ANNUAL REPORT OF THE BUREAU OF HEALTH.

BUREAU OF HEALTH,

Manila, August 5, 1907.

SIR: Pursuant to instructions issued by the honorable the Secretary of the Interior for the Philippine Islands, I have the honor to submit herewith the following report upon the operations of the Bureau of Health for the period from July 1, 1906, to June 30, 1907, this being a complete report of the health work in the Islands for the year ended June 30, 1907, and the eighth annual report of this division of the Philippine Government.

ALL RECORDS BROKEN.

The effect of the sanitary reforms which have been persistently carried out during the past few years commenced to show in a most concrete and substantial manner during the period covered by this report. The public health has been more satisfactory than at any time since the American occupation of the Philippines, from which it is reasonable to infer that health conditions are better now than at any time for the past one hundred years or more. The death rate per thousand for the city of Manila has been reduced from 40.90 last year to 36.91; the rate for Americans being 5.59, which is a reduction of 3.75 over the previous year, and among Spaniards the rate dropped from 17.40 to 15.84.

There has not been a single case of plague in the Islands and not one death from smallpox in the city of Manila. Cholera in recognizable form has disappeared entirely from the Archipelago. The Provinces of Cavite, Batangas, Cebu, Rizal, La Laguna, Bataan, and La Union, where heretofore there have been approximately 6,000 deaths annually from smallpox, have not reported one death from this disease. In all, there have been over 2,000,000 vaccinations performed, the direct effect of which was that many lives were spared and thousands of persons were saved from being disfigured for life, and at the few places at which smallpox did break out it made no headway.

The solution of the leprosy problem has passed from the theoretical to the practical stage. The number of lepers September 1, 1905, was 3,580; the number June 30, 1907, is 2,826.

Great strides were made in introducing better drinking water, artesian wells being now in actual use in many of the towns of the provinces.

(More detailed information about all these matters will be found under appropriate subheads in the pages which follow.)

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THE NEW CENSUS OF THE CITY OF MANILA.

During the month of January the Bureau of Health took the census of Manila, which showed the population of the city to be 223,542 as against 219,941 given by the official United States census of 1903, which is an increase of 3,601, or 16.37 per thousand. The increase by nationalities is as follows:

There has been a decrease in the Chinese population from 21,230 to 18,028, or 15 per cent; and among those classified as "Other Europeans" there has been a reduction from 1,117 to 977, or 12 per cent.

The decrease in the number of Chinese can probably be accounted for by:

1. The large emigration to the provinces which has taken place among the people of this nationality as peace conditions in the outlying districts have become more and more secure.

2. By the operation of the Chinese Exclusion Law, which prohibits the immigration of this nationality to the Philippines and thus prevents the balancing of the losses caused by the mortality.

3. The few births, owing to the small number of the wives of Chinamen living in Manila.

4. The return of many to China to spend the remainder of their lives. 5. The census being taken at a time when a great many Chinamen were visiting their native country to celebrate the Chinese New Year.

The Acting Secretary of the Interior has approved the use of the figures of the census taken by the Bureau of Health and the same will be used hereafter in compiling all vital statistics.

The census was taken at a time when a considerable portion of the population was absent in the provinces, and no doubt many others remained uncounted owing to the suspicion with which the more ignorant residents view Government officials, they being extremely suspicious that there is some ulterior motive in view, so that the real population is probably much higher than the foregoing figures show.

One fact clearly shown was that the sanitary officials are constantly coming into closer touch with the people, and are no longer always viewed as enemies. The double function that many of the sanitary inspectors now perform, of reporting communicable diseases and insanitary conditions and of providing the indigent with free medicines and having them cared for in charitable institutions, has no doubt had much to do with this more favorable condition of affairs.

CHOLERA.

At the time the last annual report was about to be sent to press, the Bureau was again busily engaged in combating a cholera outbreak which threatened to assume serious proportions. In the city of Manila there occurred during the year 848 cases with 744 deaths, and in the provinces 7,085 cases with 5,243 deaths.

The disease commenced to spread by land both north and south, and it was only through the magnificent fight to eradicate the disease from Tayabas, made by a detail of Bureau of Health officials, that another serious outbreak like that of 1902 was avoided. The cholera spread slowly, from the Province of La Laguna, along the new road which leads from Bay to Lucena by way of Tiaong. The onward march of the disease was stubbornly resisted, and it was only after all effort was concentrated on the narrow neck of land in Tayabas Province which lies between Laguimanoc on the west coast (China Sea) and Atimonan on the east (Pacific Ocean) that its onward march was finally arrested. It is noteworthy that at no time did the disease spread by sea, thus showing conclusively that the marine quarantine measures were entirely effective.

The measures adopted in combating cholera were practically the same as those given in the last annual report: Strict outgoing maritime quarantine; prompt isolation of the sick and disinfection of the premises, and no attempt at quarantine by land.

It is hardly possible to describe the feeling of security which seemed to pervade the public. With the exception of the comparatively small increase in the freight and passenger rates that was imposed upon interisland vessels leaving Manila, no large financial loss resulted. The regular machinery of the Bureau of Health worked so smoothly that it was able to meet all demands with practically no increased outlay above routine expenditures. If it had not been for the reports which were published daily the people would scarcely have known that cholera was in their midst, except in so far as they or their friends were directly affected by the disease. The feeling of security was directly responsible for the preservation of many lives, and on account of there having been practically no disturbance to business, thousands of dollars were saved.

(A detailed report of the cholera for this period will appear later in a medical journal.)

PLAGUE.

Since the method of combating plague has been based upon the theory that its eradication could be accomplished by isolating the sick and destroying plague-infected rats, the efforts of the Bureau have met with complete success. There has not been a case of plague in the Philippine Islands during the period covered by this report except those which were accidentally caused by inoculations in Bilibid on November 16, 1906, while prophylactic inoculations against cholera were being made by a

member of the staff of the Bureau of Science. In all, there were 24 cases due to this latter cause, 14 of which died, giving a case mortality of 58 per cent. The fact that the cases occurred in a crowded institution, with an average of about 3,500 inmates, and that the disease was confined strictly to the inoculated cases, is further convincing evidence of what may be accomplished by modern sanitary science.

Manila, and in fact the entire Philippine Islands, present a plague record which stands in favorable contrast with that of the rest of the Orient. In India, about one person out of every 300, or over 1,000,000 persons annually, are dying of plague. In Hongkong, Amoy, Singapore, Saigon, and other Oriental cities having commercial intercourse with Manila, many cases are being constantly reported. Dr. Atkinson, the honorable principal civil medical officer of Hongkong, in an address before the Philippine Islands Medical Association at its last session, held in Manila February 27, 28, March 1 and 2, 1907, said:

It is an almost hopeless task to expect to stamp out plague entirely in Hongkong, seeing how liable we are from our geographical position to reinfection from the neighboring countries. Many insanitary areas and buildings have been allowed to be erected, and it is only by their erection on improved plans and by rigid prevention of overcrowding that plague or any other infectious disease can be stamped out of Hongkong.

The Philippines have been more fortunate, but of course are subject to reinfection on account of their geographical position and extensive and increasing commerce. A continued immunity from the disease can be had only through the greatest precautions being taken with vessels from plague-infected ports, and by placing the ports of entry in such good sanitary condition that even if the disease should be imported its eradication could be accomplished easily. This means, so far as Manila is concerned at least, that the work of improving insanitary areas, and removing or repairing insanitary structures, which was begun several years ago, must be pushed steadily until the last place of that kind has been eliminated.

BERIBERI.

The mortality from beriberi in Manila at large was about the same as for last year, there being 403 deaths reported from this cause as against 378 for the previous year. One death occurred among every 391 Chinese and one death among every 540 Filipinos. No deaths took place among Americans or Europeans.

In public institutions there has been a most marked reduction in the deaths from this disease. At Bilibid, for instance, the number dropped from 21 for last year to 9 for this year. Less and less difficulty is being experienced in preventing the spread of beriberi in jails and other places where the inmates are under the direct control of the Bureau. Practically the only cases with which it was necessary to deal were in those persons who were afflicted with the disease upon admission.

Upon the appearance of beriberi, the nitrogenous constituent of the ration is immediately increased by adding more meat and mongoes, and the amount of rice correspondingly reduced. In view of the remarkable results recently achieved by Fletcher at the Kuala Lumpur Lunatic Asylum, Straits Settlements, in using a rice which was boiled before being husked, no cases of beriberi occurring among 123 inmates in the same institution who were kept on this diet, while 43 cases with 18 deaths occurred among a similar number who ate rice which was unboiled before being husked. It may, perhaps, be that the success which has been had in the Philippines in the management of this disease has been largely due to the withdrawal of a portion of the rice.

The impression has also been gained during the past year that beriberi is very much less common among persons who eat only Philippine rice which is not husked until shortly before using, owing to the mold which soon renders it unfit for consumption, than among persons who use imported Chinese or Indian rice, which has often been husked for a year or more before being used. However, no systematic observations have been made upon this point and investigation may prove it to be fallacious. At any rate the fact that no Europeans or Americans whose diet is richly nitrogenous, as compared with the native Oriental, succumbed, certainly indicates that the question of diet as a cause of beriberi deserves further observation and study.

TUBERCULOSIS.

A large part of each annual report of the Bureau of Health, since American occupation, has been devoted to the discussion of cholera, plague, and smallpox, and when the term "dangerous communicable diseases" has been mentioned it was usually in connection with these maladies. Nearly every general appropriation bill that has been passed has provided funds for combating these diseases. Dangerous and formidable as they are, they are insignificant when compared to the great white plague-tuberculosis-which is the most universal scourge of the human race; about one-seventh of all of the deaths of the world being caused directly by it. During the past year in Manila one-sixth of the total deaths were actually due to this cause. This does not represent the total number of cases, as many persons who have tuberculosis die with intercurrent diseases. Tuberculosis claims more victims, produces more misery, is destructive of more happiness, creates more poverty, and interferes with the public weal to a greater extent than any other disease ever known to man. These facts are appalling, when it is remembered that the disease is preventable, though with greater difficulty than cholera, plague, or smallpox. The disease is largely propagated by unnatural conditions created by the victim or his friends. Environment is an important predisposing factor in the spread of tuberculosis, as proved by the susceptibility of those who live in dark, damp, and poorly ventilated habitations; such persons not only manifest a greater liability