﻿362 MUSGKAVE AND RICHMOND. 



The number 18,795, for the deaths of infants under 1 year of age, 

 represents 47 per cent of the total mortality, and 71 per cent of the 

 total recorded births. 



^No reliable figures are available from the provinces, but it is probable 

 that the ratios will not be found materially to differ from the ones derived 

 from the records in Manila, for whereas Manila has better sanitary condi- 

 tions, and the services of hospitals, physicians and nurses are more 

 regularly sought in the city, the provinces on the other hand have fresher 

 and better milk and other foods, and infections are perhaps less frequent. 



Three hundred and seven American children were born during the four 

 years covered by these statistics, and while no accurate figures are avail- 

 able, the infant mortality among these was less than 5 per cent. Very 

 similar results are obtained from statistics which one of us personally 

 compiled, containing the record of 150 native children born to educated 

 parents during the same period of time. However, in these two classes 

 of patients rachitic tendencies, marasmus, anaemia and other damaging 

 influences of malnutrition are sufficiently prevalent to prove that even 

 in the absence of pure, fresh milk, we are not using the available foods 

 to the best advantage. 



On examining the recorded causes of death a little more closely we 

 find some interesting and instructive figures regarding the death of 

 18,795 infants in Manila during the last four years. In 10,484 instances 

 the cause of death is given as convulsions ; in 1,416 (for three years only) 

 diarrhceal diseases and dysentery; and in 780 (for three years only) 

 simple meningitis is credited with the fatal result. In addition to these 

 figures large numbers of certificates of death where the cause is given as 

 tetanus, lack of care, debility, etc., are recorded. We but confirm the 

 expressed opinion of Major E. C. Carter, formerly Commissioner of 

 Health for the Philippine Islands, and many other prominent health of- 

 ficials and physicians, in stating that an overwhelming percentage of 

 the 10,484 deaths reported as due to convulsions were in reality caused by 

 gastro-intestinal diseases, the result of dietetic errors; this number 

 may also safely be increased to include most of the cases of so-called 

 tetanus, meningitis, debility, etc. Tetanus is prevalent in the Philippine 

 Islands and it is to be expected in a certain number of babies because of 

 the lack of care in treating the cord at birth, hut in six patients which 

 one of us was able to see during life, and in three more where Musgrave 

 made post-mortem studies, the spasms were of other etiology and tetanus 

 was not present. 



Pickets and marasmus are not mentioned in the recorded causes of 

 death, but both diseases are present among foreign and native children. 

 We are convinced after a careful study of the records, the conditions and 

 our own observations, that more than 75 per cent of the deaths of babies 

 in Manila are primarily clue to dietetic errors. 



