284 STRONG AND CROWELL. 



Since all cases presenting doubtful signs of the disease were excluded 

 we are of opinion that there were many other cases which in the ordinary 

 routine of clinical practice would have been regarded as Beri-Beri. Such 

 cases only occurred among people who consumed white rice. * * * 



No case of Beri-Beri occurred in any coolie who had been on white rice 

 for a less period than 87 days. 



Systematic examinations were made of the blood and urine of patients 

 suffering from Beri-Beri. Various methods of examination were employed 

 but in no instance were any organisms found, except those well known as 

 the causative agents of other disease. 



In the course of the inquiry patients in various stages of Beri-Beri were 

 at times in contact with parties of men on parboiled rice. The results 

 of observations made on such occasions furnished evidence that the disease 

 is not a directly communicable one. 



Removal of patients suffering from beri-beri from one place to another 

 did not influence the progress of the disease and removal of entire parties 

 from the place where the disease had occurred did not influence the progress 

 of the outbreak so long as they continued on white rice. These experiments 

 suggest, although they do not prove, that place per se or considered as a 

 nidus of infection has no influence upon the development of Beri-Beri. 



In three instances in which definite outbreaks of Beri-Beri occurred 

 among parties on white rice, substitution of parboiled rice was followed 

 by a cessation of the outbreak. * * * 



No evidence was obtained to show that any article of food other than 

 white rice was a possible source of a causative agent of the disease. 



Ankylostomes and other nematode worms were not found in a larger 

 proportion of patients suffering from Beri-Beri than in the general popula- 

 tion under observation. 



The general results lend support to the view that the disease Beri-Beri 

 as it occurs in this Peninsula, has, if not its origin in, at least an intimate 

 relationship with the consumption of white rice and justify further research 

 along these lines. 



Among the many investigators who have brought arguments, 

 based upon experiments, against the rice causation of beriberi 

 may here be mentioned Wright, Durham, Travers, Daniels, and 

 very recently Montel. 



Hamilton Wright,^^ after eleven months' study of the disease 

 in the jail at Kuala Lumpur, states that proof has been obtained 

 that beriberi is independent of diet considered as diet; that the 

 jail itself is a focus in which the virus of beriberi is generated; 

 that evidence has been produced that confirms the view that 

 beriberi is broadly speaking an infectious disease. He further 

 states : 



The diet of all prisoners was as physiologically correct as that provided 

 in the Japanese Navy after 1884, and to which is ascribed the disappearance 

 of beri-beri from its personnel by several Japanese authorities, Takaki 



" Studies from Institute for Medical Research. Federated Malay States 

 (1902), 2, No. 2, 56. 



