BERIBERI IN SIAM. 75 



the result of want of nitrogen, or is it due to the removal of the oil- 

 containing rind of the grain and so leading to fat starvation ? These are 

 points which are still sub judice and we await with much interest the 

 elucidation of this fascinating problem. From a practical administrative 

 point of view, at least, we may definitely say that beriberi is apt to attack 

 those who regularly consume white, steam-milled rice, and in support 

 of this view I shall now give you the facts from Bangkok. 



1. Beriberi was, so far as we can find out, unknown in Bangkok until 

 white, steam-milled rice began to be retailed locally. It is true that for 

 over ten years before the first outbreak in the jail, white rice was prepared 

 in one or two steam mills in Bangkok, but the whole of this was exported 

 to Europe. ' One of the first large institutions to. be supplied with white, 

 steam-milled rice was the new jail, with the result already recorded. 

 Doctor Hays tells me that it was the prisoners themselves who suggested 

 a return to hand-milled rice, which they had always been accustomed to 

 eat. The change having been made, beriberi died down and has since 

 then given practically no trouble, as the prison authorities have con- 

 tinued to supply this form of rice, which is actually prepared in the jail 

 by convict labor. 



During the nineties, attracted by the immense profits which were being 

 made by owners of steam rice mills, many mills were erected, and soon 

 large quantities of white rice were thrown upon the local market. Two 

 factors played into the hands of the rice millers. The first was the 

 abolition of slavery in Siam. Hitherto, the preparation of the household 

 rice was carried on by slave labor, but on the abolition of this practice 

 the price of labor naturally went up. The second factor is a natural 

 corollary of the former, for steam-milled rice could be produced at a much 

 cheaper rate than that manufactured by paid hand labor. By the year 

 1900 most of the old hand mills had stopped working, and on a diet 

 of steam-milled rice the people began to suffer from beriberi; our first 

 cases being admitted into the hospital during this year. 



2. A second fact in support of the white rice theory is the history 

 of our experience in the asylum for the insane. In the year 1900 

 steam-milled rice was substituted for hand-milled, and beriberi soon 

 appeared. During nine years dieting upon this rice the disease steadily 

 increased in virulence and, in all, 763 patients died of the disease. Early 

 in February, 1908, I determined to try the effects of parboiled rice. 

 Hand mills and all the other apparatus necessary for the purpose were 

 installed in the asylum. We purchased our own paddy, parboiled it, 

 milled it by hand and issued it for the first time on February 15. 



Since then not a new case of beriberi has developed amongst those 

 patients who have continued to eat this form of rice, and it is now a 

 year since it was first issued. No other alteration in diet or in hygienic 

 surroundings was made in the asylum. 



