[ 55 ] 
;ountries free from Beri-Beri, and that this paralysis is also associated with 
oss of patella reflex. . . , c nr . 
Of 34 cases of Beri-Beri in which age was determined, 6 were 25 ana 
under, 24, 40 and under, and only 4 over 40. , , . 
In conclusion. There is nothing in the above to show that a poor 
diet is a necessary factor. The food in the gaol as far as can be 
ascertained has been of the same quality as in 1901 and 1902. it appears 
to be of good quality and to contain a sufficiency of essentia s. 
prisoners appear to be well fed and in good condition. In the mines 
the food is abundant and of great variety. The miners can and do 
supplement the food supplied with various additional articles of diet. 
The wages earned are high, the work is not excessive, and the men appear 
to be in excellent condition. Great attention is paid to the cooking m e 
mines and it appears to be thorough. The food is well cooked m the gaol. 
The change made in not allowing the morning cooked rice to stand over¬ 
night is one of the possible causes of the diminution of beri-Beri, but in 
spite of this change cases have certainly originated in the gaol since, and in 
a proportion as great as amongst the general population, and greater t an 
in Kwala Lumpur itself. _ TT ... 
The theory advanced and supported by Dr. Hamilton \\ right that 
Beri-Beri is communicated via the excreta from man to man receives some 
support from the course of the recrudescences of the disease m the 
Singapore Gaol and in the Pudu one, in as far as it supports the view that 
man himself is the carrier. Opportunities of contamination of food, etc., 
by the excreta are numerous in the Singapore Gaol, and the prevalence of 
dysentery in that gaol supports the belief that it does occur. 
Opportunities also occur in the Pudu Gaol as the excreta are passed 
in the cells during 14 hours out of each 24, and though now the chances of 
contamination of the food are reduced by the food being served outside 
cells, this does not entirely prevent chances of contamination. A proo 
that it does occur is that one fatal case of Typhoid developed alter 4 mont s 
imprisonment in 1903, and in the same year one fatal case of Diarrhoea also 
after 4 months. , c , , 
In 1904 up to September there had been two fatal cases of dysentery, 
one in a prisoner who had been over 4 years in the gaol. . 
The water supplied direct from the town service reservoir is boiled 
before use for drinking purposes in the gaol, so that it is improbanie t a 
either these cases of intestinal disease or of Beri-Beri were carried by t 
W 3 .t 6 T 
The smaller amount of Beri-Beri in old established mines and in towns 
overcrowded for years such as Kwala Lumpur, as compared to new mines 
or to the same places a few years ago, does not support the view of groun 
or place infection. 
Enteric Fever. 
Typhoid Fever presents the same symptoms as in England though 
the temperature is not so high and is more irregular. In one case ou o 
the five the solitary glands of the large intestine were implicated but not 
to so large an extent as sometimes occurs m British Guiana. In two 
of the cases death was due to perforation and peritonitis. Cases are 
not uncommon amongst Europeans living in Kwala Lumpur as we s 
