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was brought to the Archipelago from Japan, and under these circum- 
stances it would be remarkable if beriberi had not been imported into 
Manila before the date given by Kéniger. However, the latter author has 
given us a very interesting report of what he considered to be the first 
invasion of the Philippine Islands by the disease. His article may be 
briefly summarized as follows: 
“From August to October, 1882, Manila was visited by a severe cholera epidemic, 
which there found a fertile soil and carried off between 15,000 and 20,000 victims 
(the population of Manila was estimated at 400,000). A panic occurred among 
the native as well as among the European population, because cholera had not 
been present since 1865 and as the mortality was more than 75 per cent. After 
the epidemic had subsided, on October 20, a terrible typhoon visited the city and 
province and destroyed all the suburban houses built of light material. As a 
consequence, almost the whole native population of Manila and its surroundings 
was without shelter. In Manila alone, 60,000 families had lost their homes. 
Nor was it possible rapidly to rebuild the destroyed houses and huts, since, fol- 
lowing the typhoon, a flood occurred and all the lower parts of the city and 
province were under water for several weeks. Building material was scarce and 
very expensive. By this time, while the cholera epidemic was still smoldering, 
a new disease, which killed its victims in a few days or weeks, was noticed 
among the inhabitants.. The native and Spanish physicians did not recognize 
the malady and the terror of the population increased. In some cases the disease 
was connected with a swelling of the glands and it therefore was believed by 
some to be a variety of bubonic plague. As soon as I saw the first cases, T had 
no doubt that I was dealing with a particularly malignant epidemic of beriberi, 
of which I had seen some eases in Japan. I caused a notice to be published by 
the Spanish medical board, explaining that the prevalent disease was not bubonic 
plague. The epidemic of beriberi rapidly spread in the province of Manila and 
along the coast to the neighboring territories. It remained stationary during 
November and December and gradually decreased during January. When I left 
Manila during the middle of March the epidemic had very much decreased, and 
there were also still present a number of sporadic cases of cholera.” 
“Beriberi had heretofore not been known in Manila. Whether the disease had 
occurred at all at this place during the last three centuries might perhaps be 
ascertained from a study of the friars’ records. However, it was not known to 
the inhabitants, including the physicians, some of whom had practiced in Manila 
for more than forty years. I myself, during a practice of three years had never 
seen a case of beriberi. This first appearance of the disease in Manila is of 
particular interest because of the enormous mortality observed during the 
beginning of the epidemic. This mortality is not surpassed by anything heretofore 
reported and is higher than it is stated to be by almost all other observers. I 
have no reliable data as to the percentage of beriberi mortality during the first 
month. There are at present no official figures of value, and if subsequently any 
should appear they would not deserve any confidence. The general impression 
existing among physicians as well as laymen during the first part of the epidemic 
was that the disease was absolutely fatal. However, during the earlier part 
of the outbreak I saw several cases which recovered. Still, I think that a 
mortality of 60 per cent for the first month is by no means too high an estimate. 
As to the total number of deaths I have only one reliable observation, according 
to which during a period of a little more than two months, over 300 deaths 
from beriberi occurred in Malabon, a place of about 25,000 inhabitants, situated 
7 kilometers from Manila. However, it is probable that this place suffered more 
ee 
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