DISCUSSION. 239 



entirely by artificial means. They were given coconut milk, tuba, 2 

 and rice water. 



Dr. Ham Avon, professor of physiology, Philippine Medical School. — 

 I have considerable experience in the matter of infant feeding from my 

 connection with the various feeding stations established tinder my super- 

 vision by the Department of Public Instruction, especially in the poorest 

 district of the city, namely, Tondo. My observations have led me to con- 

 clude that many of the breast-fed children receive rice or tapioca in addi- 

 tion to mother's milk. I have seen cases of the disease termed beriberi by 

 Doctors McLaughlin and Andrews and which the natives designate as 

 "taon." The symptom complex seems to me very closely to resemble the 

 condition which Czerny and the German authors describe as "Mehlnahr- 

 schaden." I learned that many Filipino children, although breast-fed, 

 in addition are overnourished with the carbohydrates derived from 

 rice or tapioca. The milk of Filipina women is poorer in composition 

 than that of European women. Analyses of individual samples made 

 without regard to the time of day, whether the sample is taken before 

 or after meals, or without taking into account all factors, are of no great 

 importance. However, such as we have show the milk of the Filipina 

 mother apparently to be richer in sugar and poorer in fats and car- 

 bohydrates than that of a normal European mother. 



I was able to produce in dogs a severe disease by overfeeding them 

 with carbohydrates. The disease is especially characterized by a severe 

 oedema. The clinical picture and the autopsy findings in my experi- 

 mental dogs in many respects resemble the condition which has been 

 termed beriberi in infants. 



Dr. H. Campbell Highet, principal medical officer local government 

 of Bangkok, delegate from His Imperial Majesty's Government of 

 Siam. — The paper which has been read is one of the most interesting 

 which has been given at this session. Only a very minute proportion 

 of the people dying in the East are attended by qualified physicians and 

 hence the usual statistics concerning the causes of death are misleading. 

 A check upon the records is so difficult to obtain, that the work of 

 Doctors McLaughlin and Andrews is of supreme importance. Their 

 results seem to me remarkable in calling attention to the great frequency 

 of infantile beriberi. Whether the condition is true beriberi or not, I 

 am neither prepared to agree to nor to deny. I would prefer to suspend 

 judgment until further work has been done. The pathologic appear- 

 ances which have been described are certainly those with which we have 

 beconie very familiar in the cases of adults dead of beriberi, but that 

 breast-fed infants could suffer from beriberi is probably a new fact to 



= Tuba, a fermented juiee derived from the cut flower pf the coconut palm. 

 On standing for a day or two, it ferments and forms an intoxicating drink. 



