278 WASHBURN. 



after reluming to the United States by Doctor Louis H. Pales, a former, 

 physician-in-charge of the medical work in Bilibid Prison, appear to 

 find their own refutation in the greatly reduced mortality rates under 

 the application of proper sanitary measures. Unable 8 himself to apply 

 successfully the principles of sanitary science, all his writings in medical 

 journals in the United States have been colored by his own unhappy 

 experiences in the Philippines. 



During the last fiscal year there were treated in the Civil Hospital in 

 the city of Manila "1,310 patients, of whom 818 were white people, 463 

 Filipinos, and 29 Chinese, Japanese, and other Asiatics. Of this number 

 of patients only 29 deaths occurred, 3 being patients of outside physicians. 

 As 8 of the deaths were those of patients brought to the hospital in a 

 moribund condition, they may properly be excluded from the number of 

 deaths in the institution. On this basis the death rate would be less 

 than 1^ per cent of the cases treated." 



The inadequacy and unsuitableness of the building used for several 

 years past as a civil hospital are in part compensated for by the efficiency 

 and devotion to duty of the medical and nursing staff of the hospital. 



The last United States census reports show the average urban death rate 

 in the United States as 18.6 and the rural death rate 15.4, or a difference 

 of 3.2 in favor of the rural communities. Statistics are not available 

 showing definitely the mortality rates in the Philippines outside of 

 Manila. It is probable that any difference here is likewise in favor of- 

 the Archipelago outside of Manila, where practical application of sanitary 

 measures has accomplished much through the hard work and guidance 

 of the few available medical inspectors of the Bureau of Health, the 

 Medical Corps of the Army at Army posts and the American teachers, 

 several hundred in number, stationed in the pueblos throughout the 

 Islands. No small measure of credit is due the teachers for their 

 splendid, often heroic, work in combating disease and improving the 

 sanitary conditions of the pueblos in which they have been stationed. 

 Having the confidence of the people, they have been able to aid materially 

 in applying the sanitary regulations of the Bureau of Health through 

 instruction in schools and by giving wholesome advice to local author- 

 ities. 



The health of American teachers of the Bureau of Education, distrib- 

 uted as they are all over the Archipelago, is probably a fair indication 

 of the general health of English-speaking civilians in the Philippines 

 who have avoided excesses and lived normal lives since coming to the 

 Islands. There were during the past year approximately 800 American 



8 It is proper to state that Dr. Fales was seriously handicapped as was his 

 successor, in not being free to carry out sanitary measures properly. Since 

 November 1, 1905, the Bureau of Health has had control and supervision of 

 sanitation in prisons in the Philippines, the physician charged with the care of the 

 health of prisoners at Bilibid being responsible to the Director of Health. 



