During the first ten months in 1898 the total number of deaths in Cienfuegos was 3626, out of a population which before the war was 21,500; adding soldiers and _reconcentrados_, it might be said to be 25,000, and at these figures a monthly death-rate of 362 is something fearful to contemplate. Estimating the deaths for a year at 4144, we have a rate of 166 per 1000. In the ten years ending December 31, 1889, reported by Dr. Luis Perna, over fifty per cent. of the deaths were from infectious and contagious diseases due almost entirely to bad or no sanitation. During the same year the births exceeded the deaths by 1982, a much better showing than in Havana, the difference there being 12,433 against the population in four years, and in Matanzas, 2397 lost in eight years. Of the effect of proper sanitary regulations and personal attention on tuberculosis, Dr. Perna says: "There can be no doubt that the ravages of tuberculosis could be materially arrested by compliance with the laws of hygiene. Infractions of civil law may or may not be punished, but infractions of the laws of hygiene are inevitably paid for sooner or later. In combating tuberculosis we must consider the air we breathe, the food we eat, the roof that covers us, and the clothes we wear. The disease should be recognised as contagious. Phthisical patients should be kept in well-ventilated apartments; sputa should be disinfected, and clothing and utensils used by such patients should be disinfected."