DISCUSSION. 14d 



that this was a case of acute, wet beriberi whereas it was simply a relapse 

 in a very chronic case. 



Dr. II. M. Neeb, medical officer of the first class, delegate from Her 

 Majesty's Government of the Netherlands Indies. — I wish to ask 

 Doctor Shibayama if, in his investigations of the cases observed in the 

 Island of Banea, in the mines, where fresh rice was given, he made sure 

 that there were not previous cases or relapses. It is true that patients 

 who have had beriberi and recovered therefrom, so as apparently to be in 

 a healthy condition, a long time afterwards if suddenly placed in bad 

 surroundings, for instance, violent change of climate or excessive hard 

 labor, will not infrequently suffer a relapse. If, now, patients are given 

 fresh, unpolished rice, it might appear, if they contract beriberi, as if 

 this food were the cause, whereas there may be nothing but a relapse 

 produced by other conditions and not by the rice. 



In regard to the question of beriberi on sailing ships, I wish to state 

 that about a year ago Professor Nocht studied two cases where men 

 had died from this cause. Doctor Bodenwaldt examined pathologic- 

 anatomic preparations of the spinal cord and peripheral nerves and found 

 the changes to be quite the same as those which occur in exotic beriberi, 

 so that Professor iSTocht has. come to the opinion that both varieties of 

 beriberi are identical. 



Eakhe (beriberi) has been termed Polyneuritis epidemica during this 

 discussion, but investigations in Japan have demonstrated, to a certain 

 extent, that the alterations in the nerves are mainly secondary degenera- 

 tions, the principal change being in the vascular system. For that 

 reason the symptom complex differentiating hahhe (beriberi) and in- 

 toxication polyneuritis is easy to determine. I do not wish to confuse 

 beriberi with the polyneuritis of intoxication. 



Dr. E. D. Kilbourne, captain, medical corps United States Army, mem- 

 ber of the United States Army Board for the Study of Tropical Diseases as 

 they exist in the Philippine Islands. — In reply to Doctors Aron and 

 Fraser I will state that the amounts of phosphorus and potassium shown in 

 the table were average amounts taken from a large number of men over a 

 period of several months. Although the figures may hot be absolutely 

 correct, they are of value in showing the relative amounts of phosphorus 

 and potassium in the three groups, • and show a greater reduction in 

 potassium than phosphorus in the affected groups. The phosphorus and 

 potassium contents of various foods used to compute the tables were 

 themselves average figures taken from a number of different analyses, so 

 the amounts given in the table are considered to be fairly correct. I 

 fully appreciate the criticism which Doctor Aron makes of my calcu- 

 lations, but analyses of identical rice made in different laboratories show 

 at least as great variations in composition as he states occur between 

 different kinds of rice. 



