DISCUSSION. 243 



As to malaria being a causative factor in producing convulsions in 

 these cases, I can only say that the blood was not examined, as the 

 infants were not seen clinically. In one or two instances I found an 

 enlarged spleen and a liver of a chocolate-brown color. 



Dr. Allan J. McLaughlin, Assistant Director of Health, assistant 

 professor of hygiene, Philippine Medical School. Manila, P. I. — I wish 

 to correct a false impression which Doctor Musgrave has gathered from 

 our paper. We have never dogmatically said that this disease is beriberi. 

 By referring to our paper it will be noted that we belive we have dem- 

 onstrated a pathologic entity responsible for many deaths of infants 

 and for which we know of no better term than moist beriberi. Perhaps 

 Doctor Musgrave can suggest a better one; if so, we shall be happy to 

 substitute his diagnosis, tentatively at least, until the question of name 

 is ultimately decided. 



In regard to his statement that there are no breast-fed children, 

 strictly speaking, in the Philippines, I desire to state that we are per- 

 fectly cognizant of the very common practice among the poorer classes 

 of Filipino mothers of giving young children a variety of solid food in 

 addition to the supply drawn from the breast ; but this does not con- 

 stitute artificial feeding, and the fact remains that the bulk of the chil- 

 dren of the Filipino poor are mainly breast-fed. The majority of the 

 deaths from the disease in question, which we tentatively term beriberi, 

 occur in infants under three months of age. 



The pernicious custom of giving solid food to the children is not 

 usually practiced until after the infant is three or four months old. 

 We admit, as Doctor Musgrave has suggested, that many Filipina mothers 

 are tubercular, but this condition can ' only be considered as another 

 factor in the poor nutrition of the Filipina mother. Tuberculosis is not 

 hereditary and a diligent search for tubercular lesions in the cases under 

 discussion produced negative results. 



DISCUSSION ON THE PAPER, "UNSOLVED HEALTH 



PROBLEMS PECULIAR TO THE PHILIPPINES," 



BY DOCTOR HEISER. 



Dr. II. Campbell Ilighet. — I have listened with great pleasure to 

 Doctor Heiser's paper and at the same time with the deepest sym- 

 pathy. Those of us who are engaged in administering sanitary measures 

 in the Tropics all know the extent of the task set us and all of us have 

 suffered from the want of funds. In fact we are often apt to think 

 that our respective governments show but little sympathy with us, so 

 small is the appropriation allowed for sanitar}' work, but, as Doctor 



