ETIOLOGY OF BERIBERI. 279 



reported by Fraser and Stanton,'" and will be considered later in 

 this paper. 



Fletcher in 1907^" states: 



Durinjir the year 1905 an epidemic of beri-beri broke out in the Kuala 

 Lumpur Lunatic Asylum. Commencinp: in February, it reached its height 

 in July and August, declining somewhat towards the end of December, 

 Out of 219 lunatics treated in the asylum during the year 94 persons were 

 affected, of whom 27 succumbed to the disease. The chief constituent of 

 the rations supplied to the inmates of the asylum was uncured (Siamese) 

 rice, and in view of the fact pointed out by Dr. Braddon that beri-beri 

 occurs chiefly amongst communities with whom such rice is the staple 

 article of diet it was decided, with the sanction of the Government, to place 

 half the lunatics on cured (Indian) rice. The Government readily gave 

 its consent and the experiment was commenced on Dec. 5th, 1905. Except 

 for the difference in the rice the two parties — those on cured and those on 

 uncured rice — received the same kind and the same amount of rations. 

 Excepting the rice the food-stuffs for all patients were prepared together 

 in the same kitchen and cooked in the same cooking pots. 



The lunatics are housed in two exactly similar buildings on opposite 

 sides of a quadrangle surrounded by a high wall. On Dec. 5th all the 

 lunatics at that time in the hospital were drawn up in the dining shed 

 and numbered off from the left. The odd numbers were subsequently 

 domiciled in the ward on the east side of the courtyard and no alteration 

 was made in their diet, they were still supplied with the same uncured 

 rice (Siamese) as in 1905. The even numbers were quartered in the ward 

 on the west of the quadrangle and received the same rations as the oc- 

 cupants of the other ward, with the exception that they were supplied 

 with cured (Indian) rice instead of the uncured Siamese variety. The 

 following is the ordinary diet scale of the lunatic asylum: fresh meat, 4 

 ounces four times a week; fresh fish, 5 J ounces two times a week; salt fish, 

 5S ounces once a week; vegetables, 8 ounces daily; curry stuffs, 15 ounces 

 daily; and cocoanut oil, S of an ounce daily. Uncooked rice: Siam, 28 

 ounces to be supplied as per sample for uncured rice ward; Bengal, 28 

 ounces to be supplied as per sample for cured rice ward. At the com- 

 mencement of the experiment all patients showing unmistakable symptoms 

 of beri-beri were removed to the district hospital, which is two miles 

 distant from the asylum. On Dec. 5th there were 59 lunatics in the 

 asylum; of these 29 were put on cured rice and 30 on Siamese rice. The 

 next patient admitted to the asylum was admitted to the Bengal rice ward, 

 and the one admitted after him to the uncured rice ward, the next to the 

 cured, and so on alternately to the end of the year. 



The result up to December 31 1906 (i. e., one year and 26 days) was 

 that 34 out of 120 persons fed on uncured rice suffered from beri-beri and 

 18 died, whilst among 123 patients dieted on cured rice there were no 

 deaths from beri-beri and only two cases, both of whom were suffering from 

 the disease on their admission to the asylum. 



"Lancet (1909), 1, 451; Studies from Institute for Medical Research. 

 Federated Malay States (1909), No. 10. 

 " Layicet (1907), 1, 1776. 



