“'Maternity: Letters from Working Women' edited by Margaret Llewellyn Davies depicts the lives of some women at the turn of the twentieth century. As literate women and members of the Women's Co-operative Guild, they were acutely aware that they were better off than many others. The fact that most of them had led lives of unceasing pain and humiliation makes the experience of the other nineteenth century British working women all the more horrifying. …
…..
'Maternity' reveals that a life of bad health, overwork, under-nutrition and sexual exploitation was the lot of most women. … Though the medical world continued to emphasise the ignorance of mothers, the mothers' letter in 'Maternity' show women's awareness of the needs of mothers and babies. Most mothers did breastfeed and took a shy pride on this fact. When they failed to breastfeed this was yet another sorrow to add to the endless account of misery. They knew that artificial feeding was dangerous and also that stress exacerbated physical problems even though this was not acknowledged 'scientifically' … The very anxiety that they might not be able to breastfeed would have increased the risk of lactation failure.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 185-188).

“The milk companies have argued that their products kept children alive for all the mothers who could not breastfeed and there was a 'demand'. The fact that the new organisation and stresses of industrialised society created so many of the burdens for women that prevented them from breastfeeding meant that the companies themselves were creating the conditions which ensured that their product would be needed.
…..
…the effect of this on infant feeding has been repeated around the world. The process of industrialised urbanisation appears to cut women off from their support systems and expose them to stresses, both emotional and physiological, which make it more difficult for them to breastfeed. Hard work itself does not impede lactation, as clear evidence from so many rural societies indicates, nor living in a city, as thousands of privileged Europeans and North Americans have proved in the 1980s. … Milk companies and doctors are always claiming that women do not want to breastfeed. This seems exceedingly rare in the rural situation, but does occur in the urban. … The introduction of damaging practices makes breastfeeding failure likely and a mother who experienced difficulties is bound to discourage her daughter. Several of the letters in 'Maternity' describe the experience of a 'gathered breast' (i.e. mastitis) or an abscess. This indicates that they were probably not feeding the baby frequently in the early days after the birth and this early restriction is often linked with later lactation failure. …
…..
There are so many changes which accompany the process of industrialisation that it is an oversimplication to pinpoint one as a cause of decline in breastfeeding. Among these confitions were a loss of intimate knowledge and support, an intrusion of erroneous medical supervsion into a personal relationship and the widespread availability of products which were promoted as adequate breastmilk substitutes. The new methods of production which made life more difficult for breastfeeding women and increased the numbers of dead babies were producing hundreds of products which were widely advertised with extravagant and misleading claims and were making a good profit for their manufacturers.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 189-190).

“At the turn of the century the 'milk depots' were established in France, Britain and the United States with the declared aim of providing uncontaminated milk for babies. They were also a good way of monitoring the babies and their mothers. Their founder, Dr Budin, tried to encourage breastfeeding, but like so many of his contemporaries he dreaded overfeeding and steps to avoid this ruined breastfeeding for many women. These depots were the forerunners of health clinics all over the world where a cheap of free product is used to tempt mothers to come and submit to the vigilant eyes of those who know best. The decline of breastfeeding has paralleled the spread of these institutions.

Many have argued that the milk depots saved lives, and certainly it must have been a relief for mothers whose milk was failing, because the skill to re-establish lactation had been lost and the change in social relations deterred them from feeding one another's babies, to knoe that they could get a supply of cheap milk for their babies. However there was no proof that the depots had any effect on the infant mortality rate which began to fall after 1905. The Medical Research Committee noted in 1917 that the drop in infant death rate was the same in widely separated towns, some of which had milk depots and some not. What the milk depots established was the link between artificial milk distribution and the health centres which persists to this day, the world over.
…..
Outbreaks of epidemics of infections in 1929 and 1936 were milkborne, according to the British Medical Association who issued warnings in the national press. At that time 2,000 deatgs a year were due to bovine tuberculosis. When mothers bought their week's supply of pasteurised or sterilised milk from the milk depots, it still had to be kept fresh. Sterilised milk kept better, but in fact the process destroys more nutrients than pasteurisation. Mothers also used sweetened condensed milk, either whole or skimmed depending on what they could afford, but the tin had to be opened in the shop and somehow kept uncontaminated in the home. One investigator found that diluted Nestle's condensed milk, incubated at 37 degrees centigrade, contained 11 million bacteria after twenty-four hours. Dr Coutts's report (see page 190) found most samples of infant foods already contaminated before use. Hygiene was impossible in the average overcrowded, ill-equipped home. Only the rich had water closets, and working-class people in most urban areas had middens which were large, leaky uncovered receptacles, sunk below ground level, or ash privies which were cemented at the bottom and above ground level and had ash thrown in at the front and the contents removed from the back. These facilities were often shared by several families. In the Yorkshire city of Hull between 1918 and 1939, 79 per cent of infant deaths due to diarrhoea were in housed with privies or pail closets.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 193-195).

“Poor mothers all tried to breastfeed and attempted it even if they were told not to, but in spite of continual railing against those unworthy mothers who did not suckle their babies there was little interest or research into breastfeeding difficulties and no training of medical students in the subject. What advice there was actually contributed to the breastfeeding failure and the lucky ones were those who escaped the erroneous advice of the health workers. Rural women who did not have access to the milk depots had quite different problems. … This women was desperately poor, often hungry and overworked, but she had no problems with her milk supply. She lived close to her mother and relatives but had never learned about 'overfeeding', scrubbing her nipples or the importance of routines: … She lived in such a remote part of the country that she was beyond the ministrations of health visitors so she stayed obliviously certain that breastfeeding worked: … She was also deprived of the widespread advertising of baby foods.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 195).

“The advertisment opposite was published in Maternity and Child Welfare in 1917 when many doctors were still blaming mothers for allegedly 'refusing' to breastfeed. The Glaxo advertisement boasted that six city health departments, corporations and a 'School for mothers' had used a total 354,000 pounds weight (778,800 kilos) of their dried milk powder.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 196)

“Besides the changes in production methods, other factors which accompany industrialisation affected infant feeding. The Fall River study of infant mortality in a textile manufacturing town in 1908 cited artificial feeding as a significant cause of the excessive number of deaths from diarrhoea, but it was observed that a proportion of mothers who stayed at home were also bottle-feeding. The authors of this study claimed that the main factors in a high infant mortality case were a high proportion of 'foreign-born' mothers, high female illiteracy and a high birth rate. The stress of rapid change, the absence of supportive female relatives and the attempt to adjust to an alien way of life seem to disturb important cultural practices which protect mothers and babies. It is difficult to discover the exact reasons why a mother stopped breastfeeding, but contemporary experience shows that the availability and promotion of alternative foods usually has a demoralising influence on both individual and social confidence in breastfeeding. … If replacement feeds were used a womans' breastmilk supply might decrease and her need for the substitute foods become established. This would also make her more likely to become pregnant and more closely spaced births would lower the chances of survival of her babies. In the country as a whole 58 per cent of babies were still breastfed at twelve months in 1911, but the urban rate was lower than the rural.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 200)

Punca penularan wabak secara umum ialah penyahhutanan besar-besaran untuk tujuan pembukaan kawasan ladang dan perlombongan yang besar, serta jaringan jalan-jalan pengangkutannya, yang mengakibatkan ketidakseimbangan ekologi dan penularan wabak. Pekerja migran yang dibawa masuk oleh pihak British pula tidak mempunyai daya ketahanan semulajadi terhadap wabak tempatan. Pakar serta kakitangan perubatan British pula, kurang berpengalaman dan berpengetahuan mengenai wabak-wabak tersebut, lalu mengakibatkan puluhan ribu pekerja terkorban olehnya: “…jangkamasa 1896-1914 merupakan tempoh yang paling penting untuk memahami peranan British dalam mengawal penularan penyakit ekoran eksploitasi ekonomi yang dialami oleh negeri Melayu di bawah pentadbiran British. Menurut J. Norman Parmer, “British rule first made the incidence of disease and death very much worse than before. The clearing of land for estates, the expansion of mining and the construction of public works disturbed existing ecological balances, causing diseases to spread and multiply. The large immigrant labour forces assembled for these capital investments lacked natural immune systems. The colonial government, the chief provider of medical services, also lacked experience and knowledge and as a consequence many tens of thousands of workers died.”” (Noraini Mohamed Hassan, 2004: |"Penyakit tropika di Negeri-Negeri Melayu Bersekutu, 1896-1914 : tumpuan kepada penyakit beri-beri, malaria dan penyakit usus", BAB SATU: PENGENALAN).

Antara rekod rasmi yang terawal berkenaan penularan wabak beri-beri di Tanah Melayu, kebanyakannya di kalangan para banduan penjara, pada bulan Mei tahun 1875: “Bermula tahun 1790 hingga tahun 1857, sebanyak 20,000 banduan dibawa masuk ke NNS (Negeri-Negeri Selat). NNS menjadi jajahan British yang telah menerima banduan paling ramai berbanding wilayah kolonial yang lain. Selain menerima kemasukan banduan, banduan dari penjara-penjara NNS turut dihantar keluar ke Penjara India. Ini kerana pusat pentadbiran British di Asia ketika itu adalah di jajahan kolonial India. Namun sejak penubuhan dan perkembangan penjara di NNS, terdapat satu penyakit misteri yang telah menyerang keseluruhan populasi penjara. Ia melibatkan sebahagian jumlah banduan yang mana sebanyak 25% daripada jumlah keseluruhan populasi banduan mati kerana penyakit ini. Antara gejala penyakit yang ditunjukkan adalah seperti keadaan lesu (lassitude), bengkak (oedema), kebas kaki dan tangan, kehilangan selera makan, masalah penghadaman, dan gangguan sistem saraf. Manakala bagi banduan yang berada pada tahap kronik menunjukkan gejala lumpuh, masalah sistem jantung, diikuti dengan restlessness (kegelisahan) dan akhirnya meninggal dunia. … Beri-beri yang paling awal direkodkan di Penjara Negeri-Negeri Selat adalah pada bulan Mei tahun 1875. Sejak awal direkodkan, kebanyakan laporan di penjara mengklasifikasikan penyakit beri-beri ini sebagai penyakit berjangkit. Ini kerana penyakit ini menular dengan kadar yang sangat pantas dan tidak diketahui status penyakit yang sebenar. Pada tahun 1877, ia mula dikelaskan secara rasmi sebagai satu penyakit khusus iaitu penyakit beri-beri. Hakikatnya, sebelum diumumkan sebagai penyakit beri-beri pada tahun 1875, terdapat jumlah kemasukan yang tinggi direkodkan. Sebagai contoh, dapat dilihat dalam tahun 1870, terdapat 1981 kemasukan banduan ke hospital, tahun 1871 sebanyak 1933 kes, kemudiannya meningkat tahun 1873 kepada 2500 kes. Pada tahun 1874, jumlah kes beri-beri di Penjara NNS masih berlaku secara konsisten.” (Siti Alwaliyah, Ahmad Kamal Ariffin Mohd Rus @ Jebat: Malaysian Journal of History, Politics & Strategic Studies, Vol. 46 (1) (July 2019): 27-57: |"Penularan penyakit beri-beri di penjara Negeri-Negeri Selat: penelitian terhadap sebab dan langkah-langkah kawalannya, 1870-1915", m.s.32).

Sebagai State Surgeon Negeri Sembilan, Dr. William Leonard (W.L.) Braddon menghadapi wabak beri-beri yang menular di sana. Pada mulanya beliau mendirikan pusat pemulihan pesakit beri-beri di tepi pantai Port Dickson, dengan sangkaan udara segar di sana dapat membantu, namun jangkaannya meleset. Menjelang tahun 1899, beliau diberi geran untuk mendirikan makmal kajian terhadap pesakit beri-beri. Berdasarkan dapatan kajian, beliau membuat kesimpulan bahawa penyakit tersebut tidak disebabkan oleh bakteria: “Braddon did much to treat beri-beri as well as to find out its cause. He established a sanatorium for beri-beri patients near Port Dickson. However, his faith in a seaside cure and an infection theory evaporated with the statistics from the sanatorium. By 1899, with a modest government grant, he set up a small laboratory and conducted over 80 experiments based on blood and tissues from beri-beri patients and healthy controls that, to him, ruled out bacteria as a cause of the disease.” (Lim Kean Ghee, 2016: |"THE HISTORY OF MEDICINE AND HEALTH IN MALAYSIA", m.s.53).

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 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: |"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: "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: "Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914, m.s.276, 278).

Institute for Medical Research (I.M.R.) ditubuhkan pada tahun 1900 di Kuala Lumpur, bagi mengkaji punca dan tatacara kawalan wabak Beri Beri dan lain-lain. Pengarah pertamanya ialah Dr. Hamilton Wright: “There were many theories about the cause and nature of the disease, and in 1900 the worried British authorities established the Institute of Medical Research in Kuala Lumpur with the aim of solving the mystery of beriberi and other diseases … Dr. Hamilton Wright, the first Director of the Institute of Medical Research, wrote to Sir Patrick Manson about the cause of beriberi and assured him that they were 'sure to find the organism soon” (Enid Wylie, 1988: |"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA", m.s 3-4).

“While on leave in Britain in 1904 Braddon sent his 537 page manuscript The Cause and Prevention of Beri-beri to the Secretary of State for the Colonies. … He claimed to have proved that the disease was 'a species of grain-intoxication' and 'what is more important, the means of preventing the disease are shown to be easy of application' (that is, by eating parboiled instead of polished rice). He urged the Government to give the work full publication and to implement 'the means of protection wherever the disease now occurs in countries under British Protection', … the paper was forwarded to Sir Patrick Manson for comment … Manson' s comments were favourable and the manuscript was returned to Braddon with the request that he make a precis of the work. Manson did not consider that Braddon had absolutely proved his theory but commented that he 'shows great industry and skill in the collection and interpretation of statistics and other matters relating to beri-beri. Braddon was gratified by Manson's reaction because, only two years before, Manson had announced that Travers' experiments in Pudoh gaol had 'proved up to the hilt' that neither rice nor any other kind of food had anything to do with beri-beri. Braddon had at least reopened the question as Manson recommended that Braddon be provided with the opportunity to carry out more experiments to prove his theory. … He argued that white polished rice (which he called 'uncured' rice as distinct from parboiled or 'cured' rice) became infected by an organism, 'probably a special fungus' which produced a toxin. He believed that this toxic substance which was produced by this special fungus poisoned those who ate it in large quantities. … He offered special thanks to Dr. E. A. O. Travers 'for much stimulating criticism in consistent opposition to the views expressed in the work and in Appendix I of the book he quoted the main part of Travers' report on his experiment carried out in Pudoh Gaol in Selangor during 1895 - 1896, but not published until 1902. It was this paper which had prompted Manson's statement that Travers had proved that beri-beri was not connected with diet. Braddon supplemented the paper with information gleaned from official reports made by Travers and his colleagues and interpreted the resulting information to refute Travers' proof that the incidence of beri-beri was not connected with diet.” (Enid Wylie, Journal of the Malaysian Branch of the Royal Asiatic Society Vol. 61, No. 2 (255) (1988), pp. 93-122: |"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"), m.s. 9-17).

Pada tahun 1907, Dr. Braddon berjaya meyakinkan pihak kerajaan untuk menerbitkan “teori beras” secara rasmi, iaitu pernyataan bahawa Beri-Beri adalah disebabkan oleh beras kilang dari Siam dan Burma yang dimakan oleh banduan Penjara Pudu. Ianya diterbitkan sebagai “The Cause and Prevention of Beri-Beri”: “Over more than a decade of observation, experiment and opposition from his fellow medical officers 'Beri-beri Braddon', as Manson dubbed him, had become convinced that the cause of the mysterious disease was associated with one type of rice, imported polished rice. The clinical symptoms of the disease resembled ergot poisoning and in the literature he examined so critically a possible mechanism for the introduction of the poison was suggested - an undetected fungus producing a toxin which poisoned those who ate the rice. … Braddon believed that the pericarp of the red rice (that is, husked but not milled rice) protected the grain from the hypothetical fungus. It is now known that the thiamine (vitamin B^ essential for life is contained in the scutellum, embryo and aleurone layer of the grain. In the case of parboiled or 'cured' rice which is prepared by steeping rice in water and then boiling and drying it, the process actually carries a large fraction of the vitamin from the bran into the endosperm of the seed where it remains even after it is milled. The process facilitates husking but hardens the bran. … Travers objected to his theory on the basis of his observations on three institutions in Selangor - 'a lepers' asylum, a home for incurables, and a criminal prison' - which were supplied with rice from the same store for over six months but only the criminals developed beri-beri. Braddon responded: The explanation here lies in the relative quantity eaten, which is less in the hospitals than in the prison dietary. In the diet of the lepers, as in that of the patients of all hospitals, there is more variety, and fresh meat, eggs or fish are given every day, which is not so in the prison.” (Enid Wylie, Journal of the Malaysian Branch of the Royal Asiatic Society Vol. 61, No. 2 (255) (1988), pp. 93-122: |"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"), m.s. 9-17).

Namun begitu, walaupun Dr. Braddon berjaya menemui puncanya, kesimpulan beliau telah tersasar: sangkaan beliau terdapat organisma beracun yang belum diketahui pada beras tersebut yang menjadi puncanya: “Pada tahun yang sama (1907), Dr. W. Fletcher yang memegang jawatan sebagai Patologis Institut Penyelidikan Perubatan turut menjalankan eksperimen di Kuala Lumpur dan memperoleh keputusan yang hampir sama. Selain itu, uji kaji kimia terhadap sampel beras Siam dan beras India turut dilakukan oleh ahli kimia Institut Penyelidikan Perubatan untuk memastikan perbezaan kandungan kimia yang terdapat dalam setiap satu sampel berkenaan. Kajian kimia yang berterusan terhadap sampel-sampel ini meyakinkan penyelidik Institut Penyelidikan Perubatan untuk membuat satu hipotesis iaitu kekurangan nutrien dalam beras adalah penyebab beri-beri dan bukannya racun seperti yang diutarakan oleh Dr. Braddon.” (Noraini Mohamed Hassan @ Sumbu Dunia Melayu: Hubungan Keserumpunan Malaysia-Indonesia, 2017: "Penyelidikan Beri-Beri di Tanah Melayu dan Hindia Belanda, 1880-an Hingga 1914, m.s.279-280).

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: |"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: |"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"), m.s. 9-17).

“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: "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: |"THE SEARCH FOR THE CAUSE OF BERIBERI IN THE MALAY PENINSULA"), m.s. 9-17).

Pada akhir kurun ke-19 dan awal kurun ke-20, perkhidmatan perubatan kolonial hanya terhad di kawasan bandar sahaja. Kemudahan kesihatan awam dan sistem kawalan kebersihan awam berada di tahap yang rendah. Kajian kawalan penyakit masih di peringkat awal, dan kawalan wabak penyakit juga terhad. Pembukaan hutan secara besar-besaran bagi peluasan ladang-ladang getah menyumbang kepada penularan wabak malaria: “19th-early 20th century: western medical services only to urban populations. Public health facilities poor, sanitation negligible, epidemiological research in infancy, infectious disease control limited, opening up jungle areas for new estates (rubber expansion) contributed to constant fresh outbreaks of malaria.”

“Kedatangan penjajah Inggeris dan penguasaan mereka ke atas ekonomi-politik Tanah Melayu telah mengubah keadaan fizikal semulajadi dan struktur kependudukan dengan membawa masuk imigran dari negara China dan India. Pembukaan hutan adalah antara punca yang mendedahkan nyamuk malaria kepada pekerja (Lim C.Y. 1967:311). Manakala keadaan daif dari segi pemakanan dan tempat tinggal buruh lombong dan estet telah menyemarakkan penyakit seperti disentri, beri-beri, kudis buta, cirit-birit, taun dan lain-lain. Angka kematian yang tinggi disebabkan oleh penyakit berjangkit dan infeksi menunjukkan persekitaran kawasan-kawasan yang diteroka penjajah Inggeris berisiko kepada kesihatan dan nyawa. Antara tahun 1890-1900 bilangan pesakit yang dirawat di Perak telah meningkat dari 8213 kepada 13730 orang. Angka kematian dari penyakit berkaitan juga telah bertambah lebih dua kali ganda dalam tempoh yang sama (Perak Administration Report 1901 dan Selangor Government Gazette vol VII dalam Kuiek B.S. 1990).

Orang Melayu yang tinggal di persekitaran yang sama atau berhampiran dengannya juga terdedah kepada penyakit berkenaan. Walaupun nisbah pesakit Melayu yang dirawat adalah antara 10-18.0 peratus dari jumlah pesakit, tetapi dengan sifat orang Melayu ketika itu yang sukar dan takut pergi ke hospital maka jumlah sebenar pesakit Melayu adalah lebih besar. Laporan FMS (1926:4) menyebut orang Melayu sebagai golongan yang membawa masalah kepada pentadbiran kesihatan kerana kejahilan, kuat berpegang kepada amalan tradisi di samping prasangka mereka kepada perubatan moden.”

(Sumber: Noraziah Ali, Shaharuddin Ahmad, Sari 15 & 16 (1998) 101-128 Taraf Kesihatan Wanita Melayu Sebelum Merdeka, m.s.112).

“The displacement of Malay logic with the cultural logic of colonialism was effected through the extension of medical services on a mass scale, often exceeding measures that would have been necessary to maintain the labor force to meet capitalist labor requirements. Having begun to extend colonial logic throughout the community, legitimacy is thus achieved. Malaria, for example, is caused by Anopheles maculatus, and the effect of the penetration of capital into and its disruption of the ecosystem on the hinterland is underplayed. European drugs (quinine) could cure the illness and public health measures such as drainage and oiling, implemented by or under the authority of colonial officials, could control it. Hence the colonial administration was essential to maintain health through the offices of the medical and sanitation departments. (An alternative logic would simply run: capitalist penetration produces or exacerbates illness (in this case, malaria) and thus health is achieved through the limitation or rejection of capitalist enterprise).” (Lenore Manderson, International Journal of Health Services, Vol. 17, No. 1 (1987), pp. 91-112 (22 pages): "HEALTH SERVICES AND THE LEGITIMATION OF THE COLONIAL STATE: BRITISH MALAYA 1786-1941", m.s.96-97).

“…capitalist and administrative interests converged again with the establishment of direct control in Perak in 1874 and the subsequent extension by 1895 of British power in Selangor, Negri Sembilan, and Pahang. Increased state activity was necessary to establish and maintain the conditions necessary for economic life by providing both the infrastructure and labor force necessary for the expanding mineral extraction and plantation sectors. Increasing awareness of health problems, and in some respects the very production of those problems, led to increased state intervention with a broad base to its medical programs.” (Lenore Manderson, International Journal of Health Services, Vol. 17, No. 1 (1987), pp. 91-112 (22 pages): "HEALTH SERVICES AND THE LEGITIMATION OF THE COLONIAL STATE: BRITISH MALAYA 1786-1941", m.s.102).

“The opening up of land, including building roads and railways as well as appropriating land for rubber, had in fact 'created' the problem of malaria. This is not to suggest that malaria had not existed earlier. However, its incidence was of limited concern to the administration then, since the population to whom the administration was responsible was largely not in areas where infection was a possibility. A few reports only refer to 'Penang fever' and to 'jungle fever' among convicts in Malacca. Chinese and European capitalists were working tin mines in the Malay States from the 1850s, but their health was not an issue. In addition, the Malay population, at least according to Gerrard in 1913, were settled in areas where malaria was least likely to be a problem. However, medical departmental reports from 1874 from the Malay States document the increased incidence of illness concomitant with penetration. The Pahang Report of 1899, for instance, noted that 'disturbance of the soil connected with tillage, the construction of roads, the erection of buildings & c., accounted for a good deal of sickness'. The Perak Report of the same year referred to the high mortality rates that accompanies the railway construction works, irrigation works, and the opening up of new estates, as well as within the mining sector. Malaria was not the only problem; dysentery, diarrhea, respiratory diseases, and beri-beri all contributed to the high mortality and morbidity rates.” (Lenore Manderson, International Journal of Health Services, Vol. 17, No. 1 (1987), pp. 91-112 (22 pages): "HEALTH SERVICES AND THE LEGITIMATION OF THE COLONIAL STATE: BRITISH MALAYA 1786-1941", m.s.103).

“Like beri-beri, malaria took on an economic as well as human toll, although the concern with its incidence came later. Rubber began to be important at the turn of the century. … Mortality and morbidity rates were high among the population directly involved in this rapidly expanding sector: in 1909 the crude death rate was 400-500 in each newly opened area. In 1899, the London School of Tropical Medicine opened to study diseases that directly threatened colonial economic interest; the Institute of Medical Research in Kuala Lumpur was opened two years later. Swettenham, then Resident General of the Federated Malay States, in stating government policy that led to the establishment of the Institute, provides evidence of the way in which beri-beri and malaria were defined as medical problems that could only be resolved through Western technical expertise.” (Lenore Manderson, International Journal of Health Services, Vol. 17, No. 1 (1987), pp. 91-112 (22 pages): "HEALTH SERVICES AND THE LEGITIMATION OF THE COLONIAL STATE: BRITISH MALAYA 1786-1941", m.s.104).

Sementara itu, mutu bekalan susu di Tanah Melayu tidak terkawal dan seringkali tercemar, dicampurkan dengan bahan lain, atau dicairkan. Keadaan ini dijadikan peluang oleh beberapa syarikat Eropah untuk menggiatkan pemasaran produk-produk makanan bayi di sini. Fokus usaha mereka ketika itu adalah memupuk kebolehpercayaan keselamatan produk-produk mereka untuk kegunaan umum, berbanding mutu bekalan susu semasa. Namun begitu pada peringkat awal ini, harga produk-produk ini agak tinggi, dan hanya mampu dibeli oleh kalangan warga elit asing dan tempatan. Oleh sebab itu, mereka hanya mengiklankan produk-produk tersebut di akhbar-akhbar berbahasa Inggeris tempatan sahaja: “In colonial Malaya, condensed milk was marketed from the late 19th century. Infant formula was available from the turn of the century and was widely advertised, first in the English-language press and later also in the vernacular presses. At the same time, other social and cultural factors served to discourage breast feeding. There were changes in ideas regarding ideal body weight for both women and infants, and regarding infant care and diet; these ideas were presented in the mass media. In addition, maternal and child health clinics, established in the 1920s to reduce the high infant mortality rate, both propagated popular beliefs about infant weight and supplied milk and educated women to artificially feed their infants. Industry, the media, and health services all promoted, if not always intentionally, bottle feeding rather than breast feeding. Bottle feeding as an ideal, if not a reality, was thus well established before the intensive promotion of milk products by multi-national corporations that followed the political independence of the colony.”

(Sumber: Lenore Manderson, International Journal of Health Services, Vol. 12, No. 4 (1982), pp. 597-616 (20 pages): |"BOTTLE FEEDING AND IDEOLOGY IN COLONIAL MALAYA: THE PRODUCTION OF CHANGE", m.s. 597).

“…hampir setiap tahun, wanita yang dimasukkan ke pusat rawatan mental adalah disebabkan oleh faktor moral akibat daripada masalah domestik iaitu kehilangan ahli keluarga atau saudara-mara yang rapat. Kehilangan suami terutamanya akan menyebabkan wanita menghadapi masalah kerana kehilangan sumber pendapatan keluarga. Hal ini turut mengakibatkan mereka berasa tertekan untuk terus menyara kehidupan diri serta anak-anak mereka. Selain faktor moral, golongan wanita yang menghidap penyakit mental juga disebabkan faktor fizikal. Antara kategori penyebab bagi faktor fizikal termasuklah minum alkohol berlebihan tanpa kawalan, demam malaria, epilepsi, sakit jantung, phthisis, sakit tubuh badan, serangan terdahulu, berusia, pengaruh keturunan dan ketagihan candu. Selain penyakit-penyakit ini, penyakit wanita turut mencatat bilangan pesakit yang agak ramai dalam menyebabkan masalah mental dalam kalangan wanita seperti penyakit kelamin, mengandung, selepas melahirkan anak, penyakit rahim dan ovari, penyusuan, dan akil baligh (CO275/84 1911).” (Koh Kuan Wei, Zubaidah VP Hamzah & Azlizan Mat Enh, 2022. “Penyakit Mental dalam Kalangan Wanita di Negeri-negeri Selat: 1886-1920,” dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.163-164).

“…pada awal abad ke-20, sebuah hospital khas telah dibina di Perak khususnya untuk merawat orang Melayu. Pembinaan rumah sakit tersebut menyebabkan bilangan kehadiran orang Melayu ke rumah sakit meningkat, tetapi percubaan ini tidak berulang di negeri tersebut (Wan Faizah 2010). Namun menurut Lenore Manderson, kebimbangan mengenai kadar kematian postnatal yang meningkat khususnya menyebabkan penekanan diberi untuk melatih wanita tempatan berkhidmat sebagai jururawat. Residen Pahang contohnya menegaskan bahawa ramai bayi meninggal dunia kerana 'improper feeding during the first year' dan ramai juga yang 'killed by their filthy dwellings' and 'inherited disease from their parents' (Manderson 1996: 206). Begitu juga kadar kematian bayi yang dianggarkan 161:2 orang pada tahun 1899 dan terus meningkat kepada 334 orang pada tahun 1900 (Manderson 1996). Umumnya, Manderson, L. berpendapat bahawa:

'By the turn of the century, women had also become objects of state interest via attention to hugh infant mortality, with public health interventions in the colonies again following developments in Britain. Maternal and infant health gained importance as the costs of importing labor rose and the government and estates began to look to their workforces to reproduce themselves. Even so, women received little care during pregnancy and confinement. They suffered from anemia due to malaria, hookworm, and poor nutrition, and their general health status was aggravated by frequent childbearing (Manderson 1999: 105).'”

(Sumber: Koo Boon Dar, 2022. “Wanita dan Sejarah Kejururawatan di Tanah Melayu: 1800-1957,” dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.236).

- Early 1890s: study in Liverpool: 1000 cases of infantile diarrhea deaths: artificial feeding at least 16 times as dangerous as breast feeding. At the time perceived more due to sewage disposal, absence of clean piped water, lack of heating facilities, lack of storage facilities, and dilution and contamination of condensed milk

- Nestle and the Anglo-Swiss Condensed Milk Company (London - Nestle) began to advertise Milkmaid condensed milk, with relatively large bold typeface advertisements appearing regularly.

- Borden's American Eagle Brand tinned milk, Highland Brand Helvetia Cream were competing for the market.

- Katz Bros (Nestle distributor) advertised Mellin's Infant Food (from Mellin's Food Works, London) as 'a perfect substitute for mother's milk, adapted for all children from birth'

- Nestle advertised Ideal Milk.

- Bear Brand milk became available under the Sledge Brand label, marketed under this trade name until 1916.

Mellin's Infant Food regularly advertised in Saturday edition of The Straits Times.

Allenbury's Foods (Allen and Hanbury's Ltd., London) were advertised on a fortnightly basis in the Saturday Straits Times in competition with Mellin's. Offered graded dietary plan: #1: birth-3 months, #2: 3-6 months (both hot water only), #3: 6 months-older: Malted Milk for adding to cow's milk / Allenbury's Diet ('pancreatised milk and cereal food') for adults.

Tinned milk for both adult and infant consumption was a common commodity in the Straits Settlements (Singapore, Malacca, and Penang) and the peninsular Malay States. Sledge, Milkmaid, Ideal Milks and the French 'condensed and sterilized milk' Triomphe, were readily available, with at least 1 advertisement for tinned milk appearing daily in the press; Mellin ads: product 'untouched by hand'. Sledge Brand: won gold medal at Geneva Exhibition 1896, claimed requested by Princess of Wales as travel milk.

Sledge Brand advertised daily - claimed product quality by incorporating extract of Daily Bulletin 1904-09-26 by W.C. Welborn (Chief of Bureau of Agriculture Manila) of butter fat quantity; Dahl (Norway) advertised daily: 'most flattering testimonials from medical men'. Luitre (France) advertised daily; Milkmail, Ideal, Borden, Gianelli Majnos advertised regularly; Allenbury advertised weekly, offered 48-page booklet: 'Infant Feeding and Management' (ST 1905-01-09 p9)

- 1908: Fussell's and Company introduced Butterfly Brand milk in the Straits Settlements, F.M.S., Burma, Siam; Nutricia (Dutch), Nestle joined infant food with Nestle's Milk Food 'for infants, children, and invalids': 'quite a new departure based on science and practical experience' (ST 1908-01-08, p.3).

Sun Brand and Aurore Milk (cheapest - $5.50 per case of 48 tins) available; Nutricia Milk claimed product used by Singapore Government Hospital for one and a half years 'to the entire satisfaction of the Government' (ST 1911-09-01 p.5); Sledge Brand advertised securing new milk supply contract to medical institutions in SS and FMS (ST 1911-09-07 p.9). Still expensive.

Earlier brands ceased to advertise, others continued.

Swimmer Brand Natural Milk advertisements appeared daily; Allenbury's Foods ('closely resembling human milk') and Nestle's Milk Food 'for infants and convalescents' advertised regularly.

Milkmaid took quarter to full page ads in ST daily: 'Milkmail Milk. Best for Babies. Best for Invalids. Best for All'. Advertised milk supply contract. Sledge still defended: 'Is it likely that the government medical institutions would use Sledge Brand Milk for so many years if those in authority had not satisfied themselves as to its excellent Quality, Purity, and Reliability' (ST 1913-01-29, p.1).

Infantina ads: 'Theinhardt's food for infants. The most rational substitute for mother's milk'.

Nestle's Milk Food: $7.50 per dozen tins (65c/tin). Glaxo: twice as expensive

Flag Brand Full Cream Condensed Milk (from Societa Commissionaira Orientale); Milkmaid ads acclaimed appointment to the King and contracts with British Admiralty, War Office, and India Office (p.7), 'chosen for use in the Government hospitals in the Straits Settlements and F.M.S. proves that Milkmaild Milk is the best' (ST 1913-01-06, p.7).

Infantina ads 2-3 times a week in newspapers, advertised availabilty in Medical Hall or Medical Office; Fussell's ads: 'There is no milk that can equal Fussell's for babies .. Is your baby sick and fretful? If he is, it is undoubtedly caused by the milk you are giving him. Change to Fussell's Fresh Natural Milk' (ST, 1913-01-08, p.2).

(ST p.6): Milkmaid + Nestle's Milk Food in full-page ads, offered special feeding bottles with teat and valve for 35 cents