[ 46 ] 
Beri-Beri. 
Beri-Beri still continues directly or indirectly to be the cause of a 
considerable proportion of the total mortality. It is no longer epidemic or 
endemic in the gaol or other public institutions, so that the observations 
which are most needed, those on the onset of the disease, have been 
impossible. 
The rapidly fatal cases are now exceptional in the hospitals, and where 
a history was obtainable one-third of the patients had been ill for three 
months or more, nearly all the others for over one month. The shortest 
histories were of io, 12, 19 and 20 days respectively, and these were 
not reliable. 
The duration of the Acute or prodromal Beri-Beri described by Dr. 
Hamilton \\ right was therefore passed in these cases, and I am, therefore, 
not in a position to confirm or develope his observations on the pathological 
changes in that period. 
I he patients, 838 in the past 12 months, were mainly from the surround¬ 
ing mining districts, but 76 were from the town itself. These may have been 
late relapses, but in the gaol there have been in the past 18 months four cases 
with no previous history of Beri-Beri who developed the disease more than 
two months after admission to gaol. It appears, therefore, that the source 
of infection is still present in the gaol and probably in the town also. 
The history of the outbreaks of Beri-Beri at the Pudoh Goal have been 
the subject of many careful enquiries and much investigation. The first 
Director of this Institute, Dr. Hamilton Wright, in Studies No. 2, 
published full statistics up to May 1st, 1903. Dr. H. E. Durham in slightly 
different form also published statistics “ Journal of Hygiene , ” January, 1904. 
Detailed statistics up to a later date have been published by the State 
Surgeon, Selangor, E. A. O. Travels, m.r.c.s., “Journal of Tropical Medicine ,” 
September 15, 1904, as well as previous accounts of the earlier outbreaks. 
In continuation of the statistics published in Studies No. 2 the follow¬ 
ing figures are of interest as showing the decline of the outbreak there 
described. I have excluded cases in which the patient was suffering from 
the disease on admission and those which were observed in prisoners awaiting 
trial. In the fourth column only cases are included in which no previous 
history of Beri-Beri could be obtained. The frequency of relapses even 
ufter considerable periods and with apparently no probability of re-infection 
renders this subdivision necessary, but it must be admitted that these re¬ 
lapses are more frequent when fresh cases are occurring, and it is noteworthy^ 
that though the diminution in the number of relapses was less rapid than 
that of tresh cases, still, during the period of 7 months when no fresh cases 
occurred, there were no relapses. Many of the relapses are probably re¬ 
infections so that the third column under-estimates the real number of fresh 
infections. 
The figures show a rapid decline in the number of fresh cases towards 
the end of 1902, followed by a cessation of fresh cases for a period of 
7 months, and since then in the last 13 months occasional cases have occurred 
but no epidemic. During this time there was one period of 4 months and 
one of 2 months in which only relapsed cases occurred. During the 
whole period there were 22 cases commencing in the gaol and of theseI8 
had no pre\ 1011s history of the disease, some of the others were certainly 
