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Enclosure in No. 77.

SIX-MONTHLY REPORT OF THE INSTITUTE FOR MEDICAL RESEARCH, Kuala Lumpur, FEDERATED MALAY STATES.

Beri-beri.

As indicated in a previous report, an investigation is now in progress to determine the position of rice as an etiological factor in beri-beri.

Hypotheses assuming a connection between rice eating and the disease have been put forward by numerous observers during the past ten years, but have failed to find favour with most medical authorities. Recently, as the result of observations by a few Government medical officers in the Federated Malay States, a considerable body of evidence has been accumulated tending to incriminate Siamese rice as the principal source of a poison which produces beri-beri. This latter view has found its most persistent supporter in Dr. W. L. Braddon, State Surgeon of Negri Sembilan, who has dealt with the question in some detail in a recent publication entitled "The Cause and Prevention of Beri-Beri.” Without entering into the merits of the arguments that have been urged in favour of and against this hypo- thesis, it suffices to say that a careful review of the evidence seemed to afford justifi- cation for putting the question to the test of experiment.

"

The variety of names used by writers to describe rices has led to some confusion. In this investigation we are using two kinds of rice, which we shall refer to as Siamese rice and Indian rice, known respectively as "Bras siam" and "Bras kling' by dealers and consumers in the Peninsula. It must be pointed out that the differ- ence between these two sorts of rice is solely one of treatment previous to milling, and not, as the names seem to imply, a difference in their source of origin.

The rice consumed by the immigrant labourers into the Peninsula is grown mainly in Siam, Burmah, Kedah, and Province Wellesley. It is imported here as padi (unhusked rice), and in the mills of Singapore and Penang is converted into either Siamese or Indian rice according as the demand is for one or other of these varieties.

To meet the requirements of all classes, except the Tamil, white rice or Siamese rice is produced. This is the "uncured stale rice" of Braddon, and is the variety believed by him to be the principal source of the beri-beri poison. In making this form of rice no preliminary treatment is required. It is milled by machinery, and the husk, together with the pericarp and surface layer of the seed, removed.

The Tamil labourer prefers a rice similar to that consumed by him in India, and for its production a process analogous to the one in use in that country is employed in the mills here. The padi is soaked in water for a period of from 24 to 48 hours, excess of water is run off, and the padi transferred to lightly-covered cylinders, where it is steamed for from five to ten minutes. The padi is then removed to an open paved court, and dried by exposure to the sun; it is then either stored as padi or immediately milled.

For the purpose of the investigation, it was necessary to secure two parties of men under similar conditions as to environment, &c., and whose food supply was under control. In consultation with Dr. Braddon, it was decided to avail ourselves of the offer of Mr. T. R. Hubback, of Pertang, of his 300 Javanese contract coolies employed in road construction in a remote part of the Jelebu District. These coolies prefer Siamese rice, but as in the previous year, 1906, several cases of beri-beri had occurred among them, Mr. Hubback, adopting the suggestion of Dr. Braddon, had issued only Indian rice, and during the six months preceding the commence- ment of our investigation, no cases had developed. The coolies had, in the mean- time, been transferred to new quarters, and were divided into two parties of approxi- mately equal numbers, one party at Kuala Ayer Baning, 13 miles from the nearest settlement, Pertang, and a second party at Durian Tipus, eight miles further on towards the Pahang boundary. For many miles in all directions about the quarters occupied by these coolies there were no settlements save a few scattered Malay villages, and the chance of communication with possible sources of beri-beri infec- tion reduced to a minimum. It was thought, therefore, that the conditions were suitable for an investigation into the part played by food in the causation of the disease.

In April all the coolies were examined by Dr. Fletcher, District Surgeon of Selangor, and myself; no signs of existing or recent beri-beri were found. An

53

interval was allowed to elapse during which any latent case might be expected to develop, and as all remained healthy, Siamese rice was issued to the Durian Tipus party for the first time on May 12th, the Kuala Ayer Baning party remaining on Indian rice as before.

On June 7th, Dr. Stanton arrived, and took charge of the investigation there. He has since been engaged in making daily examinations of the coolies, determining the incidence of various diseases among such as ankylostomiasis, &c., that may have a bearing on the development of beri-beri, and especially giving attention to the earliest stages of the disease. The results of these observations, which are of a highly important character, will be given in detail in our completed report.

On August 1st, the first signs of beri-beri were noticed in a coolie at Durian Tipus, and up to October 15th, 15 cases in all had developed among the coolies fed on Siamese rice. No cases have developed among the coolies fed on Indian rice. It is proposed at an early date to change the rices, the coolies continuing in the same quarters, those who have hitherto been given Siamese rice to be given Indian rice, and vice verså.

Samples of the rices (two catties) as issued daily to the coolies have been taken and forwarded to the laboratory at Kuala Lumpur for investigation. Preparations have been made of the soluble constituents of the Siamese rice samples and experi- ments carried out to determine if any poisonous principle is contained in them. This part of the investigation has unfortunately been delayed owing to an accident which incapacitated me from work for some weeks. It is now going forward, and has already given promise of some interesting results, which it is hoped we shall be able to communicate in a later report.

No comment is made on the general results of this investigation so far, as it is believed that it would be injudicious to do so at this stage.

42784

(No. 498.)

MY LORD,

No. 78.

SIERRA LEONE.

THE GOVERNOR to THE SECRETARY OF STATE. (Received December 7, 1907.)

Government House, Freetown, Sierra Leone,

November 19, 1907.

IN continuation of my despatch, No. 349, of the 27th of August, 1907,* I have the honour to enclose copy of a memorandum by Dr. J. Allen Scotland, dated 6th August, referring to one of the reports on work done in Colonial laboratories, which were transmitted with your circular despatch of the 19th of June, 1907.†

2. The delay in forwarding the memorandum now enclosed has been caused by a clerical error in the original memorandum.

Enclosure in No. 78.

I have, &c.,

L. PROBYN,

Governor.

MEDICAL OFFICER, Kaballa, to ACTING PRINCIPAL MEDICAL OFFICER, Freetown.

(No. 90.)

SIR,

I BEG to acknowledge the receipt of your circular letter, No. 27, with laboratory reports with copy of a circular despatch from the Secretary of State.

"

2. In reply, I beg to say the report of Dr. Castellani on yaws is most interesting, as this disease is endemic in some part of the Protectorate. In dealing with yaws (Frambœsia) Dr. Castellani says: Gattoo" is another name in "West Coast of Africa." I beg to point out this statement is misleading. By it one believes that

↑ No. 41.

• No. 58.