 1: Atypical ‘Ill-balanced’ Diet and a ‘Well-balanced’ Diet
(Both Yielding 2,600 Calories)
(in Ounces per consumption unit per day)
Food
Cereal
Pulses
Milk
Leafy vegetables
Non-leafy vegetables
Fruit
Vegetable fats and oils
Fish, meat and eggs

Well-balanced Diet fl

Ill-balanced Diet
23
0.5-1.5
none or negligible amount
0.5-1.0
2.0-5.0
negligible
less than 1.0
0.5-1.0

17
3
8
2'
4
2
2
2-3 (if no milk is included)

Approximate chemical composition
(assuming cereal to be milled rice)
Calories
Protein (g)
Fat(g)
Calcium (g)
Phosphorus (g)
Vitamin A (IU)
Vitamin C (mg)

2,600
55
25
0.25
0.90
1,100
60

2,600
80
70
1.00
1.20
3,000
150

Source: W R Aykroyd (December 1941), p 2; see note 8.

Economic and Political Weekly

January 1-8, 1994

questions can wc consider the problem of
nutrition solved.15

And there were also a few who felt that the
solution to the problem of malnutrition could
come about only through a social revolu­

tion.16

n
Various studies conducted during 1930s
in different parts of India clearly showed
that a very large proportion of the popula­
tion suffered f^om undemutrition and mal­
nutrition, and that as a result, they became
susceptible to infections of various sorts
draining their mental and physical energy.17
Also, a number of investigations of the
peasant and working class dietary habits in
different parts of India led to another view
that their diet was usually adequate in its
calorific value, but was not well balanced.
As one investigator of diets in colonial India
said in 1938, “...the low standard of health
among the bulk of the Indian population is
not so much due to under-feeding as to illfeeding...”13 The purposeof this section is to
provide details on the diets of the south
Indian population and thereby infer the
extent to which they were under- and
mal-nourished.
A typical ill-balanced Indian diet as com­
pared to what was considered a well-bal­
anced diet appeared as given in Table 1.

Both the diets have the same caloric con­
tent or energy value. Taking 2,600 calories
approximately as the daily energy require­
ments of an Indian adult male, both the diets
would have satisfied hunger. But the more
varied “well-balanced diet, containing less
of cereals and more of everything else, is
infinitely more satisfactory in quality...’ ’19
The variations in the physical stature and
the health of the people from one region to
another in relation to their diets drew the
attention of the early nutrition workers in
India. Bytheendof 1920s, RCMcCarrison
showed experimentally for the first .time
that the diet of the south Indian people on an
average was perhaps the poorest as com­
pared to those of other regions.20 This study
along with many later studies showed that
a general deficiency in diet was more or less
prevalent all over British India. In a series of
striking experiments conducted by
McCarrison at Coonoor in 1920s, he sought
to determine for the first time the relative
values of seven typical Indian dietaries ‘ ‘by
feeding a group 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’ ’ .21 He noted that the
rats fed on the ‘Madrassi diet’ gained least
weight over a period of time, while those fed
on the Sikh diet gained themaximum weight
during the same period. Table 2 gives the

relative effects of the experimental diets on
rats:
Let us now consider the diets of the rice­
eating population, particularly of south In­
dia.
Among the various cereals cultivated in
British India, the area under rice exceeded
that under all the others put together. This
was particulary true in the provinces of
Bihar, Bengal, Orissa and Madras where
rice was the staple food of the majority of
the population. Table 3 gives a comparative
picture of the diets of the ‘ ‘poor rice-eaters’ ’
in various parts of India. The figures given
below were published in 1941 “based on
surveys carried out in widely separated parts
of the country—areas some of which are
several thousand miles distant from each
other”. Talking about the diets of the riccTable(5: Scale of Average
Calorie Requirements

Age Group
Adult male (over 14)
Adult female (over 14)
Child 12 and 13 years
Child 10 and 11 years
Child 8 and 9 years
Child 6 and 7 years
Child 4 and 5 years

Coefficient

Calorie
Required

1.0
0.8
0.8
0.7
0.6
0.5
0.4

2,600
2,100
2,100
1,800
1,600
1,300
1,000

Source: Aykroyd, Health Bulletin, 1938, p 2; see
note 9.

Table 3: Mean Intake of Various Foodstuffs

(Ounces per consumption unit per day)

Rice
Pulses
Leafy vegetables
Non-leafy
vegetables
Vegetable
fats and oils
Fish, meat and
eggs

Madras Presidency
Rural
Tea
Families
Area
Plantation
with
Labourers
Leprosy:
Madras City

Bengal
Rural
Area

Assam
Tea
Plantation
Labourers

Orissa
Rural
Area

Central
Provinces
Rural
Area

Kashmir*

Tehri**
Garhwal

15.0
(millet 5 oz)
1.3
0.3

18.0

LL0

25.0

19.0

19.0

26.0

26.0

16.0

1.0
none

0.8
negligible

0.4
0.2

0.9
0.8

1.0
1.4

1.1
1.5

0.6
5.2

1.8
0.5

13

3.0

3.0

7.0

4.0

6.0

3.0

2.0

4.7

0.5

0.5

0.5

0.3

0.3

0.3

0.2

0.9

0.2

negligible

1.5

1.4

0.7

0.7

0.6 . .

negligible

0.2

negligible

Notes: Condiments and sugar in small quantities were also included in the diets.
* The families included in this survey consumed a little milk (2.2 oz per consumption unit per day).
**
•• One of the Puniah
Punjab states in the Himalnvan
Himalayan foothills.
Source: Aykroyd (1940), p 343, see note 22.

Table 4: Average Intake of Calories, Proximate Principles, Calcium, Phosphorus, and Iron Per Consumption Unit Per Day

Average
Protein
Protein
Number of
(g)
Consumption
Units
Group I
Group II
Group m
Group IV

5.8
5.7
4.3
2.8

35.9
48.0
62.7
57.6

Fat
(g)

Carbo­
hydrates

Calories

Percentage of
Total Calories
Derived from
Cereals

Calcium

Phosphorus
(g)

Iron
(mg)

4.4
20.7
26.9
67.5

368.9
446.4
488.9
445.9

1,664
2,173
2,399
2,607

95.4
83
87
57

0.60
0.48
0.31
0.47

0.75
0.97
1.51
1.01

22.4
23.9
32.8
20.3

Source: Aykroyd and Krishnan (1937), pp 671-73, see note 23.

Economic and Political Weekly

I,

I

January 1-3, 1994

caters in India (based on the data as shown
in Table 3), Aykroyd observed that,
the diets of the poor rice-eaters are very
similar in composition throughout India...
The available data justifies the following
statements: the poor rich-eater in India con­
sumes, in addition to his staple cereal, only
very small quantities of other foods such as
pulses, vegetable, and meat. Milk is taken in
negligible amounts or notat all. While foods
other than those listed [above], such as fruits,
may occasionally be consumed, the table
gives a fairly accurate picture of the compo­
sition of ordinary daily diets [of the rice­
eating populations]....
If the diets shown are worked out in terms of
protein, minerals, and vitamins, and the re­
sults compared with the standards suggested
by the Technical Commission on Nutrition
and other standards drawn up by physiolo­
gists, itis found that the rice-eater’s diet falls
short of such standards in almost every im­
portant constituent?2
While this was the general impression about
the value of the daily diet of the rice-eating
populations in India, the diets of the various
sections within south India seemed even
more deficient in content and quality.
In relative and absolute terms, the south
Indian diet was grossly deficient practically
from every point of view—total calories,
total and animal proteins, total and animal
fats, carotene, vitamin A, B2, and C, iron
and calcium. The result was the low powers
of resistance and endurance to infection.
In an effort to estimate the diet values of
the peasants in south India, W R Aykroyd
and B G Krishnan undertook a survey of a
number of villages in 1936.23 It is worth­
while summarising the essential features of
this important study for it formed the basis
on which a number of suggestions were
made later in order to evolve a meaningful
policy and thereby correct the ill-balanced
diet of the population.
This survey was the first of its kind and
was also a fairly comprehensive one con­
ducted on the dietaries of south Indian peas­
ants. It covered 44 families, totalling 274
persons, from various districts over a period
of 20 days. A notable feature of this survey
was that it attempted to assess the economic
position of the population surveyed. Gross
income of each family was assessed roughly
taking into account the value of the crops
produced and the wages obtained from coo­
lie work and other labour. The sample popu­
lation was divided into four groups; their
essential features are given below:
Group I: Eight families in Overtownpet
village, Chingleput, consisting 67 persons.
They were tenants with an average holding
of three acres of land per household. Aver­
age annual income of this group was reck­
oned as between Rs 50 and Rs 80 per family.
GroupII: Four families in Karumpakkum
village, near Chingleput, consisting 28 per­
sons. They were distinctively more prosper­

58
k

!

ous than Group I. Their annual income was
between Rs 200 and Rs 300.
Group III: Twenty-nine agricultural fami­
lies in various villages in the neighbourhood
of Mayanur, Trichinopoly district, consist­
ing of one 168 persons. “This included
families of different income and economic
status, and regarded as a cross section of a
village community. At the upper limit, there
was a brahmin family owning 10 acres of
wet land and a considerable quantity of
livestock.whose annual income was about
Rs-300; at the lower limit, there were fami­
lies supported by coolie work, leasing* an
acre or so of dry land, and owning one or two
head of cattle with a gross annual income
under Rs 100. The average family income of
this group was somewhat higher than in
Group I, being in the neighbourhood of Rs
100 per annum.
Group IV: Thre^families not engaged in
agriculture, near Mayanur, consisting 11
persons. The income of these families was
between Rs 350 and Rs 500.
Group I was the poorest of the four. Table
4 gives details of the average intake of
calories, proteins, fats, etc, for each group
of families surveyed. Some of the signifi­
cant findings of this survey were: (1) In 31
out of the 44 families studied, milk and milk
products were absent in the diet; (2) Except
in case of a few prosperous families, foods
other than cereal were consumed in very
small quantities; pulses formed an impor­

tant ingredient in the diet of the south Indian
villagers; (3) Protein and fat intake was low,
particularly protein and fat of animal origin
was almost absent; (4) Vitamin A was present
in ‘infinitesimal quantities’ in the diet of 39
of the 44 families; and (5) Many diets were
found deficient in vitamin C.
Themostsignificantoutcomeof thisstudy
was the realisation that the problem of undemutrition and malnutrition in south India
was more serious than had yet been under­
stood and appreciated. In terms of adequacy
of calorie intake, one-third toone-half of the
families was estimated to be underfed. The
central concern of this survey was to work
out the minimum energy expenditure bud­
get of a south Indian peasant. More pre­
cisely, Aykroyd and Krishnan’s village sur­
vey tried to answer the question: * ‘How far
arc the diets of the various families suffi­
cientin quantity?’’They did not consider the
generally accepted European or American
standard as useful in order to compare the
observed calorie intake and therefore tha^
felt it necessary to calculate the minimsi^P
requirements of a south Indian peasant,
subject to nature of work performed and the
local conditions. But it is difficult to work
out the calorie requirements when intake is
restricted by poverty or other circumstances.
Aykroyd and Krishnan were very much
aware of this: “A complaint'of hunger is
perhaps better evidence of insufficient calo­
rie intake than a textbook deduction.”24

Table 6: Frequency Distribution of Certain Diseases per 1,000 of Sick Persons Compared with
Nutritive Values of Diets in Five Main Provinces in India
Divisions

North India
Central India
Bombay
Bengal
South

Diet Values
Expressed as
Average Weight
in Gram of
Experimental
Rats

Pulmo­
nary
Tuber­
culosis

233
220
198
180
155

1.60
1.01
2.01
2.12
2.61

Distribution of Diseases per 1,000
______of the Sick Persons
Leprosy
Beri­
BeriGastro Diarrhoea
and Duo­
and
beri
denal
Dysen­
Ulcers
tery
0.02
0.02
0.02
0.50
1.03

0.30
0.84
0.70
0.96
2.95

13.50
13.75
15.00
19.80 4
19.20

0.05
0.18
0.06
0.30
2.60

McCarrison’s results as quoted in S C Seal, ‘Diet and the Incidence of Diseases in India*, Indian Medical
Gazette, 73 (May 1938), p 295.

Table 7: Incidence of Phrynoderma, Angular Stomatitis and Bitot’s Spots
Number Number Percen- Number Percen-Number Percen- Number Percen­
Exa- Showing tage Showing Cage Showing tage Showing tage
mined More
PhrynoAngular
Bitot’s
Than One
derma
StomaSpots
titis
Clinical
Sign

Coonooc

Mettupalayam
Calicut
Ail children

Boys
Girls
Boys
Girls
Boys
Girls

715
779
41
274
377
65
71 '
2
426
52
"
5
76
280
2003

14.8
15.0
17.2
2.8
12.2
6.6
14.0

67
29
29
1
2
1
129

8.6
10.6
7.7
1.4

0.5
1.3
6.4

68
21
48
1
43
4
185

8.7
7.7
12.7
1.4
10.1
5.3
9.2

16
1
21
1
35
2
76

2.1
0.4
5.6
1.4
8.2
2.6
3.8

Source: Aykroyd and Rajagopalan (1936), p 431, see note 41.

Economic and Political Weekly

January 1-8, 1994

respiratory system. These two accounted though slowly,, to a lowering of vital profor about one-quarter of the total number of ; cesses, to impaired, resistance to inicrobic
sick persons admitted in hospitals in MaMa­ and othcrpathogemcagents of disease and
dras. Also he believed that the high inci­ to the development of maladies of many
i i\: -fjn;- •*'
dence of leprosy and tuberculosis in Madras kinds’
An important fact that came through a
presidency was related to the poor diet of the
rice-eaters. Table 6 shows the frequency number of surveys was that malnutrition
distribution of certain disease per 1,000 of was more marked among the poor of the
the sick persons compared with the nutritive towns and cities than among the poor of the
values of diets in the five main divisions in countryside. This was true not only of the
general population, but also of the children
colonial India. ’’
This led to a belief that ‘ ‘the distribution of in south India. The main reason for this
certain diseases is in inverse ratio propor­ urban-rural difference in malnutrition level
tional to the nutritive values of their diet was found in the quality of rice consumed,
irrespective of climate, race, environments, which formed the bulk of the daily diet of
etc.”2 Significantly, though leprosy and both urban and rural populations.tuberculosis were found to be common
The highly polished/milled rice (taken
among people whose diet was ill-balanced,
widely by the urban people) was less nutri­
they were more common in regions where tious as compared to the home-pounded or
rice was the staple food, containing little roughly milled or parboiled rice consumed
protein and vitamins. Hence, they were more by villagers. In giost parts of India par­
common among the people of Bengal and
boiled rice—i c, rice which is steamed be­
Madras than among those whose staple diet fore milling—was consumed in preference
consisted of wheat jowar, or other grains
to raw milled rice. A diet largely composed
richer in protein and among those who took of raw milled rice, with little of pulses,
milk and milk products.
vegetable, etc, contained insufficient vita­
Besides these, a number of widely preva­ min BI. which gave rise to beriberi; whereas,
lent ‘deficiency diseases’ were identified
“parboiled rice retains a-considerable proamong the people. Studies revealed that portion of its vitamin Bl content even when
diseases. highly milled”-33
“nrtarrfmm
apart from the rlinicnllv
clinically defined diseases,
a subclinical state of deficiency is the pri­
Beriberi was in endemic form in certain
mary cause of the general ill-health and
parts of the presidency where milled rice
lowering of resistance of the people and is was the staple article of daily diet.36 More
indirectly responsible for the most severe importantly, it was mainly confined to a
ravages of this country by the various tropi- narrow tract on the east coast in the districts
cal diseases such as malaria, kala-azar, tu­ of.Ganjam, Vizagapatnam, Godavari,
berculosis, leprosy, cholera, anaemia, diar­ Krishna, Guntur and Nellore.37 About 95 per
rhoea, etc.”33 These ‘deficiency diseases’, cent of the 40,000 cases reported annually in
though less obviously manifested, came to the Madras presidency occurred in these
be realised as were of greater practical im­ districts. “In this area, the population con­
portance than the more obvious but less sumes raw rice, whereas elsewhere in south
common diseases. As McCarrison put it: India, and throughout most of the country,
“the milder grades of deficiency of certain the poorer classes prefer parboiled rice.’’38
food-essentials—particularly of vitamins Early in 1920s, after conducting his valu­
and mineral elements—were much more able survey on the causation and prevalence
widespread among the people than the se­ of beriberi in the Madras, 'presidency,
vere grades; and that they led as surely.
McCarrison observed:

Beriberi in Madras is a place disease. Ils
; peculiarly limited distribution in this presi­
dency appears to indicate that there are
telluric, climatic and hygienic factors, as
well as conditions relating to the storage of
rice, concerned in its causation that require
consideration equally with the dietic factors.
It is true that a cause of Beriberi is well
known—deficiency of vitamin B—but
causes of Beriberi are not yet well known.”
In fact, the rural-urban difference noted
above was more due to another important
factor while in the rural areas at least some
amount of one of the millets formed a part of
the diet, in urban areas there was a social
prejudiceagainstmillets, particularly against
ragi. Millets were generally regarded as the
food of the poor villager and also as the food
of the prisoners. Raw milled rice was the
staple food of the educated class. Such
prejudices were observed even among the
children. This was brought out clearly by­
Aykroyd and Krishnan in their study in 1937
on the state of nutrition of school children in
south India.40 They took a sample of 714
boys and 955 girls in the age group of four
to 20 (the majority of whom fell in the age
group 9 to 17) from 24 hostels situated in
various parts of the Madras presidency.
Many of the hostel superintendents had
expressed that they had the greatest diffi­
culty in persuading the children to eat ragi
and other kinds of millet, even when millet
was the staple food of the district from
which they came.
A few important studies had been con­
ducted in 1930s to record the incidence of
malnutrition and symptoms of deficiency
diseases among the children in south India.
We will mention here one of them carried
out by Aykroyd and Rajagopal in 1936.41
Their study covered about 2.000 school
children from three different towns and
compared the incidence of the following
deficiency diseases among them:

(a) Angular stomatitis: deficiency of some
part of (he vitamin B2 complex was consid-

Table 10: Income and Expenditure of Labourers in Madras City (1935)
Income Per
Family

1Below Rs 120
]Per month

No of families
47
Per cent in each
income group
7.4
No of consumption
units per family
3.03
Monthly income per
consumption unit
(Rs, annas, pais)
5-12-6
Monthly expenditure per
consumption unit of food
(Rs, annas, pais)
3-5-0
Percentage of total
income spent on food
57.06
Expenditure on milk per
consumption unit (Rs) . 0-1-2
Source: Aykroyd (1941), p 7, see note 8.

60

Rs 20 to 30

Rs 30 to 40

Rs 40 to 50

Rs 50 to 60

Rs 60 to 70

167

198

118

69

20

Above 70

20

All Families

639

26.1

31.0

18-5

10.8

3.1

3.1

4.19

4.89

526

6.15

7.63

6.08

4.92

6-0-8

6-15-6

8-8-7

8-13-4

8-7-2

12-3-3

7-9-6

3-5-8

3-8-1

3-14-8

3-12-0

3-10-2

5-3-6

3-10-8

5634

54.93

50.41

4925

48.81

4838

52.63

.0-4-7 ..

.0-4-1

0-4-0

0-7-11

0-3-6

... .0-2-4 ... _ 0-3-5 ......

B -

; w.
■

.

•-.{

•

....

v’-.-h

J Suggesting a standard of dietary for the
country was impossible, becanscofthe variable conditions of life, racial habits, physiquc, and c
climate
limate in different parts of
Ihdia. The few studies conducted so far had
showed clearly that the average intake of
almost all the communities, even if supplied
the calorie requirements, provided no mar-,
gin to serve as ‘reserve energy’. Therefore,
it was felt that “in suggesting a standard of
dietary, we should bear in mind that it must
not only provide the bare nutritional re­
quirements but must ensure a margin of
safety and a degree of resistance to dis­
ease’’.23
However, Aykroyd and. Krishnan at­
tempted “in a rough and ready fashion” to
estimate the minimum energy requirements
of a south Indian peasant Assuming that the
south Indian peasant spends eight hours of
the 24 in sleep, eight hours at work, and
eight hours ‘sitting at rest’, his energy ex­
penditure budget was thus worked out as
follows:
8 hours
8
8 H

sleep at
work at
sitting at
rest

• calorie ** calorie per hour

54**
180**
86**

432*
1440*
688*
2.560*

-■* As-for the dietary requirements of infants
i in India, the HealthBulletin could give only
tentative recommendations, since “uptothe
up to the
tartativerecommendations,
present the subject., has not been fully
investigated by scientific methods’’. The
following were the estimated daily require­

ments of ‘average normal infants’ of vari­
ous ages.

1st week
1st month
2nd month
3rd month
5 th month
8th month
12lh month

200 calories
350 „
400 ,,
450 „
600 ,.
700 ..
800 ..

Such estimates of minimum requirements
formed the basis for estimating the extent of
malnutrition as well as the ill-effects of
malnutrition. Based on different sets of as­
sumptions. different estimates were made
as to the extent of malnutrition in colonial
Indial. Aykroyd estimated that the propor­
tion of underfed in normal times was about
30 per cent of the population. * JohnMegaw
of the Indian Medical Service put the figure
around 60 per cent in 1935.” In the next
section, we shall turn to certain important
consequences of the ill-balanced and often
inadequate diets of the ‘poor rice eaters' in
colonial south India.

and the food habits ofvarious sections ofthe
population. As for the ill-effects of undernourishment, the following words of
Aykroyd made in 1946 after years of working in India summarise the situation:
It is impossible to estimate accurately what
proportion of disease in India has its roots in
malnutrition. But there is plenty of evidence
that it is one of the most important factors
underlying the dismal public health situa­
tion.

Further he went on to say,
In viewof what is known about the deficien­
cies of Indian diets, it is not unreasonable to
suppose that the incidence of diseases which
become more prevalent in times of food
scarcity is influenced by diet in normal
times.50

In fact, the famous experiments of
McCarrison with rats in 1920s led him to
believe that,

The great majority of the rats in that experi­
ment enjoyed good health when fed on a
well-constituted diet such as is used by Sikhs
of the better class, while the great majority of
those fed on an ill-constituted diet, such as is
commonly used by the poorer classes of this
country, developed diseases of two chief
kinds: respiratory and gastro-intestinal.11

More specifically, McCarrison observed
that the diet in common use by,the people of
“All things considered”, they observed, “we
Madras, which was very poor and ill-consti­
are inclined to estimate the minimum daily
tuted, was largely responsible for the high
calorie requirements per consumption unit
The effects of malnutrition attracted the
incidence of diseases of digestive and respi­
of south Indian peasant families as lying in
ratory systems. For example, he showed
attention of the colonial authorities greatly
the neighbourhood of 2,500.
since the late 1920s. as we Ihave already
that among every 1,000 sick persons in the
Although the figure 2,500 calorics was
i_
—jQ Madras jn 1933, about 180
pointed out and by the end of 1930s signifihospitals
considered as the minimum for all practi­
suffered from diseases of the digestive sys­
cant progress had been made in the under­
cal nutrition work, e g, in drawing up diet
standing of the physiological requirements
tem. and 76 suffered from diseases of the
schedules for institutions, Aykroyd and
Krishnan cautioned thatitrepresented only
Table 8: Clinical Signs of Deficiency Disease in ’Poor’ and ’Better Class’ Schools (Coonoor)
an average: “...all individual cases falling
Number Number Percen- Number Percen- Number Percen- Number Percensomewhat below it need not be regarded as
Exa- Showing
tage Showing tage showing tage Showing tage
under-fed’ ’. However, considering this fig­
mined One or
Bitot’s
PhrynoAngular
ure as reasonable, the calorie intake in
derma
Stoma Spots
More
Groups I and H was definitely insuffi­
Clinical
litis
cient. In the Group m, the mean intake
Sign
approaches the minimum requirement “but
~50
10
‘Poor’
Boys 158
15.8
63
31.6
26
16J
25
conceals (since the intake of a number of
0
schools
8
9.7
Giris
62
12
19.4
13.0
6
families was in excess of the minimum)
‘
Better
6
1.0
Boys 621
65
10.5
41
6.6
7.0
43
under-nutrition in a considerable propor­
Class’
0.8
21
Giris 212
29
13.7
7.1
1
9.9
15
tion of families”. Thus they felt justified
schools
in stating that one-third to one-half of the
Source: Aykroyd and Rajagopalan (1936), p 433, see note 41.
families studied did not consume enough
food during the period of investigation.
The survey in Chingleput district took
Table 9: Statement on Medical Examination of Pupils of Sri Minaxshi Sundareswara Vidyalaya,
place in January 1936, while the rest was
Karaixudi, Ramnad District, 1927 to 1930
carried out durin g July-August of the same
Diseases and
September
October
September
October
year.
1930
Defects
1928
1927
1929
What we see clearly from the informa­
Malnutrition
52
71
73
105
tion presented above is that a large propor­
Skin, other diseases
2
3
tion of the south Indian population were
24
39
Eye diseases
20
3
not only underfed but also ill-fed. As per
Dental diseases
2
1
1
the Health Bulletin of 1938, the minimum
Others
calorierequirements for the ‘ ‘average man.’ ’
______________________________________________________________________________________
and those for different age and sex were as - - Source: K S Srinivasa Iyer, ‘Medical Inspection of Schools’, Bulletin ofthe South Indian Medical Union,
__ __ 1____________________ .71/1^
TVrmJvrlQtn
.
-•• •
follows?7
2U12X December
1930. pn?an
240. . ‘ ’

m

i

&sr

i
cred the causative factor; fissures at the
angles of the mouth usually found in asso­
ciation with the lesion of the tongue; ,
(b) Phrynoderma: considered as due to vita­
min A deficiency; it relates to dryness of skin
(described as toad skin); the subject whose
skin is thus affected is often afflicted with
sore mouth; the progressive wasting of the
child suffering from malnutrition is usually
manifested in the condition of the skin;
(c) Xeropthalmia: an eye trouble caused by
deficiency of vitamin A, a cause for blind­
ness; their incidence was noted by observing
patches of foamy yellowish-white substance
(known as Bitot’s spots) appearing on the
conjectiva...

These were considered ‘‘the conspicuous
symptoms of malnutrition”. Table 7 shows
the incidence of these symptoms among the
children of Coonoor, Mettupalayam, Calicut,
as reported by Aykroyd and Rajagopal. It
shows that nearly 25 per cent of the children
examined suffered from these three dis­
eases alone.
In the same study they also compared the
incidence of the same deficiency diseases
among the children in ‘poor’ and ‘better­
class’of schools in Coonoor town and found
them considerably higher in the ‘poor’
school.42 The ‘poor’ schools included two
schools for the children of the dhobies
(washermen) and sweepers, while the 'bet­
ter-class’ school included children from
economically better-off families, though
many children of the very poor parents also
attended these schools. Table 8 summarises
the comparative positions of the children of
the poor and better class schools in terms of
phrynoderma, angular stomatitis and
xerophthalmia (Bitot spots).
The extent of malnutrition among the
children was thus evidently very high in the
entire Madras presidency. The Madras
corporation’s reports regularly recorded a
high incidence of xerophthalmia and
stomatitis due to diet deficiency among
corporation school children in Madras city.
Generally, the corporation schools were at­
tended by the children of thepoorest classes.
During the years-1930 to 1934, nearly 20 per
cent of the children in the corporation schools
in Madras was found to be suffering from
malnutrition.43 Regular medical examina­
tions of the children conducted in other parts
of the presidency also revealed a high inci­
dence of Malnutrition among the children,
as can be seen, for example, from Table 9 of
a school in Karaikudi town in Ramnad dis­
trict for the period 1927-1930. It shows
clearly that at least one-fourth of the chil­
dren were malnourished. It may be noted
here that such a high percentage of malnour­
ished children was also common in - the
Bengal and Bihar provinces where, rice
formed the bulk of the diet44
The data given above are obviously selec­
tive, but they certainly reflect the poor state
of health of the children in colonial India:

Economic and Political Weekly

poor physique, impaired vigour, gastro-in­
testinal disturbances, low resistance to in­
fections and other pronounced symptoms of
malnutrition—all these features arc com­
mon among schoolchildren throughout a
great part pf India.45
Many later studies confirmed that malnu­
trition, particularly protein malnutrition was
a problem of very considerable magnitude
in the poorer communities of south India.
They showed a high prevalence of frank
cases of kwashiorkor, and marasmus (ema­
ciation) among the children in south India.
Someswar Rao et al’s survey in late 1950s of
the extent of protein malnutrition in south
India estimated that 1 per cent and 1.7 per
cent of children suffered from frank cases of
kwashiorkor and marasmus.46 Their survey
covered about 4,500 children from families
whose monthly income was less than Rs
100, in the states ©f Kerala, Madras (pres­
ently, Tamil Nadu), Andhra Pradesh and
Karnataka.
Besides these symptoms of malnutrition,
there were also other disorders, such as
rickets, osteomalacia, dental carries, caused
by nutritional deficiencies. For example, it
was found that the incidence of badly formed
or decayed teeth was widespread among the
rice-growing parts of India.47
A diet deficient in protein, iron, vitamins,
etc, also had adverse effects on maternal and
infant mortality rate. By late 1930s suffi­
cient medical evidence had been collected
to show that nutrition was at the bottom of
the-problem of matemal mortality. A defi­
cient diet of the mother was found to cause
cessation of growth of the child in the foetus.
This was an important cause for the high
incidence of feeble and premature birth of
infants all over colonial India; and prema­
ture birth was certainly a cause for the
higher infant mortality. In colonial south
India, neonatal deaths accounted for about
50 per cent of the total infant deaths. Recent
studies have implicated matemal malnutri­
tion as an important cause of the high infant
mortality in many developing countries.
Aaron Lechitg’s study in this respect sug­
gests that ‘ ‘both short- and long-term mater­
nal nutrition status may be causally related
to infant mortality.”48 This does not mean,
as he points out, that other factors, namely,
medical care and environmental sanitation
are not important determinants of infant
mortality.
In one of their many pioneering studies,
Balfour and Talpade observed in 1932 that
‘‘the unsatisfactory conditionsof the infants
may have been either due to lack of protein
or to lack of vitamin B” in the diet of the
mothers.49 Later in 1962, talking about preg­
nancy wastage, C Gopalan referred to a
survey carried out in south India which

revealed that among poor women whose
dietaries during pregnancy provided 1,4001,500 calories and about 40 grams of pro-

January 1-8, 1994

tein daily, 20 per cent of pregnancies had
terminated in abortion, miscarriages or still
Also, the effect a still birth as compared to
a live birth on the survival chances of a
undernourished mother was significantly
higher. This was brought out clearly in 1929
by Ubhaya and Adisheshan in their study of
the factors associated with maternal mortal­
ity in south India.51 They surveyed 7,324
confinements registered in Madras, Madura,
Trichinopoly and Coimbatore during the
period October 1927 to September 1928.
Among the confinements analysed, there
were 7,176 live births and 166 still births;
the proportion of latter to the former being
2.31. The overall maternal death rate was
17.89 per 1,000 births. But what is more
important to note here is that ‘ ‘the maternal
death-rate in the case of confinements re­
sulting in still births was a little over 5 times
the death-rate in the case of confinements
resulting in live births”.
Pregnancy-anaemia, largely nutritional in
origin, was found to be one of the chief
causes for the high maternal mortality in
India, particularly among the working class.2
This was confirmed to be true in the case of
Madras city also, as showed by an investiga­
tion conducted by A L Mudaliyar in 1932
into the causes of maternal deaths in the
various city hospitals.53 Of the'436 maternal
deaths out of26,207 confinements, he found
that pregnancy-anaemia caused 50 deaths
(about 12 per cent). Mudaliyar’s study sug­
gested that this was largely due to deficien­
cies in food intake. Also, his study found
that the deaths due to toxemias of preg­
nancy, considered as the consequences of
dietetic deficiency, was about 10 per cent.
Although malnutrition perse may not have
caused these maternal deaths; it would have
certainly aggravated in some sense the de­
velopment of toxemias of pregnancy.54 Of
course, sepsis continued to be the chief
cause for maternal deaths.
As for the extent of malnutrition among
the working class population in colonial
south India, very little information is avail­
able. Much of what we have is related to the
workers in Madras city. There was no sys­
tematic enquiry into the living conditions of
the working class until the survey of the
Family Budgets of Industrial Workers in
Madras city was undertaken in 1935.55 The
family budget survey sought to analyse what
a working class-family actually spent, not
only on the bare necessaries of life but also
on the social obligations, on ‘‘the satisfaction of certain wants springingj from the
—
----- —
social conditions
in which people were
placed and reared up. ”
It observed that the food consumed by the
industrial workers was deficient in calories,
and proteins, fat, minerals and vitamins
except B1. Table 10 gives the findings of the
above mentioned survey on the diet of the

61

V

industrial workers in Madras city. The illbalanced diet was estimated to cost from Rs
2 to Rs 3 per adult per month, depending on
the nature of cereal and differences and
fluctuations in food prices. The cost of the
well-balanced diet was estimated as Rs 4 to
Rs 6 per adult per month.
Two important findings of this survey
which are related to level of malnutrition
among the working class should be men­
tioned here (Table 10).
...monthly expenditure on food, even injhe
lowest group; was slightly above that neces­
sary to purchase an ill-balanced diet suffi­
cient in quantity. Presumably, therefore, the
majority of families were above the starva­
tion level—they had enough to eat.
The percentage of total income spent on food
averaged 52.6 per cent in all families. [But
the] expenditure on food per consumption
unit did not rise proportionately to income
per consumption unit.

The average amount spent by all families
surveyed on food per unit of consumption
per month was Rs 3-10-8 as against Rs 6 per
unit of consumption per month required for
a well-balanced diet.56 Only the highest in­
come group (with income above Rs 70 per
month) could spend enough on food to pur­
chase a well-balanced diet It should be
noted that the amount spent on milk in­
creased but in small amount until the highest
income group is reached. Aykroyd’s expla­
nation for this trend does sound reasonable.
The probable explanation is that an illbalanced diet is the normal diet of the poor
in south India, and poor families will not
readily make sacrifices in other items of
expenditure to purchase a diet of superior
quality. It is only when income reaches a
level which allows needs other than food to
be fulfilled with relative ease that more
money is devoted to buying a better diet.57
Similar tendencies were also noted in
family budget enquiries carried out in
Ahmedabad, Shplapur, Howrah, and
Bombay, on the industrial workers with
monthly income ranging from below Rs 20
to Rs 80 per family.58
While the Family Budget of Industrial
Workers in Madras City suggested that the
majority of workers were above the starva­
tion level, C W Ranson’s observations in
1938 on the workers’ state of health in
Madras sfeem to contradict it: ‘ ‘considering
that the figures furnished by M/s Binny and
Co for 1919 were average wages and that
there must have been many employees who
received less than the average, a large num­
ber of the workers should have been living
under what were virtually famine condi­
tions.”59
What may be said in general terms about
the working class is that the usual diet avail­
able to the bulk of the industrial labour was
not balanced and was inadequate in calorific
value. As the memorandum submitted by

62

the medical authorities to the Royal Com­
mission on Indian Labour in 1929 stated, ‘‘it
[the diet] is 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 resis­
tance.”60

IV
There is an abundance of evidence to
suggest that a large number of the people in
colonial south India suffered continually
from a number of deficiency diseases; their
susceptibility to these diseases was a result
of their diets which were defective in many
respects, particularly in terms of ‘protective
food’. Under- and malnutrition meant not
only low resistance to infections, loss of
vitality and productivity, but in many cases
also death. A Isfi-ge number of deaths in
colonial south India may have been due to
malnutrition perse, aggravated by the onset
of certain infectious diseases. It is not pos­
sible to get a precise figure of the impact of
malnutrition on mortality in the past; but it
needs to be pointed out here that the ques­
tion of nutrition-mortality link so far has not
received adequate attention by the scholars
working on demographic change in colo­
nial India. It is necessary to first assemble
together the available data on the regional
variations in the diets of the Indian popula­
tion before and during inter-war period in
order to prove or disprove as to whether the
billk of them suffered from moderate mal­
nutrition but remained stable and just above
the minimum requirements to survive. Un­
til then, Klein’s immunological hypothesis
may remain undisproved, though it also
does not sqaurely answer certain questions
such as the following: How was it that
immunity developed by early 1920s and not
earlier or later, given the fact that for a long
period of time the people were exposed to
these diseases, without much improvements
in their diet standards?; Which age group of
the population had more immunity to these
diseases? What about the children: were
they more or less immune to these dis­
eases?. Their diets were certainly poor and
aided spread of infectious diseases. Nearly
half of ’the total deaths were among the
children. Why did such a trend continue?
Was it because they never developed suffi­
cient immunity to escape from attacks of
these infectious diseases?. If immunity did
develop around early 1920s, why is that till
today certain parts of India, particularly the
states of Bihar and Orissa, continue to expe­
rience a high mortality rates?; they have
been exposed to these diseases at least for
as long as the rest of India.
Many such questions can be raised. The
lesson I derive from scanning through the
results of the studies on diets and its rela­
tionship with diseases in colonial south

India conducted in 1920s and 1930s is that
we should not be overhasty in explaining the
mortality decline in the inter-war period.
More empirical analysis is required before
we can arrive at even a preliminary view on
the nutrition-mortality link.
Any discussion on the nutritional status of
a given population of the past has to be
cautious for a number of reasons, one of
them being the lack of information. While
discussing the value of contemporary stud­
ies on nutrition for historians, Scrimshaw
remarks that ‘ ‘Nutritional mechanisms and
consequences that can be discerned only
with great difficulty from the usually sparse
and inadequate historical data can often be
understood with reasonable certainty through
access to detailed contemporary informa­
tion and analysis”.61 We need such an
indepth study. What I have presented here
may be considered a small step’ in that
direction.

Notes
[I wish to thank S Ambirajan, A Vaidyanathan, C
Gopalan, C S Subramaniam, D Veeraraghavan,
and Shambu Prasad for their comments on this
paper. Many of their valuable suggestions to widen
the scope of this essay will be incorporated in a
larger study which is under progress. The errors
that remain are mine.]

1 Sumit Guha, ‘Mortality Decline in Early
Twentieth Century India: A Preliminary
Enquiry’, The Indian Economic and Social
History Review (hereafter 'IESHR), 28,
4(1991), pp 371-91. Tim Dyson’s (edited)
India's Historical Demography: Studies in
Famine, Diseases and Society, London,
1989, has very little to say on this very
important and a complex relationship be­
tween nutrition and mortalilly.
2 Ira Klein, ‘Population Growth and Mortality
in British Indian Part II: The demographic
revolution’ JESHR, 27, 1(1990), pp 33-62.
3 Guha, p 387, see note 1.
4 Guha cites Sukhatme’s ‘The Process.View
of Nutrition’ in S K Roy (ed) Frontiers of
Research in Agriculture, Calcutta, 1983, Ibid,
p 387.
5 Guha, p 387, see note 1.
6 MassinoLivi-Bacci, ‘The Nutrition Mortality
Link in Past Times: A Comment’, JIH, 14(2)
1983, pp 293-98.
7 Michael Worboys, ‘The Discovery of Mal­
nutrition betweenthe Wars’, in D Arnold
(ed) Imperial Medicine and Indigenous So­
ciety, Oxford University Press, Delhi, 1989,
pp 208^25.
8 W R Aykroyd, ‘Economic Aspects of the
Problem of Nutrition in India’, Indian Journal
ofSocial Work, II, 3 (1941), p 1.
9 W R Aykroyd, ‘The Nutritive Value of Indian .
Food and the Planning 6f Satisfactory Diels’.
Health Bulletin, No 23, revised and enlarged.
Government of India, New Delhi, 1938.
10 Ibid.pl.
11 ‘Dietary and Nutritional Standards' in India*
(editorial), IMG 7 l(Ju!y 1936), p 405.
12 ‘The Nutritive' Value of Indian Foods and
the Planning of Diets’ (editorial), Indian

Economic and Political Weekly

January 1-3, 1994

YB-

P

Medical Gazette (hereafter IMG), 72 (May
Madras, Government of Madras, 1933.
Organisation (hereafter BWHO), 20 (1959),
54 Gangulee (1938), p 129, see note 15 and also
1937), pp 299-300.
pp 603-39. y
refer to Gopalan (1962), p 204, see note 50 and
47 Gangulee (1938), p 139-40, see note 15.''
13 Aykroyd (1938), p 7, see note 9.
note 33.
14 IMG, (1937), p 300,-see note 12.
48 Aaron Lechtig, ‘Relationship between Ma­
15 B N Gangulee, Nutrition and Health in India,
ternal Nutrition and Infant Mortality’ in 55 Report of the Enquiry into the Family Budgets
of Industrial Workers in Madras City; Govern­
London, 1939, p 15.
WaltorSantoseta! (eds), Nutrition and Food
ment of Madras, 1938 (hereafter, 1935 Family
16 Asforexample.PCRayremarkedin 1941 that
Science: Present Knowledge and Utilisation,
x Budget Enquiry). .
“the problemof nutrition is not only a scien­
Vol 3: Nutritional Bio-Chemistry and Pa­
tific problem but also a social problem’’ and
thology, New York, 1980, pp 567-80.
56 Ibid, p 131.
that it “should be tackled by radically altering 49 MI Balfour and S K Talpade, ‘The Influence 57 Aykroyd (1941), p 8, see note 8.
the social system”; refer his article “The prob­
of Diet on Pregnancy and Early Infant Mortal­ 58 Ibid, p 8.
lem of nutrition in India”, The Indian Review,
ity in India’,IMG 61 (November 1932), p 606. 59 C W Ranson, A City in Transition, Madras,
42,4 (1941), pp 209-12.
1938, pp 41-42.
50 CGopalan, ‘Effects of Nutrition on Pregnancy
60 Gangulee (1938), p 222, see note 15 and D
17 ‘The Nutritive-Value of Indian Foods and the
• and Lactation’, BWHO, 26.2 (1962), p 203.
Planning of Diets’, Indian Medical Gazette 51 N R Ubhaya and R Adisheshan, ‘Maternal
Veeraraghavan, The Rise and Growth of
(hereafter IMG), 72 (May 1937), pp 299-300;
Labour Movement in the City, ofMadras and
Mortality in India: A Preliminary Study’, IMG
and D C Wilson and Widdowson, ‘A Com­
its Environs 1918-1939, PhD thesis, Indian
(October 1929), p 555.
parative Nutritional Survey of Various Indian 52 L Wills and MM Mehta,‘Studies in Pernicious
Institute of Technology, Madras, Chapter 1.
Communities’, Indian Medical Research Mem­
Anaemia of Pregnancy’ ,1JMR 18 (July 1930), 61 NS Scrimshaw, ‘The Value of Contemporary
oirs (hereafter IMRM), No 34 (March 1942).
Food and Nutrition Studies for Historians’,
pp 283-306.
Journal of Interdisciplinary History, 14(2)
18 SPNiyogi, VN Patwardhan, and RGChitre, 53 A L Mudaliyar, Report ofan Investigation into
1983, pp 529-34.
‘Balanced Diet, (Part I)’, Indian Journal of
the Causes ofMaternal Mortality in the City of
Medical Research (hereafter IJMR), 24 (Janu­
ary 1937), p 787.
19 W R Aykroyd (1941), p 2 see note 8.
20 Robert McCarrison, ‘A Good Diet and a Bad
One: An Experimental Contrast’, IJMR, 14
(1927).
21 Details of. these experiments are taken from
Gangulee, p 230, see note 15.
22 WRAykroyd, ‘The Poor Rice-Eater’s of Diet’,
Shanti Ghosh
Bulletin of the Helath Organisation of the
League ofNations, 9, 3(1940), p 344.
THE
articles
by
Gupta
and
Rohde
(EPW,
widely accepted. Infants of undernourished
23 W R Aykroyd and B G Krishnan, ‘Diet Sur­
veys in South Indian Villages’, IJMR, 24 (Janu­ June 26, 1993) and Mina Swaminathan women weigh less from birth through in­
ary, 1937), pp 667-688.
(EPW, September 25, 1993) have raised
fancy compared to those bom to better nour­
24 Ibid, p 682.
interesting issues. Let me say at the outset ished women. The nutrient need of smaller
25 Gangulee, p 232, see note 15.
that breast-feeding remains the ideal food babies is less than of bigger babies. Most
26 Aykroyd and Krishnan, p 684, see note 23.
for the baby and exclusive breast-feeding Indian babies continue to grow well for
27 Aykroyd (1938), p 2, see note 9.
28 Aykroyd, Nutrition, Oxford Pamphlets on In- for the first four-six months leads to better four-six months on breast milk alone. WHO
dianAffairs, Oxford University Press,21,1946. nutrition, better growth and virtual freedom CollaborativeStudies have shown that when
from infection. There are innumerable other infants of similar birth weight’ and body
29 As quoted in Gangulee, p 229, see note 15.
weight were investigated, there were no
advantages but I will not go into them here.
30 Aykroyd (1946), see note 28.
31 R McCarrison, Mzmrion and Health (The Can­ It is a bond between the mother and the baby significant differences in volumes of milk
tor Lectures, The Royal Society of Arts, 1936, leading to tremendous emotional satisfac­ produced between undernourished and wellFaber and Faber, London 1956).
tion to both. Almost all Indian rural women
nourished mothers, supporting the hypoth­
32 As quoted in S C Seal, ‘Diet and the Incidence breast-feed naturally without thinking of the esis that infant size is one of the determi­
of Disease in India’.ZA/G, 73 (May 1938), p294.
benifits either nutritional or psychological. nants of the volume of milk secreted. Mater­
. 33 Ibid, p 300.
The milk is there, they have seen-everyone nal under-nutrition does not seem to have
34 McCarrison (1936), see note 31.
around them breast-feeding and so they any adverse effect either on initiation of
35 Aykroyd (1940), p 349, see note 22.
36 R McCarrison and R V Norris, ‘The Rela­ breast-feed the baby automatically. They do lactation or the duration of lactation.
Lactation involves considerable nutrient
tionship of Rice to Beri-Beri in India’,7Af??Af not think of the economic benefits and the
No 2 (1924).
amount of money saved. Thinking in eco­ expenditure for the mother, the estimated
37 GovernmentOrder (hereafter GO), 1565 (Pub­ nomic terms somehow reduces the mother caloric expenditure varies between 400-700
lic Health Department; (hereafter PH), 17 to a good milk-yielding cow, even though
K cal/day. There is no deposition of body fat
November 1922; and Letter from R McCarrison in the context of the national economics during pregnancy among poor women to
to the Surgeon-General with Government of
this might evoke a great deal of academic meet the extra need during lactation. Major­
Madras (No D/200, Decembers, 1922), in GO
interest.
ity of lactating women frony low income
639 (PH), April 14,1923.
The subject of maternal nutrition and groups subsist on diets which provide 120038 Aykroyd (1940), p 349. see note 22.
breast-feeding has evoked a great deal of 1600 K cal/day irrespective of whether they
39 GO 639 (PH). April 14.1929.
40. W R Aykroyd and B G Krishnan, ‘The State of interest. Earlier studies by the National In­ are lactating or not. The expenditure in­
Nutrition of School Children in South India’, stitute of Nutrition had shown that under­ volved in producing 500-600 ml of milk per
Part-n, IJMR, 24 (January 1937), pp 707-25.
nourished women secrete 500-800 ml of day is about 450-600 K cal per day. Under
41 W R Aykroyd and KRajagopal,‘The State of milk [Ramachandran 1989]. More recent normal circumstances such a large energy
Nutrition of School Children in South India’, studies using electronic balances for mea- deficit is likely to result in weight loss of
Part-L UMRJA (pdbbes 1936). pp 419-37.
42
suremait of milk intakes of infants have 1.5-2.0 kg per month. Even though women
43 Referred to m ibid, p 419
confirmed this. Women in developed coun- . continue to work both inside and outside the
44 Seal (1938), see note 32.
tries can secrete 600-1000 ml ofmilk a day home, the alterations in body weight during
45 Gangulee (1*938), p 215, see note 15.
bu t milk intake of’infants bom to undemour- lactation are of too small a magnitude to
46 K Someswar Rao et al. ‘Protein Malnutrition ished women was lower [WHO 1985]. That make any difference to energy needs; With
in South India’. Bulletin ofthe World Health . infant modulates maternal milk/yield is : j cessation of lactation again it is no more

DISCUSSION

Breast-Feeding: Beyond Economics

Economic and Political Weekly. - January 1-8, 1994 •' '>

63

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i

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i

than adequate for maintenance of body
weight. This is a complex and intriguing
issue. Someill understood adaptive changes
occur in lactating women so that energy
balance is maintained in spite of marked
variation in energy expenditure.
Plasma prolactin levels are higher and
remain at the elevated level throughout the
period of lactation in women from undernourished communities. It has been speculated whether high protective level may play
a vital role in ensuring preferential transfer
of nutrients to breast milk in under-nour­
ished women. They may have an anabolic
role and result in more efficient utilisation
of available nutrients by the mother. Most
women can produce adequate amount of
milk for the baby for four-six months. The
reason for giving up breast-feeding are nor­
mally flimsy like breast not being heavy
with milk and wrong advice by health work­
ers, etc.
Massive food supplementation is not fea­
sible. Available data suggest that there is no
substantial improvement in maternal nutri­
tion status even in supervised food supple­
mentation programmes [Prcntier AM ct al
1980]. The women should be encouraged to
eat an extra helping of the family food. This
needs very sustained and relevant health and
nutrition education and not a supplementary
feeding programme. The ICDS programme
in India, provides a unique opportunity to.
study this problem, since food supplemen­
tation to pregnant women during the last
trimester ofpregnancy and to lactating moth­
ers is a part of the programme.
Most women have to work, either the
unpaid family work or household chores,
fetching water and fuel, working on the
family land, etc, or paid work to augment the
family income. This is where the problem
comes in. They are not often able to take the
baby with them and so the baby is breast-fed
at longer intervals, compromising the baby’s
nutrition as well as adversely affecting the
breast milk yield. There are no easy solu­
tions to this problem. Expressing breast
milk and leaving it for a caretaker (a) grannyor even a eight-ten-year old sibling) to give
it to the baby does not seem practical be­
cause of lack of hygienic standard at home.
Day care centres could fill the care taking
role in the urban areas, but it is difficult to
organise them in the rural areas as the place
of work is often at a great distance from the
village. Besides the quality of the day care
centre would have to be of a high standard
otherwise what the baby gains in breastmilk
will be lost in frequent infections. It is a
dilemma and yet hats off to a majority of
women who still manage to breast-feed in
spite of all these problems. This is not to say
that every effort should not be made to
device locally suitable child care centres
and adequate resources made available for
thcpi^Community’s support is vital and

perhaps we can look forward to that as a
result ofthe 73rd Amendment of the Constitution which hopefully will empower the
community, both men and women.
Mina Swaminathan is right when she says
that most poor families are not giving the
necessary amount of milk to the baby which
which
would cost Rs 460 a month. That is exactly
the point Gupta and Rohde are making that
because of the high cost, the baby is fed
inadequate amount of diluted milk leading
to malnutrition and so the alternative -r
of
breast milk with all its difficulties is still a
far better alternative. One could not agree
more with Swaminathan when she says that
comprehensive reviews of laws and policies
and evaluation of schemes and programmes
based on recognition of the triple role of
women as mothers, producers and consum­
ers will be needed to develop support ser­
vices for breast-feeding mothers.
There is no doubt that milk companies
with their skilful marketing strategies make
inroads into the practice of breast-feeding
and influence the health professionals (note
the number ofmedical meetings and confer­
ences supported by milk companies) fami._
as
lies and. public.
Tinned milk is portrayed
a suitable substitute and the advertisements
seem to encourage a woman to become
doubtful about her capability to breast-feed,
Health workers by and large are not able to
give the right support either. This is not just
an urban phenomenon but has permeated
many rural areas also. Problems are many
and I often wonder how the vast majority of

women are able to cope with it, but surely*
cope they do. The
~ problems
_
» are worse in*
urban areas with vay little or no family*
support, need to work, often long distances
away from home and the tantalising displays of milk tins and bottles in the shops.
The role of breast-feeding in preventing
conception needs to be stressed much more,
-Breast-feeding
prevents more pregnancies
than all the contraceptives combined. It is
postulated that breast-feeding is responsible
cfor
----j.the
-----c—
u.. ™—
reducing
potential
fertility
by 30 per ’
cent in Asia. There are so many arguments
in favour of breast-feeding, national eco­
nomics being one of them.
References
Gupta A and Rohde J E, (1993), ‘Economic
Value of Breast-feeding in India’, Economic
and Political Weekly, June 26.
Indian Council of Medical Research (1984),
Recommended Dietary Intake for Indians,
New Delhi.
Prentice A Metal (1980), ‘Dietary Supplements
of Gambian Nursing Mothers and Lactatf^
Performance’, The Lancet ii:623.
Ramachandran, Prema (1989), ‘Lactation-Nutri­
tion-Fertility Interactions’ in Women and Nu­
trition in India, C Gopalan and Kaur Si ’minder
(eds) Nutrition Foundation of India.
Swaminathan, Mina (1993), ‘Breast-feec g and
Working Mothers’, Economic and 1 'ideal
Weekly, September 25.
World Health Organisation (1985), The Q . tntity
and Quality of Breast Milk, Repo: ‘ f the
WHO Collaborative Study on Breast-*' ling,
Geneva:

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