Friday, 11 March 2011

Singapore's Medical History

"My Busy Body Corner" blog written in 2010 provides an account of Singapore's old medical, dental and nursing buildings, and what happened to them.


Betel nut vs Areca nut | Sirih pinang | Sirih junjung | Tepak sirih (Part 1)

The betel vine (pokok sirih) is a hardy vine with dark green leaves (daun sireh) shaped like hearts. The leaves are often confused with that of the pepper vine (pokok lada hitam). The leaves are crushed in water and the water is used as antiseptic for cleaning skin infections and grazes, and usually for cleaning the private parts following maternal delivery (giving birth) in addition to salt soaks. The leaves are also used in making a wedding gift (sirih junjung) to mark a virgin bride (anak dara). Without the sirih junjung, it is generally taken that the bride is not a virgin (bukan anak dara).

Sireh emas or the golden betel vine with young betel leaves (light green). This variety has red stems and is prized for its bactericidal properties. The leaves are either chewed as a pastime or offered to visitors to chew. The leaves are crushed in water and used for bathing to cleanse the skin and private parts following maternal delivery (mandi selepas bersalin). This betel vine was photographed in the author's backyard. Courtesy of Faridah Abdul Rashid,
The areca palm grows quite easily in dry sandy soil, not necessarily by the sea or on seaside lands. It is a tall palm with smaller and shorter fronds than the coconut  palm/tree or the date palm. The areca fruit is small like the size of an individual oil palm fruit. Unlike the oil palm fruit, the areca fruit does not grow in clusters. Like the coconuts and dates, the areca fruit appears as a single fruit on an individual stalk, and many stalks are attached to a bigger bunch. One bunch may contain 4-6 areca fruits. The areca nut is a smooth nut inside a stiff shell after dehusking (removal of the stiff fibres). When cut, the cross-section is a mosaic of white flesh and red-maroon streaks. I have not tasted the areca nut so I cannot tell you what it tastes like.

Areca palm with areca fruit in bunches (foreground). A laichi tree appears in the background. These trees were photographed in the author's garden at home. Courtesy of Faridah Abdul Rashid,
Buah pinang for which Penang was named. This is the areca fruit, inside it is the areca nut.
Dehusked areca nut
Areca nut after dehusking

Usage in the literature and frame of reference
Old books written during British colonialism in Malaya had used the term betel nut producer or trader, which I think should be corrected in books published today. The term "betel nut" is incorrect and a misnomer. The correct terms are "areca nut" and "betel leaves".

Trade commodity
In early trade within the Malay states and extending to her neighbours, the islands of Sumatra and the Philippines, the Indian subcontinent, countries surrounding the Indian Ocean, and countries of  Indo-China, there was one commodity that stood high above all others, that was, betel nut (more correctly, areca nut). 

Habitual eating
The areca nut is sliced thinly and wrapped in betel leaves, along with a dab of slake lime and sometimes with added tobacco and spices for added taste. Most communities eat it daily and serve it to visitors in a specific tray called tepak sireh. Refusing to eat it when it is served is not an offense. 

Icon of Malay weddings
The tepak sireh is now used as a wedding icon on modern Malay wedding invitation cards. However, it should be noted that the bronze tepak sireh is found is many countries where the Hindu faith once dominated. It is not solely Malay and should not indicate Malayness.

Habitual eating, health and undesirable effects
The folks who occasionally chewed areca nut and betel leaves generally have good oral health. However, prolonged use have been connected to oral cancers.  As I recall in Penang General Hospital circa 1976, one oral cancer case was so severe that an afflicted elderly Indian lady was crying in pain even while she was waiting in the hospital lobby for the nurse to call her name. It was very sad just watching her cry in pain and in vain. From my mother's experience having watched her father tendered to Indian patients, she said that the Indian lady's case was a terminal one. I don't know what became of that Indian lady.

Useful pages on areca nut:

British Colonialism and the Pith Helmet

British Colonialism dominated Malaya (Tanah Melayu) in 1856. The most striking outfit as we look back at British Colonialism is British clothes. For the early Malay doctors, some wore pith helmets. 

The pith helmet (also known as the safari helmet, sun helmet, topee, sola topee, salacot or topi) is a lightweight cloth-covered helmet made of cork or pith (typically pith from the sola, Aeschynomene aspera, an Indian swamp plant, or A. paludosa, or a similar plant). Designed to shade the wearer's head and face from the sun, pith helmets were once often worn by Westerners in the tropics, but have also been used in other contexts. Source: Wikipedia.

In three B/W photos taken during the flood that hit Kelantan circa 1914/15, the British doctors wore pith helmets as they went about their daily work either in sampan or horse carriage (courtesy of Muzium Kelantan; photos are not shown here).

In a B/W portrait of Dr Husin bin Mohamed circa 1916, he wore a pith helmet (courtesy of his children; photo is not shown here).

There maybe other photos of the early Malay doctors sporting pith helmets as part of their formal doctor's white uniform.