282 WASHBURN. 



The marked lowering of the death rate in the United States, prin- 

 cipally in cities, from 1890 to 1900, and in Cuba, Porto Eico, and 

 Panama more recently, is invariably attributed to improvement in the 

 water supply, in the method of disposal of sewage, to the elimination of 

 cesspools and stagnant ponds, to proper drainage, to the destruction of 

 or protection against disease-bearing mosquitoes, to a better milk supply, 

 or to more healthful dwellings; in brief, to improved sanitary conditions. 



In Panama, "malaria lias been so controlled that the sick rate of our total 

 force in the month of April, 1907, was less than 17 per thousand; that is, out of 

 every thousand men at work on the canal we had on an average during the month 

 only 17 sick in hospitals each day. Among 6,000 Americans in the employ of the 

 Commission, including some 1.200 American women and children, the families of 

 these employees, we have but little sickness of any kind, and their general ap- 

 pearance is fully as vigorous and robust as that of the same number of people in 

 the United States. During the year 1906 our death rate from disease among 

 American employees was less than 4 per thousand. We believe that we have 

 demonstrated that the tropical diseases, yellow fever and malaria, can be entirely 

 controlled in the Canal Zone * * *. For the last sixteen months pneumonia 

 has been very fatal among our negro laborers, being confined almost entirely to 

 this class of labor. It affects the whites very seldom. * * * I am inclined 

 to think that the advances made in recent years in tropical sanitation will have 

 a much wider and more far-reaching effect than freeing Havana of yellow fever 

 or enabling us to build the Panama Canal. I think the sanitarian can now show 

 that any population coming into the tropics can protect itself against these two 

 diseases by measures that are both simple and inexpensive; that with these two 

 diseases eliminated life in the tropics for the Anglo-Saxon will be more healthful 

 than in the temperate zone; that gradually, within the next two or three centuries, 

 tropical countries, which offer a much greater return for man's labor than do 

 the temperate zones, will be settled by the white races, and that again the centers 

 of wealth, civilization, and population will be in the tropics, as they were in the 

 dawn of man's history, rather than in the temperate zones, as at present." 10 



Great as is the work clone by the United States in her other tropical 

 possessions, a work of no less magnitude is being accomplished here. 

 Whether in the Tropics, in the temperate zones, or in the arctic regions, 

 the maintenance of health is ever largely dependent upon good hygiene 

 and good sanitation. Any untoward influence of "tropical light" may 

 apparently be easily obviated by the selection of underwear of the proper 

 color, and an appropriate head covering, e. g., a cork helmet. These 

 simple and inexpensive preventive measures appear to have been almost 

 completely ignored by the American soldier and civilian in the Philip- 

 pines. 



What does the future promise in the way of further improvement in 

 the health conditions in the Philippines? Within the coming year a 

 modern sanitary sewerage system for the city of Manila and a system of 

 water supply better in quality and quantity than the present one will 



10 "Sanitation in the Canal Zone," an address to the graduating class, 1907, of 

 the Cornell University Medical College; Gorgas, J. Am. Med. Ass. (1907), 49, 6. 



