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--- beri-beri [2023/01/09 20:40] – [1901-1912: Peranan Christian Eijkman dll] sazli
+++ beri-beri [2023/01/10 14:30] (kini) – [1902-1903: Wabak Beri-Beri di Penjara Pudu] sazli
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 Ternyata hasil kajian yang lebih ampuh adalah melalui pemerhatian di lapangan, khususnya di lombong Eropah di Jelebu. Beliau mendapati pekerja kontrak yang baru cenderung menghidapi beri-beri tahap serius, berbanding pekerja lama yang telah "bebas". Antara perbezaan ketara dalam kehidupan mereka ialah pekerja bebas menyediakan makanan sendiri (biasanya berdasarkan beras tempatan / tradisi), manakala pekerja kontrak diberi makan beras kilang (biasanya diimport) oleh kontraktor mereka. Maka [[w_l_braddon|Dr. Braddon]] mengarahkan permakanan pekerja kontrak dipelbagaikan, dan dipindahkan dari rumah kongsi mereka. Hasilnya menggalakkan, dan menjelang tahun 1901, beliau telah menerbitkan hipotesis bahawa punca beri-beri ialah beras kilang, dan kesannya dapat dilihat di penjara Seremban selepasnya. //"However, it was his observations at a European mine in Jelebu that confirmed for him what he suspected. Old hands, free men or ‘laukhek’ catered their own food, which included a varied diet and local parboiled rice, whereas ‘sinkhek’ were supplied imported polished rice by a local contractor. The ‘laukhek’ did not suffer from beri- beri as much as the ‘sinkhek’. On his advice ‘sinkhek’ were put on a more varied diet, but he also recommended that they be re-located. Beri-beri among the ‘sinkhek’ disappeared, but because of the re-location this event did not prove his theory. But by 1901, he had submitted his assertions that polished rice caused beri-beri, whereas parboiled rice did not and recommended that parboiled rice replace polished rice. In the Seremban prison, the benefits of this change were seen immediately."// (Lim Kean Ghee, 2016: {{ :buku:drlimkeangheebool-thehistoryofmedicineandhealthinmalaysia.pdf ||}}[[https://www.gerakbudaya.com/History-of-Medicine-and-Health-in-Malaysia|"THE HISTORY OF MEDICINE AND HEALTH IN MALAYSIA"]], m.s.53-54).
+Selain itu, beliau juga mengenalpasti amalan dan sumber permakanan yang berbeza di kalangan bangsa-bangsa utama di Tanah Melayu ketika itu, yang dianggap turut menjadi faktor utama: //"Braddon had, in fact, made an important observation. The four ethnic populations had different dietary habits; the staple food of the Malays was rice, milled by hand in their own kitchens; the Tamils sieved out the bran after parboiling the rice; the Chinese consumed only white rice, imported, then milled by steam-driven machines and cleaned before it was sold; while most Europeans avoided rice altogether. It was the Chinese, Braddon concurred, who suffered seriously from beriberi, which he deduced, must therefore be due to some kind of toxin, perhaps fungal, that tended to accumulate in their rice during storage."// (Walter Gratzer, 2006: [[https://books.google.com.my/books?id=W2g8vHsjpjwC|"Terrors of the Table: The curious history of nutrition"]], m.s. 141).
 Namun "teori beras" ini menerima tentangan dari pakar-pakar serta pengurusan perubatan, oleh kerana teori yang lebih diterima umum ketika itu adalah berdasarkan jangkitan bakteria: //"Dominasi teori jangkitan sebagai punca beri-beri bukanlah sesuatu yang menghairankan pada penghujung abad ke-19 berikutan penemuan oleh Louis Pasteur mengenai bakteria dan jangkitannya sebagai punca penyakit. Hal ini menjadikan bidang bakteriologi mencapai kedudukan yang tinggi dalam pendidikan perubatan sekaligus mempunyai pengaruh yang sangat kuat dalam kalangan ahli-ahli perubatan. ... Beberapa tenaga perubatan menentang kuat hipotesis Dr. Braddon. Antaranya adalah Dr H.A. Haviland, District Surgeon, Parit Buntar Perak, Dr. Travers dan Dr.W. Gilmore Ellis, Superintendan Singapore Lunatic Asylum."// (Noraini Mohamed Hassan @ Sumbu Dunia Melayu: Hubungan Keserumpunan Malaysia-Indonesia, 2017: [[https://books.google.com.my/books?id=yGxwEAAAQBAJ|"Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914]], m.s.276, 278).
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 ==== 1902-1903: Wabak Beri-Beri di Penjara Pudu ====
-Salah satu contoh perselisihan pendapat mengenai punca wabak beri-beri di antara [[w_l_braddon|Dr. Braddon]] dengan tokoh-tokoh lain ketika itu ialah pada tahun 1902, yang melibatkan State Surgeon Selangor [[e_a_o_travers|Dr. Ernest Aston Otho (E.A.O.) Travers]]. Ianya dicetuskan oleh permohonan lawatan [[w_l_braddon|Dr. Braddon]] ke Penjara Pudu di Kuala Lumpur, berikutan wabak beri-beri yang memuncak di sana, serta ketidakpuasan hati beliau terhadap laporan yang disediakan oleh [[e_a_o_travers|Dr. Travers]]. [[e_a_o_travers|Dr. Travers]] yang telah pun sedia cenderung menolak "teori beras" beliau itu, mengemukakan pertikaian terhadap tujuan lawatan tersebut. Hal ini berlarutan beberapa tahun. Malah Pengarah I.M.R. 1900-1903, Dr. Hamilton Wright, turut mengaitkan beri-beri dengan sejenis organisme, sekaligus menolak "teori beras" Dr. Braddon: //"Dr. Hamilton Wright, Pengarah Institut Penyelidikan Perubatan Kuala Lumpur (1900-1903) dalam tulisan beliau yang bertajuk "Observations on Beri-beri in the Kuala Lumpur Gaol" contohnya, mengaitkan beri-beri dengan sejenis organisme."// (Noraini Mohamed Hassan @ Sumbu Dunia Melayu: Hubungan Keserumpunan Malaysia-Indonesia, 2017: [[https://books.google.com.my/books?id=yGxwEAAAQBAJ|"Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914]], m.s.275).
+Salah satu contoh perselisihan pendapat mengenai punca wabak beri-beri di antara [[w_l_braddon|Dr. Braddon]] dengan tokoh-tokoh lain ketika itu ialah pada tahun 1902, yang melibatkan State Surgeon Selangor [[e_a_o_travers|Dr. Ernest Aston Otho (E.A.O.) Travers]]. Ianya dicetuskan oleh permohonan lawatan [[w_l_braddon|Dr. Braddon]] ke Penjara Pudu di Kuala Lumpur, berikutan wabak beri-beri yang memuncak di sana, serta ketidakpuasan hati beliau terhadap laporan yang disediakan oleh [[e_a_o_travers|Dr. Travers]]. [[e_a_o_travers|Dr. Travers]] yang telah pun sedia cenderung menolak "teori beras" beliau itu, mengemukakan pertikaian terhadap tujuan lawatan tersebut. Malah Pengarah I.M.R. 1900-1903, Dr. Hamilton Wright, turut mengaitkan beri-beri dengan sejenis organisme, sekaligus menolak "teori beras" Dr. Braddon: //"Dr. Hamilton Wright, Pengarah Institut Penyelidikan Perubatan Kuala Lumpur (1900-1903) dalam tulisan beliau yang bertajuk "Observations on Beri-beri in the Kuala Lumpur Gaol" contohnya, mengaitkan beri-beri dengan sejenis organisme."// (Noraini Mohamed Hassan @ Sumbu Dunia Melayu: Hubungan Keserumpunan Malaysia-Indonesia, 2017: [[https://books.google.com.my/books?id=yGxwEAAAQBAJ|"Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914]], m.s.275). Akhbar ketika itu turut menyiarkan bangkangan terhadap "teori beras" yang dikemukakan oleh Dr. Braddon: //"The much vexed question of the causation of beri-beri by the consumption of bad rice is thus handled by for Traders in the Medical Report on Selangor for 1902. A comparison between the Tai Wa Ward and Leper Asylum, on the one hand, and the Pudoh Gaol on the other, affords a very convincing proof against the theory of the causation of beri-beri by a toxin contained in Rangoon rice. ... In the Pudoh Gaol, Tai Wa Ward, and Leper Asylum, we have three institutions, the inhabitants of which are the same nationality. The Rangoon rice consumed by them is supplied from the same source. It would be reasonable to support that if the disastrous outbreak of beri-beri that occured in one of them, the Pudoh Goal, during the year, were conveyed by the Rangoon rice, the patients in the Tai Wa Ward and Leper Asylum should suffer from beri-beri in the same way as the prisoners. This has, however, not been the case;"// (The Straits Times, 9 June 1903, Page 2: {{ :akhbar:straitstimes19030609-1-2-4.pdf ||}}[[https://eresources.nlb.gov.sg/newspapers/Digitised/Article/straitstimes19030609-1.2.4|"RICE AND BERI-BERI"]]).
 Petikan surat-menyurat berkaitan lawatan Dr. Braddon ke Penjara Pudu (1902-1903):-
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 Akibat kesilapan dalam kesimpulan Dr. Braddon ini, walaupun langkah pencegahannya berjaya, namun kajian selanjutnya membuktikan kesilapannya. Dr. Braddon akhirnya diketepikan dan bersara pada tahun 1908, lalu menjadi peladang di Negeri Sembilan: //"On account of this ‘grain intoxication’ theory, further research at the IMR by Fraser and Stanton were led off track and studies failed to find any poison. Braddon himself was sidelined and retired in 1908 to become a planter in Negeri Sembilan."// (Lim Kean Ghee, 2016: {{ :buku:drlimkeangheebool-thehistoryofmedicineandhealthinmalaysia.pdf ||}}[[https://www.gerakbudaya.com/History-of-Medicine-and-Health-in-Malaysia|"THE HISTORY OF MEDICINE AND HEALTH IN MALAYSIA"]], m.s.54).
+Huraian terperinci kesilapan teori Dr. Braddon: //"Dieticians of the late twentieth century would no doubt judge this diet as 'correct' and explain that the 'accessories' would have contained sufficient vitamin B1 to have supported the digestion of the starchy rice to a form useful to the body. There would have been no beri-beri because there would not have been any deficiency of vitamin B1. They would also grant that his belief that the proportion of rice eaten was significant to the extent that the greater the amount of carbohydrate there was to be digested, the greater the amount of vitamin needed to facilitate that process. That is, if the foods supplementing the polished rice contain enough vitamin to allow the rice to be digested, symptoms of beri-beri would not appear. If, however, the polished rice were not supplemented with sufficient vitamin to facilitate the digestion of the normally vitamin-rich grain, symptoms of the disease would appear. ... Braddon maintained that 'Those who eat only fresh rice - i.e., the grain newly stripped of its envelopes (husk and pericarp), and not therefore exposed for a long period - escape beri-beri' and as proof pointed to the 'hundreds of thousands of natives throughout Malaya' and other areas who are free of beri-beri. In spite of his knowledge of the different peoples of the peninsula, he had failed to appreciate the difference between the hand-pounded rice eaten by the 'natives' and the product of the steam mills of Rangoon and Siam which was provided for the indentured Chinese labourers."// (Enid Wylie, Journal of the Malaysian Branch of the Royal Asiatic Society Vol. 61, No. 2 (255) (1988), pp. 93-122: {{ :buku:10.2307_41493104.pdf ||}}[[https://www.jstor.org/stable/41493104|"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"]]), m.s. 9-17).
 **LATAR PERISTIWA: [[w_l_braddon|Dr. William Leonard (W.L.) Braddon (1862-1936)]]**.
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 //"Penggunaan beras India dalam kalangan pesakit beri-beri di hospital dimulakan seawal tahun 1902 di Negeri Sembilan. Langkah ini kemudiannya diikuti oleh tenaga perubatan di Pahang pada tahun 1906, di Perak pada tahun 1908 manakala di Selangor pula pada tahun berikutnya. Pada tahun 1910, kematian akibat penyakit beri-beri mencatatkan rekod paling rendah dalam tempoh 32 tahun (1883-1914) iaitu 11.2 peratus. Dr. G.D. Freer, Pegawai Perubatan Kanan Selangor melihat kemungkinan in pada penggunaan beras India. Keberkesanan penggunaan beras ini turut diakui di Singapura. ... Pada awal tahun 1910, Dr. Fraser dan Dr. Stanton membuat kesimpulan tentang punca beri-beri. Penyakit ini dikesan akibat kekurangan nutrien dalam beras putih yang dimesin. Kesimpulan tersebut memperkukuh hasil eksperimen awal yang mereka lakukan pada tahun 1907. Salinan laporan bertajuk "On the Etiology of Beri-beri" diajukan kepada kerajaan India, kerajaan Burma, Setiausaha Kolonial Sri Lanka dan Setiausaha Kolonial Hong Kong serta Jawatankuasa Penasihat Tabung Penyelidikan Penyakit-penyakit Tropika."// (Noraini Mohamed Hassan @ Sumbu Dunia Melayu: Hubungan Keserumpunan Malaysia-Indonesia, 2017: [[https://books.google.com.my/books?id=yGxwEAAAQBAJ|"Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914]], m.s.279-280).
+Huraian punca kekurangan vitamin B1 pada beras kilang: //"The preparation of the 'higher quality' white polished rice from Burma and Siam was a much more complex mechanical procedure. ... In the mills the rice is first sifted and winnowed mechanically to remove any impurities and then husked by being forced between discs coated with emery and cement, causing the hull to split. The grain is then scoured to remove the waxy outer bran layers. A truncated inverted cone of cast iron covered in emery and cement which revolves at high speed within a steel wire mesh is used to rub off the brain. The process is repeated several times and is followed by the polishing process which consists of passing the rice through several revolving rollers covered with sheepskin or buffalo hide. This removes the innermost (aleurone) layer and any floury particles from the grain leaving it smooth or polished. This type of milling would certainly remove any felt-like fungus such as that described by Guerin but it also removes much of the nutritive value of the rice leaving only the starchy endosperm. A study by Rosedale showed losses to be 29% of the original protein, 79% of the fat, 84% of the lime and 67% of the iron. Essential vitamins, the existence of which was beginning to be suspected when Braddon wrote his book, were also found to be lost in milling and polishing because they are mainly stored in the outer layers of the grain. A study by Hinton found that the distribution of thiamine (vitamin Bi ) in red rice was 50% in the scutellum, 33% in the aleurone layer, 9.7% in the embryo and 6.3% in the endosperm of the grain. (See Diagram 1). In addition to the loss of protein, fat, valuable minerals and vitamin Bx , other vitamins are also lost. Kik and Williams found the average losses in thirteen varieties of rice to be 76% of the thiamine, 56% of the riboflavin and 63% of the niacin."// (Enid Wylie, Journal of the Malaysian Branch of the Royal Asiatic Society Vol. 61, No. 2 (255) (1988), pp. 93-122: {{ :buku:10.2307_41493104.pdf ||}}[[https://www.jstor.org/stable/41493104|"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"]]), m.s. 9-17).