472 



NATURE 



[February 9, 191 1 



undoubtedly of profound importance in certain outbreaks ; 

 but at Klang and Port Swettenham the sequence of events 

 was not to be explained by Dr. Bentley's theory, and he 

 has, I think, overlooked two points in my published re- 

 ports which at once set aside his explanation of the 

 figures. 



The suggestion is that the origin and sustaining factor 

 in the outbreak was a camp at Port Swettenham densely 

 populated with coolie labour, the coolies of which not only 

 suffered severely from malaria, but also infected the other 

 inhabitants of the port and of Klang, and that when the 

 construction works at the port were finished at the end 

 of 1901, the camp was broken up, the coolies dispersed, 

 and the epidemic subsided. 



If this theory be correct, we should naturally expect to 

 find evidence of a severe outbreak among construction 

 coolies at Port Swettenham during 1901. 



As a matter of fact, not only was there no outbreak 

 of malaria among coolie labourers at Port Swettenham, 

 but there were actually no camp coolies. There is 

 abundant evidence that this was the state of affairs, 

 although, as the port was not opened until the end of 

 the year, it was not unnatural for Dr. Bentley to suppose 

 such a camp existed. 



To explain, I may say that most of the earth construc- 

 tion was finished at the end of 1895 (Dr. Travers gives 

 the date of beginning work as 1897, but this is a slip ; 

 see journal of Tropical Medicine, 1903). The wharves 

 were finished at the end of 1900. The only works then 

 remaining to complete the port were three iron goods- 

 sheds and the passenger railway station, for which skilled 

 labour was required. This was not forthcoming, and 

 these few buildings were not finished until September 15, 

 1901, when the port was opened. Through trains were, 

 however, running from June, 1901. 



On my first visit to Port Swettenham, in January, 1901, 

 instead of finding a great camp of coolies as suggested 

 by Dr. Bentley, I found only some twenty or thirty 

 persons. Instead of poorly paid coolie labourers, there 

 were high-paid Chinese artisans. Except for these few 

 Chinese, occupying one of a series of empty huts formerly 

 occupied by the construction coolies, the place was 

 deserted. The Government quarters on each side of the 

 main road also stood empty, and were not to be occupied 

 until some nine months" after my first visit to the port. 



This is a condition of afTairs so completelv different 

 from what is demanded by Dr. Bentley's theory, that the 

 theory obviously becomes untenable ; and to show that 

 such was actually the state of affairs in 1901, I now give 

 some extracts from published reports. 



A. — Evidence of date of beginning works. 



"The extension of the Klang line from Klang to Kuala 

 Klang (former name of the Port) was commenced on 

 January i, 1895, and at the date of writing (April, 1896) 

 is nearing completion. It is not proposed to open this 

 line until the wharves at the mouth of the river have 

 been completed " (see Report of Resident Engineer, Rail- 

 ways for 1895, Selangor Government Gazette, 1896). 



B. — Evidence that wharves were completed at the end 

 of 1900, and that remaining work was for artisans, who 

 •were difficult to obtain and keep at Port Swettenham. 



"The works remaining on hand are the passenger 

 station and goods-sheds, which are being pushed on as 

 fast as the difficulty of keeping skilled labour at this 

 unpopular, spot will permit. It is anticipated that the 

 whole of the work will be completed bv the middle of the 

 present year " (see Administration 'Report for 1900, 

 Selangor Government Gazette, 1901). 



C- — Evidence that artisans were not poorly paid and 

 were scarce. 



Under the head of "Labour" in the Administration 

 Report on Selangor for the vear 1900 (Selangor Govern- 

 ment Gazette, 1901), the 'British Resident wrote :— 



More serious difficulty is caused by the great dearth of 

 artisan and mechanical labour, the available number of 

 skilled workmen having declined rather than advanced. 

 • •.• The mechanic of this country is almost alwavs . a 

 Chinaman. He can do good work, and is well paid for 

 It, and is consequently very independent. Latterly 

 employers even of their own nationality have been quite 

 unable to get the men thev require, "and works of all 

 description have suffered in consequence." 

 NO. 2154, VOL. 85] 



D. — Evidence that there was no great coolie population 

 at Port Swettenham in 1901. 



" I was not surprised that the construction coolies had 

 suffered severely from malaria, and although at the 

 beginning of 1901 few coolies were actually living in Port 

 Swettenham, I formed a very unfavourable opinion of it 

 owing to the short residence necessary to infect new- 

 comers." This is an extract from my Official Report to 

 Government on the anti-malarial works at Klang and 

 Port Swettenham. It was published in the Selangor 

 Government Gazette, April, 1905, and reprinted in the 

 Indian Medical Gazette of September, 1905. Dr. Bentley 

 has, I think, overlooked this report. 



E. — Evidence that there was no great epidemic of 

 malaria at Port Swettenham in the early half of 1901. 



If there was a great epidemic of malaria at Port 

 Swettenham among coolies in 190 1, one would expect to 

 find evidence of it in the admissions to hospital. Now, 

 in my articles in the Journal of Tropical Medicine in 

 November and December, 1903, and .April, 1905, a table 

 appears giving the monthly admissions to Klang Hospital 

 of cases of malaria from the port. The numbers were 

 as follows: — ^January, 3; February, o; March, 3; April, 

 4 ; May, o ; June, 5. During the six months, conse- 

 quently, which Dr. Bentley supposes to have seen the 

 culmination of a malaria outburst which almost 

 annihilated Klang and Port Swettenham, the cases of 

 malaria admitted to the hospital from the vortex of the 

 storm numbered no more than 15. Dr. Bentley can 

 scarcely have noticed these figures. 



So far from Dr. Bentley's suggestion being correct, the 

 figures show that the construction coolies had left Port 

 Swettenham long before the great outbreak arose among, 

 the Government population, and those connected with the 

 shipping who went to reside there after the port was 

 opened. The epidemic at Port Swettenham, which arose 

 in 1901 after the port was opened, was not among, or in 

 any way connected with, poorly paid construction coolies, 

 but among Government servants and their families, the 

 shopkeejjers, and the well-paid loading labourers (iSo in 

 number) who were transferred from Klang. Beyond these 

 there was no population at the port. The outbreak began 

 nine months at least, to my personal knowledge, after the 

 construction coolies had left, and consequently it is 

 impossible to attribute the subsidence of the outbreak to 

 their departure. 



With regard to Klang town, I cannot quite gather 

 whether Dr. Bentley means it to be understood (a) that 

 construction works and a coolie camp existed at Klang as 

 well as at Port Swettenham, or (6) that the coolies from 

 Port Swettenham infected Klang town. 



If the former, I may say at once that no such works 

 or such a coolie camp existed at Klang. 



If the latter, why should Klang, formerly so susceptible 

 of infection, be now immune? In the nine years which 

 have passed since the outbreak in Klang, there has been 

 an enormous increase in the populations of the towns and 

 of the district. Places with much larger populations than 

 that of Port Swettenham in 1901, or even to-day, and 

 places much nearer than Port Swettenham to Klang, have 

 been devastated with epidemics of malaria. Malarial sub- 

 jects from these surrounding neighbourhoods now enter 

 Klang in far greater numbers than nine years ago from 

 Port Swettenham. Yet the residents of Klang do not 

 suffer from malaria, and statistics show that malaria is 

 hardly ever contracted in Klang to-day. Of 455 Klang 

 children examined in 1909, thirteen only showed evidence 

 of malaria. Of these thirteen, not one but had recently 

 come to Klang, and had a history of malaria before 

 arrival in the town. 



I may remark, in passing, that when he asserts that 

 the authorities remained inactive until " alarmed by the 

 fearful mortality " at the new port. Dr. Bentley does less 

 than justice to Dr. Travers and the administration, since 

 the- Klang scheme, which was to prove so dramatic a 

 success, had already been approved before the occurrence 

 of the Port Swettenham outbreak. 



Dr. Bentley also suggests that the credit for the 

 improvement of the health of Klang may be ascribed to 

 quinine. Quinine, as a matter of fact, was freely adminis- 

 tered at Port Swettenham in 1901, but no public distribu- 

 tion of quinine as a prophylactic was undertaken at Klang. 



