beriberi " in chedubA inland. ARAKAN, BURMA1./ By G. G. JOLLY, c.i.e., m.b., LIEUTENANT-COLONEL, Officiating Director of Public Health, Burma. In the rainy season of 1929, beriberi appeared in epidemic form in Cheduba, a large island which forms a township in the Kyaukpyu district of the Arakan division of Burma. The island, which, according to the 1921 census, had a -population of 32,521, almost entirely Arakan Buddhists, lies to the south- west of Kyaukpyu Island, on the eastern boundary of the Bay of Bengal, in latitude 18?50' N. The inhabitants are very back- ward; the island contains no proper roads, and internal communications are of the most pri- mitive description, communication between the sea coast and the interior being very difficult ' 384 THE INDIAN MEDICAL GAZETTE. [July, 1930. insects. As for the the from a few by required consumption during rajps. Apart sailing rice is hand till it turns white. In boats, which carry rice to Akyab and Bassein pounded addition to the Sub-Assistant Surgeon in the open season, the only connection with rice, found that was what the outside world is by means of a steam curry eaten, containing he considered to be a launch of the Arakan Flotilla Company, which quite inadequate supply of fish or as a with calls at Cheduba village once a week, linking prawns, prepared soup which were deficient in it with Ramree and Kyaukpyu on Kyaukpyu vegetables quantity. The Sub-Assistant conclusions were Island. There is 110 hospital, dispensary or Surgeon's that rice was the cause of the outbreak. doctor 011 the there are several mouldy island, although He formed this because he considered pleaders; litigation as usual having developed opinion if diet were the the ahead of medicine. that, deficiency cause, disease should not be so associated The first intimation of the occurrence of the definitely with the rains. He noted that the rains had disease was received by the District Health been severe this season. He con- Officer in the month of October, and a unusually early cluded that the ate this rice to Sub-Assistant Surgeon of the Public Health people mouldy and that the disease was due to a was to Chedu'ba to excess, Department despatched toxin in the rice. He believed that investigate. He found 011 his arrival on the present towards the end of or with 12th October, that the outbreak had subsided, August September, an in the the rice also he saw 38 cases, of which a few improvement weather, and, although in and also that the hard were not out of danger, there were no fresh improved condition; labour in the rice fields over then, cases developing, and, excepting for the deaths being by the did not eat so much of the rice, which had occurred, the vast majority were people the amount of toxin convalescent. He was informed that most of thereby reducing consumed. He formed the that the hand the cases had occurred in the months of July opinion pounded as used the was not totally and August. The principal signs and symp- l'ice, by villagers, devoid of vitamin B. toms he reported were loss of knee-jerks, numb- This was the at the end of October, ness and weakness of the lower extremities, position as and ankle drop, and (edema, principally of the lower and, the outbreak had subsided my was with limbs, in about 50 per cent, of cases. The only department fully occupied urgent " end cardiac involvement he reported was hyper- work, I postponed further enquiries till the " of the In November the island was in a number of cases, but later en- year. trophy who quiries showed that palpitation was a common visited by the Hygiene Publicity Officer, on causes and symptom. A noticeable feature was the strong carried out publicity work the of and in 1930 appetite of those attacked. Most of the cases prevention beriberi, February developed fairly suddenly when the men and an Epidemic Sub-Assistant Surgeon was posted to Cheduba to continue and t? women were out at work, and not a few were investigation, to work rapidly fatal. The majority of cases were carry out from village village educative on leaflets on among adults from 18 to 30 years old, and beriberi prevention, distributing the in among more men arc reported to have been attacked subject the Burmese language than women. the people. In April 1930 I managed to pa/ a visit to the and to condi- A the Officer, island, investigate report by Township Cheduba, tions on the stated that there had been 1,007 cases spot. with. had 64 deaths by the end of September. Subse- By this time a good deal of information quent investigation has brought the total up to been collected. It had been established beyond local 1,650 cases with 188 in the period from doubt that this disease, well known to the deaths, 01 names of the beginning of Julv up to the 5th October people under the htunua, padarek 1929. htunsketna, is endemic in the island, and haCj occurred more or less severely every rain} The Sub-Assistant first upon the Surgeon season so long as people could remember, begin' scene visited some of the affected villages, and ning when monsoon conditions were well estao' carried out with the aid ol propaganda work, of lished about the end of June or first week the Public Health leaflet on beri- Department's July. It came prominently to notice in 19* beri; He also the of investigated question because the outbreak that year was exception" diet. Rice is the and he noted that staple diet, ally severe. The villages attacke some rice he found stored in houses was principally appa- are those the sea in tn along coast, villages ' the he took in a rently mouldy, though sample interior being little affected. In 1929 the oil test-tube showed no of mould, when he sign break began in July, became widespread examined it with a hand lens 24 hours after. 1^ " " August, and subsided about the end of Septet' Rice is stored by villagers in the red con- ber. Tn 43 of the more heavily affected vill^Se" dition, in bamboo baskets or bins treated big inspected the north and east coasts ther with cow or along externally dung internally were in thatched, 520 cases, with 101 deaths. earthenware jars, or in wooden boxes, some of nd which were lined with zinc sheet, removed Tn 1929 the rains were unusually heavy, the are aj* cases in which matches packed. the weather very rough with S^ |romIn the frequent rains the rice is attaeked a good deal and strong winds, and a good deal of flooding- " 385 JuiA', 1930.] BERIBERI" IN CHEDUBA ISLAND: JOLLY. Work in the fields was hard, and the people by the well-to-do. Coconut milk becomes were exposed to much cold and wet. available in the later part of the rains. llice is the main crop of Cheduba. Several The position as regards is varieties are grown, and the island rice, parti- toddy interesting. Hie local is made from the dhani known as toddy palm. cularly the variety yakhine-tha-ma -It is esteem- plentiful during the cold and the hot which has a long slender grain, is highly of it is weather, but very scarce from to ed and commands a high price. Much May Septem- ber. In June and July the is at its exported to Akyab, Bassein and Kyaukpyu. supply lowest, and ceases to the fact The same kinds of rice are eaten by the people practically owing the in- that the stem of the dhani blossom, from of the coastal villages as by those of which the is is small and thin at terior. The stored in village houses, sap obtained, rice, being this season. In the coastal is as red is hand in small quantities villages toddy rice, pounded an article of diet. In one mills 011 the important before use. There are no rice I village visited of 300 600 bottles of a island and hand rice is exclusively houses, toddy pounded day are obtained in the used. The I have do not autumn, and, although villagers questioned much is sold to other the elders consider that the rice became mouldy in the villages, village informed me that all the children rains of and maintain that its taste and except young 1929, and a old people drink it, and that bottle a ^mell remained fresh throughout the season. day is an usual ration at this season, File of hand rice I saw in quite samples pounded 'he village supply of 600 bottles a day in the houses of the were exceptionally people October falls to 120 bottles by April, and decorticated for hand pounded rice. thoroughly in dwindles to almost none by the end of May. Jn all cases the germ was absent, and only A an occasional grain could any of the red peri- consideration of all the circumstances leads carp be detected. The rice cleanings, after the me to the opinion that while mouldy rice as a rice is pounded in the wooden mortar, are given possible factor cannot be entirely excluded, all as food to cattle and hens, and the villagers the evidence points in the direction of the have noted how well these animals thrive 011 disease being a true beriberi due to diet defi- them. When rice is cooked the water in which ciency. The incidence of the disease, just at Jt the its lowest and is boiled is thrown away.