112 ARON AND HOCSON. 



is stored and a favorable influence on the nitrogen metabolism can also 

 be observed. 



6. Metabolism experiments on a beriberi patient in a fairly advanced 

 stage of the disease show that the capability of the man to utilize the 

 nitrogen and phosphorus in the food is reduced; he demands a higher 

 intake of nitrogen and phosphorus than a normal person to attain 

 nitrogen and phosphorus equilibrium. It is especially to be noted that 

 the capability of utilizing additional doses of phytin is considerably less 

 than in that of a normal man under like conditions. 



7. While it is certain that phosphorus and nitrogen starvation cause 

 a certain and probably a great number of diseases which we term beri- 

 beri, there must be other factors, 44 especially when the cedematous form 

 is observed. 



RECOMMENDATIONS. 



A very valuable portion of the rice is removed by. the process of 

 polishing and a healthy foodstuff transformed into one which is liable 

 to cause a severe disease. Therefore, it should be the endeavor of all 

 physicians to instruct rice producers and rice manufacturers concerning 

 this process, and medical officers who have charge of the purchase of rice 

 in large quantities for native troops, employees, etc., should use only 

 grain which is either not polished or at least but slightly polished. 45 



Where the occurrence of beriberi in certain districts, in institutions, on 

 ships, etc., is possible, care should be taken to give the people forr contain- 

 ing a sufficient quantity of phosphorus and protein. The greatest success 

 would be attained by a large supply of fresh meat, or where this is not 

 available, as in these islands, a sufficiency of the native bean, mongo. 



A very promising means for the limitation or prevention of beriberi 

 would be the use of the rice bran itself, 50 or 100 grams being cooked 

 with the rice daily, as a protective or as a medicine. This rice bran 

 seems to be the cheapest and most natural supply of the organic phos- 

 phorus compound, phytin; the preparation itself, while valuable, being 

 much too expensive to be of any practical use. We are studying the 

 value of rice bran as a protective on the ship Pathfinder of the United 

 States Coast and Geodetic Survey, on which outbreaks of beriberi have 

 periodically been recorded. Bice bran as a treatment has proved itself 

 of value at Culion. The combined effect of a slightly increased protein 

 intake with a constant supply of phytin showed favorable results in the 

 treatment of the case in Bilibid, described above. 



Note. — For the discussion on these papers see the end of this number. 



"Nocht. Arch. f. Schiffs-u. Trop.-Eyg. Beiheft. (1908), 12, 5. 



45 These recommendations have already been fulfilled for the Philippine Islands 

 by an executive order of His Excellency the Governor-General, by which "the 

 use of polished rice in all public institutions is forbidden." 



