280 STRONG AND CROWELL. 



In a subsequent paper,^° he records the results during the 

 year 1907 when 136 patients were treated in the "uncured" rice 

 ward. Of these patients 28 suffered from beriberi, 4 of whom 

 were suffering from the disease on their admission, while in 24 

 the disease developed whilst they were in the asylum. During 

 the same year, 131 patients received a diet containing "cured" 

 rice; 4 of them were admitted actually suffering from beriberi, 

 but none of these 131 patients developed the disease in the asy- 

 lum. Fletcher concludes that the cause of beriberi is to be 

 sought for in the diet, and the result of his experiments tends 

 to show that white polished rice, although of the best quality, 

 is the cause of beriberi, acting either by some poison which it 

 contains or by a starvation due to some defect in the nutritive 

 value of such rice. 



Fales," from a study of an outbreak of an epidemic of beri-beri in 

 Bilibid prison, in Manila, came to the conclusion that the lack of fresh 

 vegetables conduced powerfully to both beri-beri and scurvy. 



In November, 1901, there were two cases of the disease, and no deaths, in 

 the gaol. The food was then changed to a ration consisting of 97.17 

 grammes of proteids, 17.24 grammes of fats, 491.04 grammes of carbo- 

 hydrates and 26.52 grammes of salts. In this diet there were 85.05 grammes 

 of potatoes and 453.60 grammes of rice. Put into other figures, this diet 

 consisted of: Nitrogen, 172.1 grammes; carbon, 4,166.5 grammes; hydrogen, 

 61.9 grammes; sulphur, 13.2 grammes; salts, 140.2 grammes — the pro- 

 portion of nitrogen to carbon being as 1 to 24.2, whereas, calculating the 

 weight of Filipinos at 125 pounds, it was estimated that proteids ought, 

 according to Voigt's diet, to have been at least 94 grammes, fats 45 gram- 

 mes, and carbohydrates 400 grammes; or, according to Moleshott's diet, 

 nitrogen, 256 grammes; carbon, 3,789 grammes; hydrogen, 143 grammes; 

 sulphur, 23 grammes; salts, 172 grammes — i. e., N : C : : 1 : 0.15. 



The epidemic of beri-beri now began: December, 1901, 52 cases and 2 

 deaths; January, 1902, 169 and 12; February, 1,087 and 16; March, 576 

 and 15; April, 327 and 15; May, 310 and 19; June, 451 and 17; July, 233 

 and 33; August, 571 and 24; September, 522 and 31. 



On October 20 the diet was again changed, and this time proteids were 

 101.71 grammes; fats, 19.37 grammes; carbohydrates, 395.73 grammes; 

 salts, 29.13 grammes; including 119.07 grammes of potatoes and 255.15 

 grammes of rice. Nitrogen was 209.8 grammes; carbon, 3,816.2 grammes; 

 hydrogen, 70.4 grammes; sulphur, 17.2 grammes; and salts, 185.8 grammes — 

 N : C :: 1 : 13.4. 



In October there were 579 cases and 34 deaths; November, 476 and 8; 

 December, 89 and 3; half January, 1903, 4 cases and no deaths. 



Along with the beri-beri there was an epidemic of scurvy, and Fales 

 was of the opinion that both diseases were led up to by a deficiency of 

 vegetables, the essential principle of which he believed to be potassium 

 carbonate, of which rice contains only 0.01 grain per ounce, while potatoes 



^'Journ. Trop. Med. (1909), 12, 127. 



" Castellani and Chalmers, Manual of Tropical Medicine. London (1910), 

 890. See also, Journ. Am. Med. Assoc. (1907), 48, 778. 



