298 STRONG. 



counterirritation on the skin, known by the natives as puente; the 

 scars which later result, are apt to puzzle the uninitiated in regard 

 to their origin. These ulcers are sometimes mistaken for syphilitic 

 lesions. Their method of production by the application of lime and 

 later by binding on a piece of betel-nut is described in detail by Doctor 

 Nichols in Part XIII, page 285, and is illustrated in Plate XVIII. 



From this brief summary of the studies performed at Taytay, it may 

 be seen that while the conditions in this town are generally unsani- 

 tary, the death rate varying in different years from 27.91 per 1,000 

 to 45.42 per 1,000, they at times may become most unsanitary. Under 

 the present conditions, epidemic diseases such as cholera, typhoid and 

 bacillary dysentery are likely to occur from time to time. The history 

 of the town shows this to be the case in regard to cholera. The great 

 epidemic of 1882 is said to have gained a foothold first in Taytay. In 

 1902, and again in 1905, cholera was also epidemic there. If the intro- 

 duction of cholera at Taytay during the present year had taken place 

 in the rainy season instead of in the midst of the dry one, another 

 epidemic of this disease woTild likely have occurred. 



In regard to smallpox, general vaccination against this malady was 

 carried out in 1905 and in March 1909. It is interesting to note in 

 this connection that smallpox was present in 1908. and 1 per cent of 

 the inhabitants died with it. The entire mortality of the year was 

 45.42 per 1,000. In 1907, when there was no smallpox, the death rate 

 was 27.91 per 1,000. Practically all of the deaths from smallpox were 

 among children under 9 years of age; indeed, nearly 90 per cent were 

 among children under 5 years of age; that is, the majority of the children 

 who died from the disease were born after the general vaccination 

 performed in 1905. Therefore, there should be no difficulty in con- 

 trolling smallpox by means of vaccination. 



There can be no question of the advisability of protecting the inhabit- 

 ants of Taytay against cholera and perhaps against typhoid fever, also 

 by vaccination. All the evidence that we have from the provinces 

 relative to cholera has shown the practicability and the efficiency of 

 vaccination against this disease as a method of protection. The most 

 striking experience was that obtained in the town of Angat, where one- 

 sixth of the population — that is, all those who volunteered, 1,078 in 

 number — were vaccinated against cholera; a few months later, cholera 

 appeared in the village, 122 persons were stricken with the disease, 121 

 of whom were among the noninoculated. The vaccination against cholera 

 performed throughout the Islands during the past few years have shown 

 that proportionately six times as many cases of cholera have occurred 

 among those unvaccinated as in those vaccinated. Work in the Phil- 

 ippines in vaccination against smallpox has been very active recently; 

 and it is difficult to understand why so little attention has been paid 



