DISCUSSIONS ON THE PAPERS BY DOCTORS DE HAAN, 

 FRASER, H1GHET, ARON, SH1BAYAMA, AND KILBOURNE. 



Dr. Gilbert E. Brooke, port health officer, delegate from the Straits 

 Settlements, Singapore. — I assure every one that I am very glad to have 

 heard this series of papers, which shows how much careful work has been 

 performed on this subject. That the removal of the outer covering of the 

 rice grain is one of the causes of beriberi seems, from what we have heard, 

 to be probable, the phosphorus content being reduced. However, I must 

 say that it appears to me that we must be careful not to jump too hastily at 

 conclusions. Before we can accept such a conclusion as this we should 

 inquire into many other factors, for one, concerning the occurrence of beri- 

 beri in countries in which the principal diet is not rice, and another, its 

 nonappearance in countries where rice does form the principal food. 

 Another question is concerning the phosphorus content of other foods, 

 which counterbalances the lack of phosphorus in white rice. The natives 

 of this part of the world use fish wherever it is obtainable and fish 

 contains phosphorus. Doctor Kilbourne, in his paper, states that beriberi 

 was present in the Philippine Islands in 1882, but it seems unreasonable 

 to assume that the natives at that time were already eating polished rice. 

 They probably had the same diet as at present. Doctor Highct said 

 that previous to 1890 white rice was quite expensive in Siam. I should 

 like to ask him whether steam-milled rice had been exported from that 

 country. 



I have looked over the records for thirty years, covering the admission 

 of cases of beriberi into the hospitals of the Straits Settlements and 

 these develop the fact that no cases of the disease, or at least very few, 

 occurred before 1878. Beriberi began to appear about the' year 1880 

 and afterwards increased. „ We have had a considerable number of cases 

 of beriberi annually from 1879 up to the present time. We began to 

 use steam-milled rice in Singapore in 1890. There was no beriberi in 

 Singapore jail from 1896 to 1897. The prisoners were given rice 

 found in the market, which is the food of the native population, and 

 the latter also had beriberi. 



I had an opportunity of seeing the beginning of a case of beriberi 

 taken from the quarantine station in Singapore. We had a number of 

 hospital attendants, Chinese, who lived in barracks. They were doing 

 the work of nurses. In October, 1896, we lacked one man. We secured 

 a person about 31 years of age. He lived with the other coolies. They 



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