70 ANDREWS. 



in a monograph upon beriberi of infants due to breast feeding, 

 reported 176 clinical cases with 2 necropsies which were per- 

 formed twenty-two and thirty-two hours respectively after 

 death. Their clinical studies are quite detailed and complete. 

 The necropsies having been performed so long after death and 

 the bodies not having been placed in ice boxes, post-mortem 

 changes undoubtedly rendered their pathologic findings, especially 

 the microscopic ones, questionable or obscure. They concluded 

 that death of the infants was due to infantile beriberi and that 

 this disease was caused by a toxin in the mother's milk. 



In spite of the large amount of work that had been done on 

 this subject, the evidence was considered by the writer insuf- 

 ficient to establish the cause of the high infant mortality in 

 the City of Manila. In the past the different papers by different 

 men have been almost entirely clinical or entirely pathological 

 and not a combination of the clinical and pathological study of 

 a large number of cases by the same worker. Hence the present 

 work was undertaken with the idea of studying a series of cases 

 clinically and subjecting those that died to necropsy. 



It was planned to carry out the following procedures : 



1. A clinical study of infant and mother. 



2. Analyses of the milk of mothers whose infants had died of the 

 disease. 



3. In case of death of the infant to secure a quick necropsy and material 

 for histological study. 



4. To determine the etiology of the condition, if possible. 



Instead of taking the cases one at a time, it was thought best 

 to study a number at the same time so that comparisons could 

 be made and differences in clinical symptoms would be more 

 striking. To accomplish this an assistant was sent into the 

 Tondo district, which furnishes the largest number of cases of 

 all districts of the city, to find the patients, and to observe them 

 from day to day. Sick infants are met with on almost any 

 street of this district. If one of them is suffering from beriberi 

 it will nearly always be found to be a plump, apparently well- 

 nourished baby. The face is full, sometimes presenting an 

 almost swollen appearance. Frequently oedema may be elicited 

 by deep pressure on the lower extremities. The little one is 

 invariably breast-fed and is usually about 2 months old. Nine- 

 tenths of the deaths occur between the ages of 1 and 3 months, 

 but it is not unusual for the infant to be 4, 5, 6, or even 7 

 months old. I encountered the disease once or twice in infants 

 that were 10 months of age. 



Unless the infant is seriously ill and the disease far advanced. 



