Taste of Life: Pune doctor’s struggle to justify buttermilk feed to reduce risk of infant mortality
Pune-based doctor Raghunath Sadashiv Joshi, who underwent training in London, took various steps to underline the use of buttermilk to reduce the risk of infant mortality
In September 1915, a young doctor based in Pune and trained in London was speaking at an official meeting organised by the sanitation department in Bombay. His name was Raghunath Sadashiv Joshi and in his hand was a glass bottle containing a thick yellowish liquid – the buttermilk feed. He claimed that the use of buttermilk feed would help reduce infant mortality rate.
The infant mortality rate is the number of deaths of children under one year of age, expressed per one thousand live births. Even though the overall infant mortality rate and child mortality rate have considerably declined in India, it still ranks high in the world.
Colonial health and sanitation reports from the mid-nineteenth century onwards recorded alarmingly high rates of maternal and infant mortality in the then-Bombay Presidency. The Infant and Child Mortality Survey carried out by the sanitation department of the Bombay Presidency in 1912-13 indicated that the infant mortality rate in Poona district was 471 per one thousand births. Neonatal deaths (from birth to the age of one month) constituted a major part of infant deaths.
The socio-environmental causes of infant mortality included infectious diseases and nutritional deficiencies. Among the former, diarrhoeal diseases were the first, and pneumonia was the second cause of death. Dr M A T Collie, a senior obstetrician in Bombay, attributed the high infant death rate, in the first month of the child’s existence, to improper “management” at the hands of midwives.
While there were certain socio-cultural factors, like the practice of early marriage, the inferior status of women in society, and tradition-bound health habits that played an important role in determining the level of infant mortality, factors such as lack of proper public health engineering also contributed to infant deaths. The number of patients in obstetric and paediatric departments of government hospitals had been small because the doctors attending to patients were male and generally many Indian women would not even talk to a man who did not belong to their family. The very idea of hospitalisation for something as “domestic” as childbirth and childcare was unheard of.
The early 1900s saw an expansion of welfare measures promoting maternal and infant care and the establishment of voluntary organisations at the insistence of reformers that were cooperative efforts of health and sanitation officers, civic leaders, philanthropists, and Indian doctors. Members of these organisations disseminated information through home visits and lectures.
Both central and provincial governments had largely left the promotion of maternal and child welfare to voluntary societies. In 1882, the Arya Mahila Samaj, founded by Pandita Ramabai, Gangubai Bhandare, and Rakhmabai Raut, started providing free milk to mothers and babies in Bombay and Poona. The Hind Mahila Samaj founded by Avantikabai Gokhale organised lectures teaching hygiene and infant care.
The Poona branch of the Seva Sadan, in cooperation with the Sassoon Hospital, started a maternity home and an infant welfare centre, where expectant mothers were given free advice and medical supplies and milk were provided gratis to poor women.
Some European doctors in India constantly raised concerns about the quality of milk. According to them, adulterated milk and foods made with milk contributed to infant mortality. Thomas Blaney, a popular private practitioner of Bombay, regarded “artificial feeding” of “conjees” (a rice gruel) used by Indian mothers as a cause and advocated the use of European infant foods instead.
However, Joshi, in the meeting, advocated the use of buttermilk feed. In 1903, at the NY Academy of Medicine, Dr Herman Schwartz read a paper titled “Buttermilk as an infant food”. Schwartz had come up with a formula to make buttermilk feed and his extensive studies over five years had indicated that it was beneficial in fermentative diarrhoeas in infants.
After the publication of this study, buttermilk feed was extensively employed in Europe and the US. Several European and American medical journals in the first two decades of the nineteenth century published papers on buttermilk feed. Buttermilk feeding was indicated in cases of indigestion, atrophy, and malnutrition. It was not advised as a permanent food and was indicated for use for sick babies recovering from acute gastro-intestinal disorders. In acute intestinal disorders, it was an excellent food when the acute stage had passed; in chronic intestinal disturbances, it was beneficial. Some doctors in Europe were using buttermilk in conjunction with malt foods.
Joshi had observed excellent results from the use of buttermilk as an infant food in foreign clinics he visited, and he was determined to bring the subject to the notice of the doctors in India. During the meeting, he cited papers authored by renowned American and European paediatricians like Howard Childs Carpenter, Henry Salge, Max Cantrovitz, and Teixerira de Mattos. He had met Dr C Herman in London who had been a staunch supporter of buttermilk feed. Herman had mentioned that the fact that it had been employed for so many years in Holland showed pretty conclusively that buttermilk, as an infant food, had more than a theoretical value. However, he was sceptical about its reception in the Bombay Presidency.
That the buttermilk was ignored as a wholesome food for children in Poona was quite natural given the strong tendency at that time to approach as nearly as possible to mother’s milk. The supply of cow and buffalo milk was limited and it was believed to be a more valuable food than ever during the abnormal conditions which prevailed and the plague and time of the First World War. European housewives in India typically made buttermilk from sour cream. This made it rather costly.
According to Joshi, the composition of buttermilk samples from Poona was: albumin, 34%; fat, 0.5%; carbohydrates, 10.3%; actual acidity, 0.3%, or more of lactic acid. This high acidity had been found to retard the development of microorganisms, he claimed. Plain buttermilk was not given to babies, but they were fed routinely on a mixture of wheat flour, sugar, and buttermilk in the following proportions: buttermilk, 1 quart; wheat flour, 4 teaspoonfuls; granulated sugar, 15 teaspoonfuls. A double boiler was used to prepare the feed. First, the flour and sugar were carefully mixed with a few spoonfuls of the buttermilk until a smooth paste resulted. All lumps were completely smoothed out. The balance of the buttermilk was then added. The mixture was now boiled taking care not to let it curdle. The feed was bottled, and if the dispensary could not afford enough bottles, Joshi suggested, the feed be put in jars. Lack of funding was a constant obstacle in working to prevent maternal and infant deaths and he insisted that the buttermilk feed was cheap.
He suggested preparing a pamphlet on “buttermilk for infant feeding” and distributing it to dispensaries and maternity and infant welfare centres in the Bombay Presidency. The buttermilk was to be prepared by trained nurses in a dispensary and placed at the disposal of physicians bottled and ready for use for infant feeding. If the physician ordered, the bottles could be delivered to families at their homes.
Joshi’s proposal, however, was not accepted by the sanitation department.
A cursory mention in a report prepared by the sanitation department indicates that Sundarabai Kirtane, head of the maternity department at the KEM Hospital in Poona, consulted Joshi and used the buttermilk feed for sick infants for a few years. I could not find any report to indicate it was used by other hospitals or organisations.
An obituary in the Marathi newspaper “Kesari” mentions that Joshi died on July 23, 1933.
Chinmay Damle is a research scientist and food enthusiast. He writes here on Pune’s food culture. He can be contacted at firstname.lastname@example.org