242 DISCUSSION. 



gested by Doctor Aron as the cause of high infant mortality instead of 

 beriberi, I think to be more reasonable because of the following: First, 

 the high infant mortality is for the greater part among the poorer class. 

 The women of the working class are at work most of the time and can 

 not feed their babies properly and so are compelled to leave their chil- 

 dren to the care of ignorant brothers or sisters, who give the infant 

 anything they have at hand whenever it cries. Second, even if the 

 babies are fed solely on the breast^ the mother, because of her ignorance, 

 usually gives her breast to her baby every time it cries, and this practice, 

 in time, leads to malnutrition. Third, the poorer class of women who 

 have been delivered in the hospitals of Manila, and there are taught to 

 feed their infants properly, leave the hospital when they have recovered 

 and never return for the treatment of the child if it becomes ill. For 

 the reasons stated above, I believe the high infant mortality in the Phil- 

 ippines to be due to malnutrition, and this high mortality can be de- 

 creased by bettering the conditions of the poorer class socially and above 

 all by educating them with respect to the care of their children. 



Dr. Fernando Calderon. professor of obstetrics, 'Philippine Medical 

 School, Manila, P. I. — It is doubtless true that babies purely breast-fed 

 ii|> to three months die of a disease called "toon," possibly infantile 

 beriberi. T have patients who have borne children all of whom were 

 purely breast-fed, and nevertheless these children died at the age of 

 three months. For this reason, I think that the establishment of in- 

 stitutions like the Gota de Leche 3 will be a great factor in decreasing 

 the high infant mortality. Instead of having one such institution, we 

 should establish ten to twenty in our city. Of course, the founding of 

 charities of this class must be associated with the education of women 

 of the poorer classes in the proper feeding of their children. 



Dr. Vernon L. Andrews, Bureau of Science, assistant professor of 

 pathology and bacteriology, Philippine Medical School, Manila, P. I. — In 

 these cases we have a pathologic entity, and while we do not positively 

 maintain it to be moist beriberi, yet we know of no better name for the con- 

 dition, and if one can be suggested we will be glad to adopt it. We believe 

 that this pathologic entity to be brought about by a nutritional disturb- 

 ance. It is similar in many respects to moist beriberi in adults. Nearly 

 all of these infants we have examined were under two and one-hall: 

 months of age, and while this does not preclude the mothers from having 

 given them a mixed diet, we feel that the giving of extraneous material 

 is a negligible quantity in such early infancy. Furthermore, the majority 

 of these infants were children of beriberic mothers, that is, of women in 

 whom symptoms of beriberi were present. 



3 An institution in Manila, established in 1004, devoted to providing pure milk 

 at a small price to the poorer classes. 



