DISCUSSION. 241 



so that when death certificates are presented and the family is asked 

 whether the child had been artificially fed or breast-fed the mother 

 would probably reply breast-fed, and perhaps deny other forms of feeding 

 if she thought such an answer to be wanted. 



One year ago, however, at the urgent request of a number of physi- 

 cians of the city, I reluctantly gave instructions to have statistics of this 

 kind gathered and as you perceive, according to them, 70 per cent of 

 naturally fed children have died, which fact alone indicates that from 

 our present knowledge of infant feeding these figures are not likely to 

 be correct. I desire to disclaim all responsibility on behalf of the 

 Bureau of Health for the statistics which have been used in the paper 

 just read covering this particular point. However, in view of the show- 

 ing just made, an investigation will be made on this point which will 

 be based upon actual observation of infants in their homes. 



The authors of this paper are to be congratulated upon the excellent 

 manner in which they have presented this matter and the concise and 

 clear arrangement of their statistics. They have made a valuable con- 

 tribution concerning the cause of infant mortality in the Philippines, 

 and with the data brought to light by Doctor Aron we should soon be 

 in position to take effective steps to reduce the mortality. 



Dr. Paul Clements, of the Bureau of Health, Manila, P. I. — I have 

 been engaged to a certain extent on the other end of the work described 

 by Doctors McLaughlin and Andrews. About 30 cases in which the 

 pathologic diagnosis was infantile beriberi were sent to the morgue from 

 my station, and it fell to my lot to collect the clinical histories. With 

 one or two exceptions the patients all were babies under three months 

 of age and the large majority were between one and two months. In 

 the course of this work the clinical picture of the disease has assumed 

 quite as much distinctness in my mind as Doctor Andrews says the 

 pathologic picture has in his; and I have no doubt whatever that the 

 disease is a distinct clinical and pathologic entity. My own investiga- 

 tions among the people with regard to the age at which mixed feeding 

 of Filipino babies is commenced leads me to agree more fully with 

 Doctor Highet than with any of the other gentlemen who have spoken 

 on this subject. I have rarely, not often, seen babies younger than three 

 months who were breast-fed and at the same time received only a neg- 

 ligible quantity of other food. 



With regard to the name by which we still designate this pathologic 

 entity, it seems that the authors of the paper have merely followed the 

 nomenclature adopted by the first Japanese observer. The condition has 

 been clearly recognized by some Filipino practitioners, and I believe 

 Doctor Albert was the first to call the attention of the profession to its 

 existence. The local name "toon" might perhaps be accepted. 



Dr. Antonio G. Sison, second assistant resident in clinical medicine, 

 Philippine Medical School, Manila, P. I. — The name malnutrition sug- 



