176 HEISER. 



from rats and vermin by systematic fumigation, in order that the 

 plague may at once be checked if by any accident introduced. Wharves 

 have been made rat proof, and vessels where docked are required to use 

 rat funnels in order to keep rodents from gaining access to the shore. 

 At the port of departure for these Islands vessels are inspected by 

 medical officers of the United States in order to ascertain that there 

 is no plague aboard. 



Typhoid fever. — While cases of typhoid fever are undoubtedly con- 

 tracted in the Philippines, yet the disease can hardly be said to be prevalent 

 here. To prevent its establishing a foothold, regulations were prepared 

 for the disinfection of excreta from such cases, for the protection of water 

 supplies, and regulations concerning inspection and sale of milk; also 

 sanitary measures for the eradication of flies were undertaken. - Whether 

 further and more stringent precautions could be taken at this time, or are 

 practicable, is a question for consideration. 



Infant mortality. — The subject of infant mortality is a vast one. In 

 Manila approximately one-half the total number of deaths occurs in 

 children under one year of age. From papers read at this meeting 

 and previously it is obvious that the largest share of it is due to 

 improper nourishment. The poverty of the people makes properly 

 marketed cow's milk, either fresh or canned, an impossibility unless 

 given in the form of charity. This for the great mass of people is 

 not only impossible but undesirable. How to bring a cheap supply 

 within the reach of the poorer classes seems to be the acute phase of 

 the infant-mortality problem. The raising of goats would seem to be 

 the solution. Already experiments in breeding a hardy variety of milk 

 goats have been inaugurated. This problem must not be abandoned, 

 but be rapidly pushed to a solution, for if left unsolved it involves 

 the heaviest mortality we are at present facing. 



Putrefactive changes in foods. — Another complicating feature and 

 cause of illness in the Tropics, particularly in the Philippines, is the 

 putrefactive changes in nitrogenous foods which take place so rapidly 

 in warm climates. The problem is either to provide ways properly to 

 preserve such foods or to find suitable substitutes which will enable us 

 to eliminate them from our tropical dietary. 



Insanitary habits. — The food question brings in its trail another 

 problem that is peculiarly ours and which we know to be the largest 

 factor in the transmission of cholera and intestinal diseases. This is 

 the habit of eating with the fingers. Proper example has done much and 

 the distribution of literature on the subject has helped; but the masses 

 are as yet untouched by either example or prcept, and we see years of 

 discouraging struggle ahead of us before they can be broken of so fixed 

 a habit, the menace of which is as yet entirely beyond their comprehension. 



Poor statistical information. — So much for the particular problems. 



