332 BREWER. 



the five years ending with 1908, there were in Manila 5,373 deaths from pulmonary 

 tuberculosis, a death rate of 4S5.3 per 100,000. During the same period, there were 

 4,472 deaths from bronchitis, a death rate of 404 per 100,000. Without doubt 

 some of these cases of bronchitis were tubercular. 



The following shows the death rate from pulmonary tuberculosis in 

 Manila and certain cities of the United States having approximately 

 the same population. These data are for the year 1908. 



Death rate. 



Manila, Philippine Islands 4S6.2 



Indianapolis, Indiana 184.7 



Louisville, Kentucky 183.6 



Providence, Rhode Island 153.4 



New York City, Borough of Queens 125.5 • 



St. Paul, Minnesota 88.8 



The statistics presented show that the mortality from tuberculosis in 

 the Philippine Islands, both in the provinces and in Manila, is greatly in 

 excess of the rates in other countries. I believe that this is absolutely 

 unnecessary and that the climatic conditions of these islands are such 

 that the people should lead an outdoor life and be free from tuberculosis. 



There is practically no tuberculosis among cattle and hogs in the 

 Philippine Islands. Of 60,000 hogs and 30,000 cattle slaughtered in 

 Manila during the year 1909, not one was found to have tuberculosis. 

 This surely argues against the climate being the cause of the great prev- 

 alence of the disease. 



From a somewhat intimate association with the natives throughout 

 a considerable area of the Islands, I believe that we can charge this 

 great mortality to the following causes : Bad hygienic surroundings, poor 

 food, and improper clothing. 



The habitation of the native Filipino is badly ventilated, and, in most 

 instances, is very dirty. Especially is there a lack of air during the 

 night, when he adds a smoky lamp, further to pollute the air he breathes. 

 An actual count of 200 houses in Manila, of all classes, made about 

 midnight, showed that less than 25 per cent of them had a window open. 

 The thatched cottages of the poorer natives seem to be well ventilated, 

 but should the visitor have occasion to enter one of those buildings at 

 night, the delusion would soon be dispelled. 



The Filipino is a great expectorator and deposits his sputum whenever 

 and wherever most convenient, and it is not uncommon to find the wall 

 and the corners of the room soiled with expectoration. 



Ninety per cent of the inhabitants are the hosts of animal intestinal 

 parasites. Investigations conducted in Bilibid have shown that these 

 unwelcome guests greatly increased the mortality among the inmates. 



The average native seems to be poorly nourished, his diet consisting 

 largely of rice and fish and a little fruit, with an occasional meal of 



