Adolphe Vorderman’s report on the prisons of Java and Madura is 142 pages, with sixteen appendices, twelve plates and a folding map, printed at Batavia in 1897 by the society that published the laboratory’s journal. It is the document that turned a chicken disease into a government question, and it was designed, by a man who had already guessed the answer, to stop him from finding it where it was not. This piece follows the report’s own pages, in my translation.

The letter

Vorderman had met Eijkman shortly before Eijkman left for Europe, and had been told the chicken results. “From my remark,” he wrote, “that I, in agreement with the results of his experiments on fowls, had never met beri-beri in prisons where red rice served as the staple food, and on the other hand had always seen white rice supplied as the staple food of the prisoners in prisons where beri-beri occurred, Dr Eijkman asked to be allowed to make use at a suitable time. On my side there were no objections to this. Only I wished first to possess data on all the prisons of Java and Madura, not only for completeness’ sake, but also in order to find out whether this peculiarity also occurred in the prisons not yet visited by me.”

So he wrote to every head of local government “with the request for information on the nature of the staple food of the prisoners and the occurrence of beri-beri among these people, without however hinting at a possible connection between these two factors.” A few days before Eijkman sailed, Vorderman could show him the replies in a table. The supervising authorities said that in 63 state prisons white rice was served, and in 34 of them beri-beri occurred, “ergo in 54 per cent,” while of the 27 prisons in which red rice was the staple, beriberi was to be found in only 1, “thus in 3.7 per cent.” Eijkman, interviewed in Holland that November, remembered the table as 64 prisons and 36, “or 56 per cent,” against 27 and 1; the report’s figures are the ones to use.

Vorderman did not trust the table. The replies did not always make clear whether “white rice” meant polished rice, stripped of the silver skin, or unpolished white rice free of red grains; and the occurrence of beriberi itself “needed closer confirmation here and there.” Besides, a deliberate inquiry might open new points of view “which would perhaps give occasion to consider the question from a wholly different side too, and would thus guard against one-sided conceptions.” On 18 March 1896 the Director of Education, Religion and Industry, “convinced of the great importance of the matter,” ordered him by a letter numbered 8 and marked Geheim, secret, to make a tour of inspection “into the state of health of the prisoners in the state prisons of Java and Madura, and more especially into the connection that might exist between the nature of the staple food and the occurrence of beri-beri among the prisoners.”

The journey

“The mention of this special part of the purpose of the journey was however kept secret, in order to prevent its becoming public and the Chinese contractors for the supply of food perhaps showing other kinds of rice than those which are usually supplied by them. Nothing was therefore mentioned about the food in the circular which the heads of regional government received about my coming journey.”

After the prisons of Batavia and Meester Cornelis he began the journey proper on 6 April 1896 at the prison of Buitenzorg, and then spent a week in the laboratory of the botanical garden there, under Dr J. M. Janse, studying the structure of the grains of the different kinds of rice. He went along the north coast from Bantam to Besoeki, with the island of Bawean, then to Madura, then from Kediri westward through the remaining residencies. The journey ended on 12 September 1896, after a second week in the garden’s laboratory, this time on the structure of djagong, maize, which was the staple of Madura and the eastern end of Java. Eijkman told the Academy in 1897 that the inquiry had run from May to October; the report’s dates are April to September.

In each prison he inspected the food in kind. A sample of the rice was taken from the supply, labelled at his lodging, sealed, and sent to the acting director of the laboratory at Weltevreden, H. F. Roll, “who, with the help of an expert and later also of Dr G. Grijns, examined the samples, distinguished them, arranged them in six columns and independently” set them out. The samples carried a letter or a number and nothing else. The question put to the experts was what kind of rice each was, and Vorderman notes that the expert was asked, where the grain was foreign, whether it came from Saigon, Rangoon or Siam.

The columns

The first idea had been two columns, red rice and white. The samples did not allow it. Vorderman describes, with the help of a plate, the stages of the grain: the unhulled gaba; the red rice that has lost its coarse husk in the pounding and kept its inner coat, the silver skin, which in that variety is red; the red rice ground white in a mill, with “remnants of silver skin in the grooves of the grain”; and the white table rice stripped of everything. He gives a chemist’s test, caustic soda, which stains the skin yellow where any survives, and a prison inspector’s test, a pinch of grains rubbed in the fold of a handkerchief to take off the loose bran so that the colour can be judged. The categories that came out of the samples were these: red rice; red rice mixed with unpolished white; native unpolished white rice; native polished white rice; foreign polished white rice; and thirteen samples that fitted none of these, some of them half-polished, which were given a column of their own. “Among the white unpolished rice are also included kinds of rice in which no more than 25 per cent without silver skin occurred, while on the other hand among the native, wholly polished kinds have also been placed those which contained no more than 25 per cent unpolished rice.”

Then the sentence on which the method rests. “Only after the prison-by-prison distinction of the kinds of rice supplied had thus been fixed were the statistical data collected by me on beri-beri sufferers and prisoners placed at the disposal of the medical men named, for arrangement in the columns of appendix 10.”

The registers

The statistics ran from 1 January 1895 to the date of each inspection. Vorderman had the prison registers to hand, and he used them. The sickness and death rates “are calculated from the ratio between the net number of prisoners and that of the beri-beri cases or deaths ascertained.” Net meant that three classes were left out: men sentenced by the regency courts to short terms, men held for one night, and prisoners passing through on their way elsewhere. Where these had to be counted, as in the state prisons of Batavia and Soerabaja, the appendix says so. He found that the gross totals the local authorities gave him counted the same man twice, once in the register of remand prisoners and again, after the High Court had confirmed his sentence, in the register of the convicted; he asked for the numbers transferred and corrected for them. He also noted why the beriberi figures could be trusted more than most prison statistics: a man in the last stage of beriberi was usually released, so the registers recorded it, and some prisoners simulated it, which the doctors knew.

“The value of the result obtained in this impartial way is undeniably increased by the fact that the statistics obtained cover a number of not less than exactly 100 prisons and 281,878 prisoners.”

The result

Page 59. “Among the 96,530 prisoners in the various prisons who were fed with unpolished rice, only 9 cases of beri-beri occurred, and those in the prison at Bangkalan, which gives a ratio of 0.009 per cent, while among the 150,266 prisoners who were fed with polished rice 4,201 cases of beri-beri occurred, that is 2.79 per cent. In the prisons in which the rice mixtures (indicated in column 4) were supplied, 85 cases of beri-beri occurred among the 35,082 prisoners, that is 0.24 per cent.” The three groups add to 281,878.

He added a note on where the chickens and the prisons met. “This last result also seems to confirm what Dr Eijkman formulates on page 234 of his paper on fowl polyneuritis, under 3. For he argues there that the quantity of silver skin present in the rice grains is not so great that any considerable part of it can be taken away (in rice feeding) without danger of the occurrence of polyneuritis.” The prisons on mixtures, a quarter of whose grains might have lost their skin, had twenty-seven times the rate of the prisons on unpolished rice.

The gaol at Toeloeng-agong needed splitting. Until the end of June 1895 it had served polished white rice, now and then mixed with red and white; the prisoners “asked however to be allowed to eat red rice, just as they were accustomed to in their villages,” their request was granted, and from 1 July 1895 the prison fed red rice. So the one prison appears twice in the appendix, once in each period, and that is why the hundred prisons are 101 in the count by prison: of 37 prisons on unpolished rice, beriberi in 1; of 13 on mixtures, in 6; of 51 on polished rice, in 36. Eijkman gave the Academy that count in July 1897 and added the one that the histories have used ever since: in the prisons on half-hulled rice, one prisoner in 10,000 with beriberi; on mixtures, one in 416; on polished rice, one in 39; “this statistic extends over a total strength of 279,623 prisoners.” Vorderman’s own total is 281,878; where the 2,255 went between Batavia and Amsterdam the report does not say. In the Nobel lecture of 1929 the survey had become “no less than 101 prisons with almost 300,000 inmates,” and the ratio “some 300 times greater” where polished rice was eaten. A biographical note of 2019 gives 95,000 prisoners on rough rice with 9 cases and 150,000 on polished rice with 4,200. All of these are the same page, rounded by different hands; 2.79 divided by 0.009 is 310.

What the prisons also showed

The appendix is full of the things a theory of rice poisoning needed and did not get. At Besoeki the Chinese contractor’s agent told him that Rangoon rice usually fed the prisoners, while at the moment of inspection native rice was being served, because the harvest had just come in and the local grain was briefly cheaper than the imported. At Toeban the contractor had supplied foreign polished rice until shortly before the inspection, which the customs receiver confirmed. At Cheribon the sample from the contractor’s store looked like the siftings of a government rice contract for Banka. At Soerabaja, in the former women’s prison, the morbidity had reached 61 per cent. In the prisons where the disease was worst the rice was polished, and it did not matter where it had been grown, or how long it had been kept: “Foreign rice has as such no particular influence on the occurrence of beri-beri; stale rice no more.” A rice merchant’s experiments, which Vorderman reported, showed that in the heat rice with its silver skin spoiled sooner than polished rice, which was the opposite of what the poisoning theory needed.

His closing chapter, “The value of Eijkman’s fowl experiments,” gives Eijkman the priority “of having first demonstrated that feeding with unpolished rice prevents polyneuritis in fowls, and that with polished rice on the contrary produces polyneuritis in those animals,” and then draws the line the report had earned. “In my opinion more success is to be expected from feeding with unpolished rice as a means of preventing beri-beri than of curing it, especially where extensive nerve degeneration already exists.” Eijkman’s trial in the Stadsverband at Batavia, he noted, rested on the supposed curative property; the trials in the prisons at Japara and Soerabaja on the preventive one. He added two cases from the prison at Buitenzorg, both insane prisoners who had developed beriberi there and improved on red rice, and allowed that the silver skin might hold “a vis medicatrix” as well.

The report was published in 1897 and answered in the newspapers for two years, mostly by people who had not read it. Vorderman wrote a Toelichting, an explanation, in the laboratory’s journal in 1898. He died at Batavia in 1902. Jan Vandenbroucke, who put the report into the James Lind Library in 2012, read it as what it is: an observational study, “unusually well protected against bias,” by a prison doctor who wrote down every step he took to keep his own expectation out of the result.

Sources

• A. G. Vorderman, Onderzoek naar het verband tusschen den aard der rijstvoeding in de gevangenissen op Java en Madoera en het voorkomen van beri-beri onder de geïnterneerden, Batavia: Javasche Boekhandel en Drukkerij, 1897. Pages 1 to 3 (the meeting with Eijkman, the letter, the 63 and 27 prisons, the commission of 18 March 1896, the journey), 21 to 24 and the first plate (the grain and its tests), 56 to 60 (the samples, the columns, “Eerst nadat aldus de gevangenisgewijze onderscheiding der verstrekte rijstsoorten vaststond …,” the 100 prisons and 281,878, the result, Toeloeng-agong, Besoeki, Toeban and Cheribon), 88 to 91 (net and gross, the registers), 101 to 104 (foreign and stale rice), and 114 to 116 (“Waarde van Eijkman’s hoenderproeven,” “Mijns inziens zal echter van de voeding met onafgewerkte rijst meer succès te wachten zijn, als middel om de Beri-beri te voorkomen, dan wel om haar te genezen”). Translated by the author of this piece. Wellcome Collection, archive.org
• “Dr. C. Eykman over de Beri-Beri,” De Locomotief, 21 November 1896, from Insulinde: the 64 and 27 prisons as Eijkman remembered them. Delpher
• “Wetenschappelijk Allerlei: De Aard der Rijstvoeding en de Beri-Beri,” De Locomotief, 12 July 1897: Eijkman’s address to the Royal Academy, the 37, 13 and 51 prisons, the one in 10,000, 416 and 39, and the 279,623. Delpher
• Christiaan Eijkman, “Antineuritic Vitamin and Beriberi,” Nobel Lecture, 1929: the 101 prisons, “almost 300,000,” and “some 300 times.” nobelprize.org
• Krzysztof Pietrzak, “Christiaan Eijkman (1856–1930),” Journal of Neurology 266 (2019): the 95,000 and 150,000. doi:10.1007/s00415-018-9162-7
• Jan P. Vandenbroucke, “Adolphe Vorderman’s 1897 study on beriberi: an example of scrupulous efforts to avoid bias,” James Lind Library, 2012. jameslindlibrary.org