BERIBERI IN SIAM. 77 



a few were still far from well. On April 31a second batch of conscripts 

 was admitted, numbering again about 400. By this time, hand mills 

 had been erected at the school and apparatus for the preparation of 

 parboiled rice installed. The healthy were given fresh, hand-milled 

 rice, the sufferers from beriberi parboiled rice. Since then, nearly a 

 rear ago, over a thousand men have passed through the school and only 

 a few cases (14 in all) have been detected; and it is more than probable 

 that in the latter instances the men came in already suffering from beri- 

 beri. The police prisoners have been fed entirely on parboiled rice and 

 throughout the past year not one case has developed. 



6. The last evidence which I shall bring forward in support of the 

 white, steam-milled rice theory is the apparent geographical distribution 

 of the disease in Siam. 



In the Province of Bangkok, some 1,700 square miles in extent, we 

 find that beriberi clings to the banks of the Menam River and to the 

 banks of the large, navigable canals which join this river with the adja- 

 cent streams throughout the flat, alluvial plains in the neighborhood of 

 the capital. Why is this? Because the river and these canals are the 

 principal means of transport, and along these steam-milled rice from 

 Bangkok is freely hawked. Back from the banks, where communication 

 is difficult, we find that the cultivators mill their own rice and by so 

 doing invariably escape beriberi. Further, amongst a total of 4,550 

 gendarmes scattered throughout the interior of Siam and fed entirely 

 upon hand-milled rice only 6 cases of the disease were reported during 

 the year 1908 to 1909. These 6 eases all occurred in one district, 

 Nakorn Sawan, which stretches on both sides of the River Menam and 

 to which steam-milled rice can gain easy access by boat. 



To sum up these facts with regard to etiology: In Siam, as elsewhere 

 in the East, the consumption of white, steam-milled rice would appear 

 to be the principal factor, and the substitution of parboiled rice or of 

 fresh, hand-milled rice is, so far as we know at present, the best prac- 

 tical method of preventing the disease. 



Where there is difficulty in getting either of these forms of rice already 

 prepared, see that good paddy is obtained and that it is milled fresh by 

 hand every day. This is especially an important, point in connection 

 with coolies engaged on large engineering works, such as railways. In 

 place of transporting white, steam-milled rice to the coolies, see that 

 the food contractors either purchase paddy locally or transport it to 

 the coolie lines, where native hand-mills should be erected and the paddy 

 milled daily by hand. In large cities, where either parboiled rice or 

 hand-milled rice is not obtainable in large quantities, try to induce 

 steam rice-millers to prepare undermilled rice for local consumption. 



White rice is the result of "overscouring," as the millers say, but I 

 am told that rice similar to hand-milled can be supplied just as easily, 



