DISCUSSION ON THE PAPER, "STUDIES ON INFANT MOR- 

 TALITY," BY DOCTORS MCLAUGHLIN AND ANDREWS. 



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

 Majesty's Government of the Netherlands Indies. — Doctors McLaughlin 

 and Andrews have told us in their interesting paper that convulsions 

 bring about the deaths of many children. I wish to inquire if blood 

 examinations were made with the view of determining whether malarial 

 infection was present. I ask this because in our experience in the Nether- 

 lands Indies it not infrequently is true that such an infection in children 

 really is the cause of convulsions and of death. 



Br. W. E. Musgrave, of the Biological Eaboratory, Bureau of Science, 

 professor of clinical medicine, Philippine Medical School, Manila, 

 P. I. — Doctors McLaughlin and Andrews are to be congratulated on 

 their contribution to the study of the subject of infant mortality. That 

 part of the paper referring to "infantile beriberi" is particularly interest- 

 ing, and the pathologic picture described deserves careful study from 

 clinical and etiologic viewpoints. The most important points for dis- 

 cussion are: First, is the described pathologic picture the expression of 

 an etiologic entity? Second, if so, is the etiologic factor that of beri- 

 beri? 



The chief diagnostic points in the pathology are dilatation and hyper- 

 trophy of the right heart, anasarca and congestion of internal viscera, 

 and congestion of the lungs. Most of these findings, as the authors 

 state, may be explained by the condition of the lungs. The described 

 lesions in these latter organs are somewhat similar to those often seen 

 in acute bronchitis in infants, especially when autopsy has been delayed 

 for several hours. Acute respiratory troubles are very common in infants 

 in this country (16 of the authors' series of 219 died of pneumonia), and 

 in the further study of these cases these should be carefully considered, 

 both from the clinical and pathologic side. The anatomic picture of 

 beriberi in the adult is not very- characteristic, and in most instances an 

 anatomic diagnosis is possible only by exclusion. Beriberi is, of course, 

 a neuritis and histologic studies always show lesions of the nerves, but 

 even these are not of a proved specific nature. The clinical side of the 

 subject is not fully worked out, and usually probably includes other 

 conditions besides the neuritis. Finally, in spite of the recent brilliant 

 work of Eraser and others on the etiology of the disease, the present 

 status of the beriberi question is indefinite and its etiology is not finally 



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