But the work of the constabulary has not been confined to police duty. They have been of the greatest assistance to the Director of Health in effectively maintaining quarantine, and making possible the isolation of victims of dangerous communicable diseases like cholera and smallpox, when inefficient municipal policemen have utterly failed to do their duty. They have given similar assistance to the Director of Agriculture in the maintenance of quarantine in connection with efforts to combat diseases of domestic animals. In great emergencies such as those presented by the recent eruption of Taal volcano, and the devastation caused by great typhoons, they have been quick to respond to the call of duty and have rendered efficient and heroic service. They assist internal revenue officers. Except in a few of the largest cities they are the firemen of the islands and by their effective work have repeatedly checked conflagrations, which are of frequent occurrence and tend to be very destructive in this country, where most of the houses are built of bamboo and nipa palm, and where roofs become dry as tinder during the long period when there is little or no rain. They have aided in combating pests of locusts, and, in short, have been ready to meet almost any kind of an emergency which has arisen.

The importance of having such a body of alert, industrious, disciplined, efficient men inspired by a high sense of duty, and physically so well developed that they can continue to perform that duty in the face of long-continued privations and hardships, is beyond dispute. The results which have been obtained by the Philippine constabulary have abundantly justified the policy which led to its organization.

Its task has been no sinecure. Eleven officers and one hundred ninety-seven enlisted men have been killed in action. Forty-eight officers and nine hundred ninety-one men have died of disease. Forty-six officers have been wounded in action. Seven hundred sixty-eight men have been discharged for disability. Seven thousand four hundred twenty-four firearms and 45,018 rounds of ammunition have been captured by, or surrendered to, the constabulary. Four thousand eight hundred sixty-two outlaws have been killed and 11,977 taken prisoners. Twelve thousand two hundred sixty-two stolen animals have been recovered.

There are many things which are not brought home to the reader by such statistics. The weary days and nights on tropical trails; the weakness and pain of dysentery; the freezing and the burning of pernicious malaria; the heavy weight of responsibility when one must act, in matters of life and death, with no superior to consult; the disappointment when carefully laid plans go wrong; the discouragement caused by indifference; the danger of infection with loathsome diseases; ingratitude; deadly peril; aching wounds; sudden death, and, worse yet, death after suffering long drawn out, when one meets one's end knowing that it is coming and that one's family will be left without means or resources,—these are some of the things that the officers and men of this gallant corps have faced unflinchingly.

The work of the constabulary and of the Philippine scouts has conclusively demonstrated the courage and efficiency of the Filipino as a soldier when well disciplined and well led.

The establishment and maintenance of order in the Philippines have afforded opportunity for some of the bravest deeds in the annals of any race, and the opportunity has been nobly met. The head-hunters of the Mountain Province, the Mohammedan Moros of Mindanao, Jolo and Palawan, the bloody pulajanes of Samar and Leyte, the wily tulisanes of Luzon, all unrestrained by any regard for the rules of civilized warfare, have for twelve years matched their fanatical bravery against the gallantry of the khaki-clad Filipino soldiers. Time and again a single officer and a handful of men have taken chances that in almost any other land would have won them the Victoria cross, the legion of honor, or some similar decoration. Here their only reward has been the sense of duty well done.

The force known as the Philippine constabulary was organized for the purpose of establishing and maintaining order. It has established and is maintaining a condition of order never before equalled or approached in the history of the islands. The policy which led to its organization has been a thousand times justified.



CHAPTER XV

The Administration of Justice

In no branch of the public administration have there been more numerous or more beneficial reforms than in the administration of justice. They have resulted in simplifying organization, in decreasing the possibility of corruption and partiality, and in diminishing the cost of litigation and the time which it requires.

For the benefit of those especially interested I give in the appendix the past and present organization of the courts. [495] The subject is too technical to interest the average layman.

The slender salaries paid to judges, the fact that in the majority of cases their appointment and promotion were due to influence and suggestion, their liability to be transferred from one court to another or from the Philippines to the Antilles, as frequently happened, and the further fact that the subordinate personnel of the courts was not a salaried one, caused the administration of justice in the Philippine Islands to be looked upon askance. There was a general belief, well founded in many instances, that lawsuits were won through influence or bribery. Clerks and the subordinate personnel of the courts were readily bribed. Indeed, they frequently demanded bribes from litigants, or from defendants in criminal cases, under promise to expedite the trials if paid to do so, or under threat to commit some injustice if payment was not forthcoming. For many years after the American occupation justices of the peace received no salaries and had to look to fees for their compensation. This system worked wretchedly. The positions were only too often filled by very incompetent and unworthy men, who stimulated litigation in order to make more money. Now all justices of the peace receive reasonable salaries.

The paying of regular salaries and the furnishing of necessary offices and supplies have done much to improve the work of justice of the peace courts, which are now presided over by men who average far better than even their immediate predecessors.

Until they were put on a salary basis the work of the Filipino justices of the peace left much more to be desired than is lacking at present. In many instances they allowed gross brutalities, perpetrated by the rich on the poor, or by the strong on the weak, to go unpunished. The following case furnished me by an American teacher is typical of what has occurred only too often:—

"On another occasion, I met the brother of my house muchacha, [496] a boy about eight. He had a sort of protuberance on one side caused by broken ribs which had not been set. I questioned my muchacha. She said her step-father had kicked the child across the room some weeks before and broken his ribs. The next day, I took the child together with Senora Bayot, the wife of the Governor's secretary, before the local Justice of the Peace. Senora Bayot translated and the child told the same story as had his sister. The Justice of the Peace issued an order for the step-father to report to him on the next day. That night my muchacha told me that her step-father had threatened to kill the child if he did not tell the Justice that he got the hurt by falling out of an orange tree. The child did as ordered, and the step-father was dismissed. When I questioned the Justice of the Peace as to why he credited the second tale, he said the child was under oath then, and was not under oath in the first statements."

It was not deemed wise at the outset to appoint a Filipino judge for the city of Manila, as it was feared that there would be a lack of confidence in a Filipino who had occasion to decide cases involving large sums of money in which Americans or foreigners on the one hand and Filipinos on the other were interested; but a few years after the establishment of the new judicial system Filipino judges had won such a reputation for justice and fairness as to gain the confidence of Americans and foreigners and the appointment of a Filipino judge for the court of the city of Manila did not arouse any opposition.

Filipino judges of courts of first instance seem usually to have been actuated by a desire to do full justice. The instances in which complaints have been made against them because of partiality to party or to race are few. Some of them have been justly criticised for tardiness in cleaning up their dockets, and it is undoubtedly true that their capacity for turning out work is on the average below that of their Americans associates.

The fact must not be forgotten that Americans are in the majority in the Supreme Court, which reviews the decisions of courts of first instance, and this undoubtedly exercises a restraining influence. It is not possible accurately to judge what would be the actions of a body of men now subject to such control if it did not exist. It is furthermore true that the Filipinos are more inclined to be suspicious of their own countrymen than of Americans, and there have been from time to time specific requests from them that judges in certain provinces be Americans.

Under the Spanish regime the fees paid by litigants were excessive and the use of stamped paper was compulsory. Its value ranged from twenty-five centavos to two pesos for a folio of two sheets according to the amount involved in the suit. Now there are fixed fees of $8 in civil suits, except in probate matters, where the fee is $12.

It was in the power of an unscrupulous litigant to make a lawsuit almost eternal. In matters involving an amount exceeding $250 it was lawful to institute proceedings in the action whereby the decision of the main issue was suspended pending decision of the proceedings, and as a decision was appealable to the audiencia, this was often done by attorneys who had an interest in delaying the suit. By instituting one proceeding after another a suit could be indefinitely prolonged.

Another method of securing delay was to object to the judge. In case the judge denied the ground of the objection, a proceeding was instituted against him and the trial of the main issue was turned over to another judge; although the proceeding arising out of the objection did not suspend the trial of the main issue, when the time came to decide the latter the decision was withheld until the proceeding arising out of the objection was settled, and as this latter was one in connection with which other proceedings could be instituted which might delay the decision and consequently the decision of the main issue, there was no end to the matter.

To-day all this has been stopped by the procedure in court. The challenging of judges is not allowed, although they must refrain from the trial of any matter when they are disqualified in any way as regards it. Proceedings which suspend the trial of the main issue cannot be instituted. The procedure itself is more expeditious, the time allowances and formalities have been reduced, and all the long Spanish civil procedure regarding the presentation of evidence has been shortened. Suits are settled with a speediness previously unknown. In order to avoid delay on the part of judges in rendering decisions, an act has been passed prohibiting the payment of their salaries without a certificate that they have no matter which has been awaiting decision for more than three months.

Owing to the inquisitorial procedure which obtained under Spanish rule, the disposition of criminal cases was even slower than that of civil cases. The cause would be commenced, either de officio, by the judge who had a knowledge of the crime, or by the prosecuting attorney, or by virtue of private accusation on the part of the person aggrieved. The case once started, the investigations made during the period known as the sumario were conducted in the absence of the accused. The latter had no hand in the case, as it was thought that the reserve and secrecy of the procedure ought not to be violated to the end that the accused might not frustrate the evidence of the prosecution by preparing his defence. Owing many times to the inactivity of the judge or of the prosecuting attorney, to the great amount of work which weighed down the courts—for actions were begun when there was knowledge of the commission of the crime, although the perpetrators were not known—and by the manipulations at other times of the private accuser to whose interest it was to harm the accused by delaying the sumario, this period was often made to extend over years and years. Meanwhile the defendant was confined in prison, as no bail was allowed in any case in which the penalty was that of presidio correccional (from six months and one day to six years' imprisonment) or greater. In addition to this the circumstance that all criminal causes in the islands had to be sent for review to the proper audiencia, caused a large accumulation of old cases in these higher courts, and this alone made their disposition a matter of some years.

To-day the procedure is rapid. Information having been brought against the defendant, the trial is had in the same term or at most during the next term of court. Sometimes the trial is suspended owing to the non-appearance of witnesses, but it can be said that cases are rare where causes are pending in the docket of the court for a longer period than two terms. Causes appealed to the Supreme Court are disposed of promptly, and as a general rule it does not take over six months to get a decision.

Defendants in criminal cases have now been granted by the Philippine Bill certain fundamentally important rights which they did not formerly enjoy; namely, to appear and defend in person or by counsel at every stage of the proceedings; to be informed of the nature and cause of the accusation; to testify as witnesses in their own behalf; to be exempt from testifying against themselves; to be confronted at the trial by, and to cross-examine, the witnesses against them; to have compulsory process issue for obtaining witnesses in their own favour; to have speedy and public trials; to be admitted to bail with sufficient sureties in all cases, except for capital offences. None of these rights were enjoyed under the procedure in effect during the Spanish regime. A man was prosecuted without being notified of the charges against him, and he was only made aware of the case against him after the sumario. When all of the evidence of the prosecution had been taken the accused was heard in his own defence. He was compelled to testify, and was subjected to a very inquisitorial examination, including questions which incriminated him. Although he had the right to compel witnesses for the prosecution to ratify over their signatures the evidence against him given during the sumario, as the defence of the majority of the accused was in the hands of attorneys de officio they nearly always renounced this privilege of the defendant, and, as has already been said, bail was not admitted in any grave offence during the trial.

No sentence of acquittal in a criminal case can now be appealed from by the government. Under the Spanish system sentences of acquittal of courts of first instance had to be referred for review to the proper audiencia and the fiscal of the latter could appeal from a sentence of acquittal by it.

The Philippine Bill grants to the inhabitants of the islands other important individual rights which they did not formerly possess.

The Spanish constitution was not in force here, and although the Penal Code contained provisions for punishing, in a way, officials who violated certain rights granted by the Spanish constitution, citizens had no expeditious method of securing their punishment. Now the Code of Civil Procedure grants them certain special remedies by which their rights can be made good. To illustrate: Under the Spanish regime the only remedy for a man illegally detained was to bring a criminal action against the person illegally detaining him. He did not have the remedy of the writ of habeas corpus nor the writ of prohibition against an official who attempted to make him the victim of some unlawful act. His only remedy was to bring a criminal action against such official, or to sue him for damages. He could not compel public officials to perform their ministerial duties by mandamus proceedings.

The individual rights conferred by the Philippine Bill, and the special remedies granted by the Code of Civil Procedure, assure to the inhabitants of the islands liberties and privileges entirely unknown to them during the days of Spanish sovereignty, and these liberties and privileges are adequately safeguarded.

Two things still greatly complicate the administration of justice in the Philippines.

The first is the dense ignorance of the people of the working class who for the most part have failed to learn of their new rights, and even if they know them are afraid to attempt to assert them in opposition to the will of the caciques, whose power for evil they know only too well.

The other is the unreliability of many witnesses and their shocking readiness to perjure themselves. It is always possible to manufacture testimony at small expense. While the criminal libel suit brought against certain members of the staff of the newspaper El Renacimiento, which libelled me, was in progress the judge showed me the opinion of the two Filipino assessors [497] in one of the cases and told me that it was written by an attorney for the defence. I could not believe this, but a few days later an assessor in another of the cases called at my house, bringing a draft of the opinion of himself and his associate which he sought to submit to me for criticism or modification, saying that I knew much more about the case than they did! He was nonplussed at my refusal to read the document, and left saying "acqui tiene V. nuevo servidor." [498] Had I redrafted the opinion, as I might have done, my "new servant" would have called later for a quid pro quo.

Some of the Filipino judges of first instance have proved weak in matters affecting the integrity of public domain and the protection of the public forests, but on the whole these officers have done rather surprisingly well. It must be remembered that the best men in the islands have now been appointed, and that another generation must come on before there will be available any considerable number of new candidates who are up to the standard of the present appointees.



CHAPTER XVI

Health Conditions

I had abundant opportunity to observe health conditions in the Philippines during the Spanish regime and they were shocking in the extreme. There were no provisions for the sanitary disposal of human waste even in Manila. If one had occasion to be out on foot at night, it was wise to keep in the middle of the street and still wiser to carry a raised umbrella.

Immediately after the American occupation some five hundred barrels of caked excrement were taken from a single tower in one of the old Manila monasteries. The moat around the city wall, and the esteros, or tidal creeks, reeked with filth, and the smells which assailed one's nostrils, especially, at night, were disgusting.

Distilled water was not to be had for drinking purposes. The city water supply came from the Mariquina River, and some fifteen thousand Filipinos lived on or near the banks of that stream above the intake. The water was often so thick with sediment that one could not see through a glass of it, and it was out of the question to attempt to get it boiled unless one had facilities of one's own.

Conditions in the provinces were proportionately worse. As a rule, there was no evidence of any effort to put provincial towns into decent sanitary conditions. I must, however, note one striking exception. Brigadier General Juan Arolas, long the governor of Jolo, had a thorough knowledge of modern sanitary methods and a keen appreciation of the benefits derivable from their application. When he was sent to Jolo, practically in banishment, the town was a plague spot to which were assigned Spaniards whose early demise would have been looked upon with favour by those in power. He converted it into a healthy place the death rate of which compared favourably with that of European cities, thereby demonstrating conclusively what could be done even under very unfavourable conditions. No troops in the islands were kept in anything like such physical condition as were the regiments assigned to him, and he bore a lasting grudge against any one inconsiderate enough to die in Jolo.

Everywhere I saw people dying of curable ailments. Malaria was prevalent in many regions in which it was impossible to secure good quinine. The stuff on sale usually consisted largely of cornstarch, or plaster of Paris. Fortunately we had brought with us from the United States a great quantity of quinine and we made friends with the Filipinos in many a town by giving this drug gratis to their sick.

Smallpox was generally regarded as a necessary ailment of childhood. It was a common thing to see children covered with the eruption of this disease watching, or joining in, the play of groups of healthy little ones.

The clothing of people who had died of smallpox was handed on to other members of the family, sometimes without even being washed. The victims of the disease often immersed themselves in cold water when their fever was high, and paid the penalty for their ignorance with their lives.

The average Spaniard was a firm believer in the noxiousness of night air, which he said produced paludismo. [499] Most Filipinos were afraid of an imaginary spirit, devil or mythical creature known as asuang, and closed their windows and doors after dark as a protection against it. Thus it came about that in a country where fresh air is especially necessary at night no one got it.

Tuberculosis was dreadfully common, and its victims were conveying it to others without let or hindrance.

A distressingly large percentage of native-born infants died before reaching one year of age on account of infection at birth, insufficient clothing, or improper food. I have many times seen a native mother thrust boiled rice into the mouth of a child only a few days old, and I have seen babies taught to smoke tobacco before they could walk.

Before our party left the islands in 1888, cholera had broken out at a remote and isolated place. A little later it spead over a considerable part of the archipelago. On my return in 1890 I heard the most shocking stories of what had occurred. Victims of this disease were regarded with such fear and horror by their friends that they were not infrequently carried out while in a state of coma, and buried alive. It became necessary to issue orders to have shelters prepared in cemeteries under which bodies were required to be deposited and left for a certain number of hours before burial, in order to prevent this result.

In Siquijor an unfortunate, carried to the cemetery after he had lost consciousness, came to himself, crawled out from under a mass of corpses which had been piled on top of him, got up and walked home. When he entered his house, his assembled friends and relatives vacated it through the windows, believing him to be his own ghost. They did not return until morning, when they found him dead on the floor.

I heard a well-authenticated story of a case in which all the members of a family died except a creeping infant who subsisted for some time by sucking a breeding sow which was being kept in the kitchen.

During the great cholera epidemic in 1882 it is said that the approaches to the Manila cemeteries were blocked with vehicles of every description loaded with corpses, and that the stench from unburied bodies in the San Lazaro district was so dreadful that one could hardly go through it.

Beri-beri was common among the occupants of jails, lighthouses and other government institutions, as well as in certain garrisoned towns like Balabac.

In 1892 I found the wife of a very dear Spanish friend dying from an ailment which in the United States could have been promptly and certainly remedied by a surgical operation. I begged him to take her to Manila, telling him of the ease with which any fairly good surgeon would relieve her, and promising to interest myself in her case on my arrival there. To my utter amazement I found that there was not a surgeon in the Philippine Islands who would venture to open the human abdomen. The one man who had sometimes done this in Spain stated that it would be impossible for him to undertake it in Manila, on account of the lack of a suitable operating room, of instruments and of the necessary anaesthetist and other professional assistants. In fact, at the time of the American occupation there was not a modern operating room, much less a modern hospital, in the Philippines. Thousands upon thousands of people were perishing needlessly every year for the lack of surgical intervention. A common procedure in dealing with wounds was to cover them with poultices of chewed tobacco, ashes, and leaves.

In many provinces the people were without medical assistance of any sort, and fell into the hands of native quacks who were little, if at all, better than witch doctors.

The most fantastic views were entertained relative to the causation of disease. In some towns it was vigorously asserted that after a peculiar looking black dog ran down the street cholera appeared. In other places cholera was generally ascribed to the poisoning of wells by Spaniards or foreigners.

Cemeteries were not infrequently situated in the very midst of towns, or near the local supplies of drinking water. Conditions within their walls were often shocking from an aesthetic view point. As the area available for burials was limited, and the graves were usually unmarked, parts of decomposed bodies were constantly being dug up. It was the custom to throw such remains about the foot of the cross at the centre of the cemetery.

Military sanitation was also very bad. I was at Zamboanga when the wreck of General Weyler's expedition to Lake Lanoa began to return. There had been no adequate provision for the medical care of the force in the field, and the condition of many of the soldiers was pitiable in the extreme. Disabled men were brought in by the shipload, and the hospitals at Zamboanga, Isabela de Basilan and Jolo were soon filled to overflowing.

The lack of adequate sanitary measures was equally in evidence in dealing with cattle disease. Rinderpest, a highly contagious and very destructive disease of horned cattle, was introduced in 1888 and spread like fire in prairie grass. No real effort was made to check it prior to the American occupation, and it caused enormous losses, both directly by killing large numbers of beef cattle and indirectly by depriving farmers of draft animals.

When I first visited the islands every member of our party fell ill within a few weeks. All of us suffered intensely from tropical ulcers. Two had malaria; one had dysentery; one, acute inflammation of the liver, possibly of amoebic origin; and so on to the end of the chapter. I myself got so loaded up with malaria in Mindoro that it took me fifteen years to get rid of it.

Fortunately the American army of occupation brought with it numerous competent physicians and surgeons, and abundant hospital equipment and supplies, for the soldiers promptly contracted about all the different ailments to be acquired in the islands.

When I arrived in Manila on the 5th of March, 1899, I found that a great army hospital, called the "First Reserve," had been established in the old rice market. There was another sizable one on the Bagumbayan drive. A third occupied a large building belonging to French sisters of charity which was ordinarily used for school purposes.

In immediate connection with the First Reserve Hospital was a tent hospital where sick and wounded Insurgents were being given the best of care.

Field hospitals were promptly established as the troops moved out from Manila, and in connection with many of these Filipinos were given much needed medical and surgical help. The recipients of such kindly treatment were, however, prohibited by Insurgent officers from telling others of their experiences lest the hatred of Americans diminish as a result.

Smallpox had broken out among the Spanish soldiers in the walled city and was spreading badly when my friend, Major Frank S. Bourns of the army medical corps, was given the task of eradicating it, which he promptly accomplished. A little later the use of the Santa Ana church as a smallpox hospital was authorized, and sick Filipinos were carefully tended there.

The army promptly set about cleaning up Manila and waging war upon the more serious ailments which threatened the health of the soldiers and that of the public. The work was at the outset put under the direction of Major Edie, a very capable and efficient medical officer. Subsequently it was turned over to Major Bourns, who, on account of his intimate knowledge of Spanish, and his wide acquaintance with the Filipinos, was able to carry out many much-needed reforms, and in doing so aroused a minimum of public antagonism.

Upon the establishment of civil government Governor Taft was very desirous of retaining Major Bourns's services, but this did not prove practicable, as he desired to give up government work and engage in private business.

There was promptly created an efficient board of health made up of men of recognized ability and large practical experience. Its chairman was Major Louis M. Maus, commissioner of public health. The other members were Mr. H. D. Osgood, sanitary engineer; Dr. Franklin H. Meacham, chief sanitary inspector; Dr. Paul C. Freer, superintendent of government laboratories; and Dr. Manuel Gomez, secretary.

This board was promptly put upon its mettle. It had inherited from the army an incipient epidemic of bubonic plague in Manila, and the disease soon spread to Cavite and also to Cebu, then the second port of the Philippines in commercial importance. It also appeared in several provincial towns near Cavite. An effective campaign against it, inaugurated at this time, was never abandoned until it was completely eradicated in 1906,—a noteworthy result to achieve in a country like the Philippines.

On March 21, 1902, I was advised that two patients at San Juan de Dios hospital were developing symptoms of Asiatic cholera, and on the following day a positive laboratory diagnosis was made. Other cases followed in quick succession, and we soon found ourselves facing a virulent epidemic of this highly dangerous disease. At the outset the mortality was practically 100 per cent. Unfortunately, there was no one connected with the medical service of the islands who had had practical experience in dealing with cholera, and we had to get this as we went along.

At the time of the outbreak, Governor Taft was in the United States, Acting Governor Wright was in Leyte, the secretary of finance and justice was in Japan, and there were present in Manila only the secretary of public instruction and the secretary of the interior. As the executive head of the government was absent, and there was no quorum of the legislative body, I of necessity arrogated to myself powers which I did not lawfully possess, appointing employees and incurring expenses without the usual formalities.

On the morning of March 22 I informed General Chaffee that four cases of cholera had occurred in Manila, and requested that an adequate military force be despatched to the valley of the Mariquina River to protect the city water supply from possible contamination.

This request was promptly acceded to, and the guard thereafter maintained proved adequate to prevent infection of the city water, although there are three towns on the river above the intake, and it was the custom of their people to bathe and wash their clothing in this stream. Many of the filthy surface wells of the city were filled as rapidly as possible, and those that could not be filled were closed.

The people, entirely unaccustomed as they were to any sanitary restrictions, believing that the disease was not cholera, and firm in their conviction that they had a right to do whatever they liked so long as they kept on their own premises, bitterly resented the burning or disinfection of their houses and effects, and the restriction of their liberty to go and come as they pleased, and in spite of the fact that the number of cases was kept down in a manner never before dreamed of at Manila, there arose an increasingly bitter feeling of hostility toward the work of the board of health. In fact, the very success of the campaign proved an obstacle, and we were assured that the disease could not be cholera, as, if it were, there would be a thousand deaths a day!

An educational campaign was immediately begun, and simple directions for avoiding infection were published and scattered broadcast. Distilled water was furnished gratis to all who would drink it, stations for its distribution being established through the city and supplemented by large water wagons driven through the streets. The sale of foods likely to convey the disease was prohibited. Large numbers of emergency sanitary inspectors were immediately appointed, and every effort was made to detect all cases as soon as possible. A land quarantine was established around the city, to protect the provinces.

In anticipation of a possible extensive outbreak of contagious disease a detention camp capable of accommodating some twenty-five hundred people had been established previously on the San Lazaro grounds, and to this place were taken the cholera "contacts." A cholera hospital was opened near this camp, and the stricken were removed to it from their homes as speedily as possible, the buildings which they had occupied being thoroughly disinfected, or burned if disinfection was impracticable.

The bodies of the dead were at the outset either buried in hermetically sealed coffins or cremated. When the detention camp and hospital at San Lazaro threatened to become crowded, a second camp and hospital were established at Santa Mesa. At this latter place both "contacts" and the sick were obliged to live in tents.

The Spanish residents were allowed to establish a private cholera hospital in a large and well-ventilated convento on Calle Herran. As the number of sick Spaniards was nothing like sufficient to fill this building, they were asked to turn over the unoccupied space in it to the board of health, which they most generously did.

In response to popular clamour a hospital under strictly Filipino management was opened in a nipa building in Tondo. Interest in it soon flagged, and the government found itself with this institution on its hands.

The epidemic came soon after the close of a long-continued war, and there were at that time in Manila not a few evil-intentioned persons, both foreign and native, who welcomed every opportunity to make trouble. The difficulties arising from the claim advanced by a number of reputable but ignorant medical men that the disease was not cholera at all were sufficiently great. They were enormously increased by false and malicious stories to the effect that "contacts" were killed at the detention camp; that patients on arrival at the cholera hospital were given a drink of poisoned vino [500] and instantly dropped dead; that the distilled water distributed free of charge was poisoned, and that the Americans were poisoning the wells.

The necessary use of strychnine as a heart stimulant at the cholera hospital was made the basis for a story that the sick were being poisoned with this drug.

These silly tales were widely circulated and quite generally believed, and as a result of the fear thus engendered, and of the desire on the part of relatives and neighbours of stricken persons to escape disinfection and quarantine, strong efforts were often made to conceal the sick and the dead, and when this was not possible the "contacts" usually ran away. There were not wanting instances of the driving of cholera victims into the streets.

In spite of the generally hostile attitude of the public and some grave mistakes in policy, the measures adopted sufficed at the outset to hold the disease in check to an extent which surprised even the health officers themselves.

On May 15 there began a rapid and quite steady decline in the number of cases.

In June, however, it increased. During July it grew steadily larger, and on the 25th of that month there were ninety-one cases, the largest number which has ever occurred in Manila on any day since the American occupation.

Throughout the early months of the epidemic Major Maus had laboured unceasingly to check it, displaying an energy and an indifference to fatigue and personal discomfort which were highly commendable. The long-continued strain ultimately began to tell on him severely. On May 17 orders were received from the Adjutant-General's Office providing for his relief on or about July 30, and stating that Major E. C. Carter, of the United States Army Medical Corps, would be available for detail as commissioner of public health on that date, if his services were desired. Arrangements were accordingly made to have Major Carter proceed to the Philippines. Major Maus's resignation was accepted, effective July 31. Dr. Frank S. Bourns was urged to take temporary charge of the situation, and consented to do so.

On the 8th of August Major Carter arrived and announced his readiness to assume his duties, but it was suggested to him that he ought first to have some time to familiarize himself with them, and Dr. Bourns was left free to carry out the special work for which he had been appointed.

This he did with promptness and despatch, the number of cases for August being but seven hundred twenty as against thirteen hundred sixty-eight for the previous month. On the 8th of September, having brought the disease under control at Manila, he insisted on resigning in order to attend to his private affairs, which were suffering from neglect, and his resignation was reluctantly accepted.

Dr. Bourns's remarkable success in dealing with a very difficult situation was largely due to his ability to devise measures which, while thoroughly effective, were less irritating to the public than were those which had been previously employed.

The policy which he had inaugurated was followed by his successor with the result that the cases fell to two hundred seventy-five in September and eighty-eight in October. In November there was a slight recrudescence, but the disease did not again threaten to escape control and in February practically disappeared, there being but two cases during the entire month.

The return of hot, damp weather again produced a slight recrudescence, and scattering cases continued to occur until March, when the epidemic of 1902-1904 ended in Manila.

In view of the conditions which then prevailed and of the extreme risk of a general infection of the city water supply, which, had it occurred, would doubtless have resulted in the death of a third of the population, this is a record of which the Bureau of Health may well be proud.

The effort to prevent the spread of infection by maintaining a land quarantine around Manila proved entirely ineffective. The disease promptly appeared in the provinces where the campaign against it was from the outset in charge of newly appointed Filipino presidents of provincial boards of health, aided, when practicable, by medical inspectors from Manila.

Before it was finally checked in Manila there were 5581 cases with 4386 deaths; while in the provinces, in many of which it necessarily long ran its course practically unhindered, there were 160,671 cases, with 105,075 deaths.

On the 27th of April, 1904, the Board of Health passed the following resolutions:—

"Whereas cases of Asiatic cholera have occurred in but three provincial towns of the Philippine Islands since February 8, 1904; and

"Whereas only one case of Asiatic cholera has been reported as occurring any place in the Philippine Islands since March 8, 1904; and

"Whereas the city of Manila was declared on March 23 to be free from the infection of Asiatic cholera; On motion

"Resolved, That the islands composing the Philippine Archipelago are, and are hereby declared to be, free from the infection of Asiatic cholera; and

"Be it further resolved, That the Commissioner of Public Health be directed to send a copy of these resolutions to the honourable the Secretary of the Interior, the Municipal Board, the United States Marine-Hospital Service, and the Collector of Customs."

As a matter of fact, however, it later proved that cholera was endemic in certain swampy regions near Manila, and in 1905 we found ourselves with a new epidemic on our hands.

At the end of the second week, beginning August 23, there had been one hundred thirty-seven cases, as compared with one hundred twenty-five for the same period during the epidemic of 1902-1904.

However, the conditions for combating cholera were now far more favourable than in 1902. Major E. C. Carter had at his own request been relieved from duty as commissioner of public health, and Dr. Victor G. Heiser, passed assistant surgeon of the United States public health and marine hospital service, had been appointed to succeed him on April 5, 1905. Dr. Heiser was a highly trained officer of one of the most efficient services which has ever been organized for the combating of contagious and infectious diseases.

He had under him in the city of Manila a small but thoroughly trained body of twenty-four medical inspectors, of whom nineteen were Americans and five Filipinos. Profiting by his previous experience and that of his predecessors in the Philippine service, he inaugurated a campaign which practically terminated the epidemic in Manila on February 21, 1906, [501] with a total of two hundred eighty-three cases and two hundred forty-three deaths.

This brief and decisive campaign reflects the greatest credit on all concerned with it.

The board of health had one great advantage in the fact that the San Lazaro contagious disease hospital had been completed. This building, with its cool wards and attractive surroundings, made it possible to give cholera victims the best of care.

There was at the outset little or no fear of this hospital, but apparently this condition of things was not satisfactory to that small but dangerous element of the Manila public which from the time of the American occupation has never let pass any opportunity to make trouble. As usual, the medium of attack was the local press. Soberania Nacional published a most extraordinary article painting in vivid colours the alleged horrors of the San Lazaro Hospital, and stating among other things that the naked bodies of the dead, tagged and with their feet tied together, lay about the entrance of that institution. A more false statement was never published.

Within twenty-four hours after its appearance terror reigned among the lower classes, and living and dead cholera victims were being smuggled out of the city to neighbouring towns.

Feeling that the vicious attitude of a certain section of the press had cost lives enough, I sent the editor of this paper a courteous invitation to call at my office. He made no response. I then wrote him, demanding a retraction, and sending him a correct statement to publish. [502]

He was at first disposed to argue the matter, but finding that I meant business published the article which I sent to him and made the following retraction:—

"We are exceedingly glad to affirm in the honour of truth and justice, that the news given by us on the seventh instant under the title 'Painful Scenes,' and 'Naked Dead,' is absolutely absurd, false and unreasonable.

"We have investigated the truth of the said notice, and can affirm to our readers that it is entirely inaccurate, as in the courtyard of the said hospital the naked dead that we have spoken of are not now exposed, nor have they ever been so exposed.

"The truth is above all things, and to rectify a baseless piece of news should not be a doubtful action on the part of the person who gave the news, but rather something in his favour that the public should appreciate it at its full value.

"To conclude, we must record our gratitude to the Secretary of the Interior, the Hon. Dean C. Worcester, for the investigations made in the premises with the purpose of ascertaining the truth of the alleged facts, and for the courteous way in which he received us this morning when interviewed by one of our reporters."

In the provinces the results of the campaign against cholera were far less satisfactory than in Manila as was to be anticipated, owing to lack of adequate personnel, but the cases, which numbered 34,238 and deaths which numbered 22,938, were far fewer than during the previous epidemic.

I shall not attempt here to trace the course of the subsequent epidemics which have occurred from time to time, but shall content myself with giving the deaths by years. In 1908, they numbered 18,811; in 1909, 7306; in 1910, 6940; in 1911, 203. In 1912, there were none, and thus far in 1913 there have been none. [503]

The superstitious practices which were formerly employed by the Filipinos to combat this scourge have given way to simple and inexpensive hygienic measures, and we can safely count on sufficient cooeperation from the people to make an effective campaign possible when it next appears.

Never shall I forget the strain of the early days of the first epidemic. Two of my best men, Dr. Meacham and Mr. Mudge, literally worked themselves to death, remaining on duty when they knew that they were in imminent danger, and in the end laying down their lives willingly for an alien and hostile people. Such things make one proud of being an American.

At times the situation was not devoid of amusing features. I had occasion to visit one of the northern provinces, where the epidemic was especially severe, in an effort to calm the panic-stricken populace. I stayed with the governor, a very intelligent Filipino. For obvious reasons I investigated his domestic arrangements, finding that he was boiling drinking water, thoroughly cooking all food, and taking all usual and necessary precautions to prevent infection.

On returning to his house the first evening, after a short absence, I found the grounds decorated with lighted Japanese lanterns. Supposing that the proverbial Filipino hospitality had risen above even such untoward circumstances as those which then existed, I asked the governor what the entertainment was to be. In evident perplexity he replied that he had not planned to have any entertainment, and on my inquiring what the lanterns were for, said he had heard that they were good to keep away cholera germs!

I have referred to the fact that the civil government inherited a fairly well developed epidemic of bubonic plague. In 1901 this disease caused four hundred twenty-seven deaths, in 1902 it caused ten only, but the demands made on the sanitary force by the cholera epidemic which began in that year rendered it impossible to give to plague the attention which it otherwise would have had, with the result that in 1903 we had one hundred seventy-four deaths. In 1904 there were seventy-eight; in 1905, forty-three; in 1906, seven; in 1907, none; and from 1907 until 1912, none. In the latter year the disease was reintroduced.

Rats become infected with it, and fleas transmit it from them to human beings. It was probably brought in by pestiferous rodents hidden inside packages of vegetables, as it appeared in a district where crates of vegetables are opened in large numbers, and did not appear in the vicinity of the piers, although shore rats are abundant there, and if diseased rodents had landed from shipping, would promptly have become infected,—a thing which did not occur.

At about the same time plague also appeared at Iloilo, where it was eradicated with a total of nine deaths. At Manila there have been up to the present time [504] fifty-nine deaths, and scattering cases continue to occur at considerable intervals.

Had plague not been promptly and effectively combated, it would unquestionably have spread rapidly, causing untold misery and heavy property losses.

As I have previously stated, at the time of the American occupation smallpox was by many people regarded as an almost inevitable ailment of childhood. It proved necessary to secure the passage of legislation forbidding the inoculation of human beings with it to prevent misguided Filipinos from deliberately communicating it to their children, not because they did not dearly love them, but because they regarded infection with it as a calamity sure to come sooner or later, and desired to have it over with once for all.

We have performed more than ten million vaccinations, with the result that the annual deaths from this disease have decreased from forty thousand at the outset to seven hundred for the year just ended. There is now less smallpox in Manila than in Washington.

In the six provinces nearest Manila it was killing, on the average, six thousand persons annually. For a year after we finished vaccinating the inhabitants of these provinces it did not cause a death among them; nor has it since caused such a death except among new-born children or newly arrived unvaccinated persons.

These extraordinary results have been achieved without the loss of a life or a limb so far as we know. The vaccine used was prepared by our own Bureau of Science with extraordinary care, and has proved to be remarkably pure and active.

We at first endeavoured to have vaccinations performed by local Filipino health officers, but, after spending large sums without obtaining satisfactory results, gave up this plan and substituted therefor a method of procedure by which the work was carried on under the very immediate supervision of the director of health. We then made substantial progress. However, under the law as it at present stands, succeeding annual vaccination, intended to insure the immunization of children soon after they are born and of unvaccinated persons who may come into a given territory, are intrusted to the local Filipino authorities, with the result that in very many cases they are not attended to. We get elaborate returns showing the number of persons vaccinated. Then comes an outbreak of smallpox, and on investigation we learn that the vaccinations so fully reported were made on paper only! In other words, the continuance of this work, of such vital importance to the Filipino people, is still directly dependent upon continued control by American health officers.

Another great problem now in a fair way to final solution is the eradication of leprosy. At the outset we were told by the church authorities that there were thirty thousand lepers in the islands. In 1905 we began to isolate and care for all supposed victims of this disease, only to find that many outcasts believed to be suffering from it were really afflicted with curable ailments. We were able to restore a very large number of them to society, to their great joy and that of their friends.

A few hundreds of true lepers were being humanely cared for in Manila and elsewhere. Many others had been driven out of the towns into forests or waste places on the larger islands, where they were perishing miserably from fever and other diseases. Still others had been isolated on sand quays, where they were in danger of dying from thirst during the dry season. Not a few wandered through the towns at will, spreading the disease broadcast.

All known lepers are now cared for at Culion, a healthful, sanitary town with good streets, excellent water and sewer systems, many modern concrete buildings and a first-class hospital.

They are not confined to the limits of the town, but wander at will, except that they are excluded from the immediate vicinity of the houses of the officers and employees of the colony.

They may have their little farms, and raise pigs, chickens, vegetables, etc., if they wish. They may, and do, float about over the waters of the neighbouring bay in boats or on rafts, and fish to their hearts' content. They are well fed and well cared for, and their physical condition improves to a marked degree promptly after their arrival at the colony. The only hardship which they suffer is that necessarily involved in separation from their relatives and friends, and this is mitigated by occasional visits which the latter may make them.

Since we began to isolate lepers, their number has decreased to approximately three thousand, and with a continuance of the present policy the disease should soon disappear from the Philippines.

During the period immediately subsequent to the American occupation, amoebic dysentery wrought sad havoc both among our soldiers and among civil government officers and employees. Four of my own family of five had it, and one had it twice, in spite of the fact that we took all known precautions; and the experience of my family was by no means exceptional. This disease then annually cost the lives of a large number of American men and women, and a considerable additional number went home invalids for life as a result of infection with it. We seemed to hear almost daily of some new case.

Careful scientific investigation carried on at the bureau of science taught us the best methods of combating this type of dysentery, and the proper disposal of human feces, the regulation of methods used in fertilizing vegetables, improvement in supplies of drinking water, and other simple, hygienic measures have reduced the deaths from it among Americans to an almost negligible minimum. Such cases as occur are almost without exception detected early, and readily yield to treatment.

The belief that Filipinos do not suffer from this disease has proved to be without foundation. It kills thousands of them every year. Those who are willing to adopt the simple precautions which experience has shown to be necessary may enjoy the large degree of immunity from it which Americans now have.

The chief cause of amoebic dysentery in the Philippines has undoubtedly been infected drinking water. From time immemorial the people have been obtaining their water for drinking purposes from flowing streams, open springs or shallow surface wells.

The wells were especially dangerous, as it was the common custom to wash clothing around them so that water containing disease germs frequently seeped into wells used by whole villages. The results of such conditions during a cholera epidemic can readily be imagined.

The drinking supplies of many provincial towns have now been radically improved by the sinking of 853 successful artesian wells.

In many places there has been a resulting reduction of more than fifty per cent in the annual death rate. Large sums are spent yearly by the government in drilling additional wells,—a policy which is warmly approved by the common people. The recent appropriations for this purpose have been $255,000 for the fiscal year 1912, $60,000 for 1913 and $200,000 for 1914.

When we came to the islands, malaria was killing as many persons as was smallpox. The mortality caused by it is now being greatly reduced by giving away annually millions of doses of quinine, and by draining or spraying with petroleum places where mosquitoes breed, as well as by teaching the people the importance of sleeping under mosquito nets and the necessity of keeping patients suffering from active attacks of malaria where mosquitoes cannot get at them. Only quinine of established quality is allowed in the market.

The results obtained in combating malaria are often very striking. Calapan, the capital of Mindoro, was in Spanish days known as "the white man's grave" on account of the prevalence of "pernicious fever" there. To-day it is an exceptionally healthy provincial town.

At Iwahig, in Palawan, the Spaniards attempted to conduct a penal colony. They were compelled to abandon it on account of pernicious malaria, which caused continued serious mortality when the American government attempted to establish a similar institution there. Application of the usual sanitary measures has made it a healthful place.

Old jails throughout the islands have been rendered sanitary, or replaced by new ones. The loathsome skin diseases from which prisoners formerly suffered have in consequence disappeared. The practical results obtained in Bilibid, the insular penitentiary, are worthy of special note. The annual death rate at this institution was 78.25 per thousand for the calendar year 1904. It increased steadily each month from January, 1904, to September, 1905, when it reached its maximum, deaths occurring at the rate of 241.15 per thousand per year. At this time the director of health was given charge of the sanitation of this prison.

By remedying overcrowding, improving drainage, installing sewers and regulating diet along scientific lines, the rate was reduced in six months to 70 per 1000, and there it stuck.

A systematic examination of the stools of prisoners was then made. Eighty-four per cent were found to be afflicted with at least one intestinal parasite. Fifty per cent had two or more, and twenty per cent had three or more. Fifty-two per cent of the total had hookworm. Active treatment for the elimination of these parasites was begun in one barrack, and after the work was completed it was noted that there was much less disease there than in the remainder. All of the thirty-five hundred prisoners were ultimately examined, and intestinal parasites eradicated if present. The death rate then dropped to thirteen to the thousand, and has remained at or near this figure up to the present time.

I have already referred to the discovery of the cause of beri-beri, and to the effect of the governor-general's order forbidding the use of polished rice in government institutions or by government organizations.

I subsequently made a strong effort to secure legislation imposing a heavy internal revenue tax on polished rice, thus penalizing its use. I failed, but such effort will be renewed by some one, let us hope with ultimate success.

In Spanish days cholera, leprosy, smallpox and other dangerous communicable diseases were constantly reintroduced from without. This is no longer the case. The United States public health and marine hospital service has stretched an effective defensive line around the archipelago and has sent its outposts to Hongkong, Shanghai and Amoy, to prevent, so far as possible, the embarkation for Manila of persons suffering from such ailments. We now have the most effective quarantine system in the tropics, and one of the best in the world. At Mariveles there is a very large and complete disinfecting plant, and vessels may also be satisfactorily disinfected at Cebu and Iloilo.

This quarantine service kept the Philippines free from bubonic plague for seven years, and has repeatedly prevented the entry of pneumonic plague, that most deadly of all known diseases.

A peculiar and shockingly disfiguring disease known as yaws occurs somewhat infrequently in the Philippine lowlands and is very prevalent in a number of places in the highlands. In many ways it resembles syphilis, and indeed at one time was considered to be syphilitic in its origin. Doctor Richard P. Strong, of the Bureau of Science, made the very important discovery that salvarsan is an absolute specific for it. The effect of an injection of this remedy closely approaches a miracle in medicine. In five or six days the condition of the patient begins to improve rapidly. By the end of the second week his horrible sores have healed.

It was with this remedy that we began our health work among some of the wilder head-hunters of northern Luzon. Think of the advantage of being absolutely certain of curing such an ailment in every case, and think of the gratitude of poor wretches, undergoing untold suffering, when they were almost immediately relieved!

Soon after this use for salvarsan was discovered, I caused a liberal supply of it to be sent to the Bontoc Hospital. For some time we were unable to persuade any victims of yaws to undergo treatment, but finally we found one at Barlig who was guilty of a minor criminal offence, arrested him, and took him to Bontoc. Instead of putting him in jail there, we sent him to the hospital for treatment.

At first he complained bitterly that we were putting no medicine on his sores. Then the remedy began to work and he decided it was "strong medicine." By the tenth day he was running around town joyfully exhibiting his rapidly healing body to every one who would look at it. On the fourteenth day he suddenly disappeared, to the deep regret of the medical men, who had hoped that they might keep him as an example of what could be done, and thus persuade others to undergo treatment. A few days later, however, he reappeared with thirteen victims of yaws from his home town, having meanwhile twice covered on foot the great distance which separates Barlig from Bontoc, and assembled and brought in his fellow-sufferers.

As we have seen, the people of Manila were formerly supplied with impure drinking water from the Mariquina River, and were therefore in constant danger of infection with cholera and other deadly diseases. At a cost of some $1,500,000 we have given the city a modern water system, the intake of which is far up in the hills above the last village. The annual deaths from ordinary water-borne diseases exclusive of cholera have fallen from 3558—the average number at the time the new system was introduced—to 1195. Recently a leak in the dam, which necessitated temporary resumption of the use of the Mariquina River water, was immediately followed by a marked increase in the number of deaths from such diseases, thus conclusively demonstrating the fact that we were right in ascribing the previous reduction in deaths to a better water supply.

This annual saving of lives is an important result, but more important yet is the fact that when Asiatic cholera reappears in the Mariquina valley, as it inevitably will sooner or later, we shall not live in constant fear of a general infection of the Manila water supply, which, judging from the experience of other cities where modern sanitary methods have been introduced, might result in the death of a third of the population. In every country a very considerable part of the population always fails to boil its drinking water, no matter how great the resulting danger may be.

Manila lacked any facilities for the proper disposal of human waste, and the conditions which resulted were unspeakable, especially in the little barrios, or groups of houses, placed close together, helter-skelter, on wet, swampy ground and reached by means of runways not worthy even of the name of alleys, as one often had to crouch to pass along them.

A modern sewer system costing $2,000,000, supplemented by a pail system, has very effectively solved this problem, while thousands of homes closely crowded on disease-infected, mosquito-breeding ground have been removed to high, dry, sanitary sites. The regions thus vacated have in many instances been drained, filled, provided with city water and good streets, and made fit for human occupancy.

The old moat around the city walls was a veritable incubator of disease. It has been converted into an athletic field where crowds of people take healthful exercise. The esteros, or tidal creeks, reeked with filth. More than twenty miles of such creeks have been cleaned out, although much still remains to be done to put them in really satisfactory condition.

There were no regulations covering the construction of buildings, and it was not unusual to find six or eight persons sleeping in a closed and unventilated room 10 x 8 x 8 feet. Manila now has an excellent sanitary code, and such conditions have been made unlawful.

The previous woeful lack of hospital facilities has been effectively remedied. At a cost of approximately a million and quarter pesos we have built and equipped the great Philippine General Hospital, one of the most modern institutions of its kind in the world, and by far the best in the Far East. In it we have very satisfactorily solved the question of getting sufficient light and air in the tropics without getting excessive heat. Its buildings are certainly among the very coolest in the city of Manila, and "the hospital smell" is everywhere conspicuously absent.

It is called a three-hundred-bed institution, but as a matter of fact the ventilation is so admirable that nearly two hundred additional beds can safely be put in as an emergency measure.

Two hundred and twenty of its beds are free. In them a very large number of persons are annually given the best of medical and surgical care. At its free clinic some eighty thousand patients find relief in the course of a year.

The increase in private hospital facilities has also been noteworthy. Among the new institutions doing admirable work should be mentioned the University Hospital, an Episcopal institution; the Mary J. Johnston Hospital, a Methodist institution; and St. Paul's Hospital, a Catholic institution. Patients are admitted to all of them without regard to their religious belief, a policy the liberality of which must commend itself to all broadminded persons.

In enumerating the hospitals of Manila, the old Spanish institution, San Juan de Dios, should not be forgotten, for it has been improved and modernized until it offers good facilities for the treatment of the sick and the injured.

All of the above mentioned institutions are in effect acute-case hospitals designed for the treatment of curable ailments. Cases of dangerous communicable disease are excluded from them, but are adequately provided for at San Lazaro where the insular government has established modern and adequate hospitals for plague, smallpox, cholera, diphtheria, scarlet fever, measles, etc., as well as a detention hospital for lepers, pending their departure for Culion.

An insane hospital capable of comfortably accommodating 300 inmates has also been provided. A few years since the insane were commonly chained to floors, or tied to stakes under houses or in yards, and were not infrequently burned alive during conflagrations. Such conditions no longer exist, but the government is not yet able to provide for nearly all of the insane who need institutional care.

The several institutions above mentioned have a very important function apart from the relief of human suffering, in that they afford unexcelled opportunities for giving practical instruction in nursing and in the practice of medicine and surgery.

A few years ago there was not such a thing as a Filipina trained nurse in the islands. I was firmly convinced that the Filipinas of this country could learn to be good nurses, and made earnest efforts to have included among the first students sent at government expense to the United States several young women of good family who should attend nurses' training schools and then return to assist in our hospital work.

I failed to secure the adoption of this plan, but later the training of nurses was inaugurated in connection with hospital work at the old Civil Hospital, St. Paul's, the University Hospital, the Mary J. Johnston Hospital and the Philippine General Hospital. At the latter institution there is now conducted an admirable school where more than two hundred young men and women are being trained. Three classes have already graduated from it, and Filipina nurses have long since proved themselves to be exceptionally efficient, capable and faithful. It will be some time before we can educate as many as are needed in the government hospitals, and after that has been accomplished a vast field opens before others in the provincial towns, where the need of trained assistants in caring for the sick is very great.

We found exceedingly few competent Filipino physicians or surgeons in the islands. This condition was due not to natural incompetence on the part of the Filipinos but to the previous lack of adequate educational facilities. The government has established a thoroughly modern college of medicine and surgery, well housed, and provided with all necessary laboratory facilities. It furnishes the best of theoretical instruction, while its students have every opportunity for practical work at the bedsides of patients in the government hospitals, all patients in free beds being admitted subject to the condition that they will allow their cases to be studied.

While there is still an evident tendency on the part of graduates of this school to feel that they know enough, and to desire to get to making money without delay, we are nevertheless managing to attract an increasingly large number of the more competent to the intern service of the Philippine General Hospital, where as the result of additional years of practical experience they become exceptionally proficient.

This institution, with its great free clinic, offers very exceptional facilities for practical instruction, and we have already trained some extremely competent Filipino physicians and surgeons.

As funds permit, hospital work is being extended to the provinces. At Cebu a thoroughly up-to-date sixty-bed institution is now open. A smaller one was established years ago at Baguio, where surgical work may be performed with great advantage on account of the rapidity with which convalescence occurs in the cool, pure mountain air, which also expedites the recovery of persons recuperating from wasting diseases.

A little more than a year ago a hospital was opened at Bontoc, the demand for accommedations being so great from the start that we did not even await the arrival of beds. Sick Igorots were only too glad to lie on the floor if their needs could be ministered to.

It had previously been the custom of the wild men to kill chickens, pigs or carabaos in case of illness, in order to propitiate evil spirits, the kind and number of animals killed being of course determined by the wealth of the patients. They have now satisfied themselves that quinine for malaria, salvarsan for yaws, and other effective remedies for common ailments are more useful and more readily obtained than was the helpful intervention of the anitos, or spirits of the dead, while the methods and results of modern surgery are a source of unending amazement and satisfaction to them.

The first surgeon to anesthetize a Kalinga became promptly and widely known as "the man who kills people and brings them to life again," and the individual on whom he operated successfully, who chanced to be the most influential chief of the tribe, became his friend for life. Indeed, the results of medical and surgical work for the wild men have been an important factor in bringing about and maintaining friendly relations with them.

Their gratitude is at times very touching. At Atok, in Benguet, there lives an Igorot chief named Palasi. When he was already old a son was born to him. This boy, who was the delight of his declining years, became deathly ill with confluent smallpox, and the Igorots considered him as good as dead. At this time Sanitary Inspector Baron appeared on the scene. He promptly turned every one else out of the house and himself nursed the boy, saving his life. Palasi wished to pay him for his services, but was informed by Mr. Baron that the government paid him, and he could not accept additional compensation. Palasi promptly made the long journey to Baguio to ascertain whether Baron had told him the truth, and was informed by Governor Pack that this was the case. The old man retired to Atok, quite disgusted with the strange ways of Americans.

Six months later he again appeared at Baguio to ask the governor about a fiesta which he had just heard it was customary to celebrate on the 25th of December. He had been told that Americans were in the habit of giving presents to each other at this time, and asked if this was the ease. Governor Pack said yes. Palasi then inquired if the feast was a good feast, and the custom a good custom, and was assured that both of these things were true. He next asked if it would be a good feast for Igorots as well as for Americans, and receiving an affirmative reply from the unsuspecting governor, triumphantly declared that he was going to give Baron his best horse. Under the circumstances the governor allowed him to do so.

In connection with the Bontoc Hospital we use two men, one of whom travels from settlement to settlement, relieving minor ailments on the spot and sending to the hospital only those patients who need to go there, while the other stays at home and receives them. From time to time these two doctors "change works." Pages from their daily journals, written in the field, often read like romance.

Were I a young man, and possessed of adequate knowledge of medicine and surgery, I would ask nothing better than to minister to the wants of these people. One might not, and indeed would not, acquire great wealth, but he would be rich in friends. Here lies a great field for practical missionary work.

In connection with the health work there have been many occurrences which were both amusing and sad. At one time there was great excitement over a sacred spring which had appeared in Manila Bay off the district of Tondo. It was duly blessed by Aglipay, the head of the so-called Aglipayano church. Coincidently with its discovery there was a sharp little outbreak of Asiatic cholera. Investigation revealed the fact that the "spring" had its origin in a broken sewer pipe. We were obliged to prevent the faithful from further partaking of its waters, and thus insuring themselves a speedy trip to the better world.

At one time cases of cholera appeared scattered generally throughout the Mariquina valley and without apparent connection. For some days we were unable to make a guess as to their origin. Then we heard that a "Queen" had arisen at the town of Taytay near the Laguna de Bay. An investigation of the Queen and her activities resulted in rather astonishing revelations. She was a very ordinary looking Tagalog girl who had secured the body of an old bull-cart, stopped the cracks with clay, partially filled it with water and decaying vegetable matter, and at rather frequent intervals had bathed in the fermenting mass thus concocted. In due time she announced herself a healer of all the ills to which flesh is heir, and the sick flocked to her. Cholera was then prevalent in some of the towns near Taytay, and there were persons suffering from it among those seeking relief. Some of them were directed to wash their hands in the extemporized tank, while others bathed their bodies in it. As a result it soon contained a cholera culture of unprecedented richness. This was given to patients applying for treatment, and was bottled and sent to those who were too ill to come in person. Hence numerous scattering cases of cholera which did not bear any relationship to other known cases.

It proved quite an undertaking to put the Queen of Taytay out of business. We first asked the local authorities to have her sent to Manila, but the presidente and the police declined to act. We then applied for a warrant to the Filipino judge of the court of first instance having jurisdiction over Taytay, but that worthy official found it convenient to be suddenly called out of the province. At last we prevailed upon soldiers of the Philippine constabulary to arrest the queen and bring her to Manila.

We had anticipated that she might prove insane, but she showed herself to be a very keen-witted young woman. We employed her at the San Lazaro Hospital to look after cholera patients. The people of Taytay were not satisfied, and a few days later a large delegation of them came to Manila and demanded the Queen. I was at my wits' end to know what to do, but old Spanish law can usually be relied upon in emergencies, and the attorney-general discovered a provision couched in very general terms, which provided against disobedience to the authorities. It was only necessary for an "authority" to have read to an ordinary person a statement setting forth what that person must not do; then if the order was violated, such person could be made to suffer pains and penalties.

I accordingly prepared a most impressive order prohibiting the Queen of Taytay from further engaging in the practice of medicine, had her followers drawn up in battalion formation, placed myself at the front and centre, caused the Queen to be brought before me, and read her my communication, at the same time charging the good people of Taytay not to tempt her again to try her hand at healing, for the reason that if they did she would surely get into serious trouble. They marched away with the Queen and I have not heard of her since.

Hardly a year goes by that some similar miraculous healer does not set up in business, and the supply of dupes seems to be unending.

While it is comparatively easy to combat disease in a place like Manila, what of the provinces, where in many cases there is not one physician to two hundred thousand inhabitants?

To meet this difficulty we have an organization of district and municipal health officers. A district may include a single province or several provinces. A district health officer is invariably a physician who has had reasonably thorough practical training in the work of public sanitation, usually at Manila.

He is supposed to spend his time in sanitary work rather than in treating sick individuals, but it is, of course, impossible for him always to refuse to treat such persons, and we encourage gratuitous work for the poor when it can be carried on without interfering too seriously with more important duties.

Presidents of municipal boards of health may exercise jurisdiction over a single municipality or over several. They are supposed to maintain good sanitary conditions in their respective towns, under the general supervision of district health officers, and to instruct their people in sanitary methods and their results, as well as to devote a certain amount of their time to the relief of the suffering poor.

On the whole it must be admitted that while this system has accomplished much, it has fallen far short of accomplishing what it should.

Men like Dr. Arlington Pond of Cebu have wrought marvels, and have conclusively demonstrated the fact that it is not the system that is at fault. Of our thirteen district health officers, ten are Filipinos. They are, with few exceptions, letter-perfect. They know what they ought to do, but as a rule lack the initiative and the courage to do it.

Recently after discovering exceptionally bad sanitary conditions in several towns of the province of Misamis, I demanded an explanation of the district health officer, an exceptionally well-educated and intelligent Filipino physician. I found, as I had anticipated, that the sanitary regulations of his towns left little to be desired, but that they were absolutely ignored.

I asked him what sense there was in paying his salary if he failed to remedy such conditions as I had discovered. He replied that if he were really going to compel people to clean up, it would be necessary to begin with the provincial governor, whose premises were in a bad state. When I suggested that in my opinion the provincial governor would be the best possible man to begin with, the doctor evidently thought me crazy!

It is as yet impossible for the average intelligent Filipino to understand that the rich and the poor, the powerful and the weak, should be treated alike.

It often happens that a province asks for an American health officer, or a Filipino demands the services of an American physician. My invariable procedure in such cases has been to request that the application be made in writing. For some mysterious reason the petitioners are seldom willing to go on record.

A short time since we had a strong demand from Iloilo for an American district health officer. I made the usual suggestion and got a written request that there be sent to Iloilo a district health officer "after the style of the district health officer of Cebu." If Dr. Pond's nationality may be considered a part of his style, then this was a request for an American, otherwise not!

With rather shocking frequency, Filipinos who must be examined for leprosy or some other dangerous communicable disease strongly insist that the examination be made by an American bacteriologist rather than by one of their own countrymen.

In connection with recent election troubles two men were wrongfully denounced as lepers. In several instances perfectly sound people have been thrust among lepers who were being taken on board steamer for transfer to Culion. This grievous wrong was committed by their enemies under cover of darkness, and in the confusion which attends the embarking of a number of people in a heavy sea. The reason why the services of Americans are often specially requested for diagnostic work is not far to seek!

It is a significant fact that our greatest success in establishing satisfactory provincial sanitary conditions has been achieved in certain of the "special government provinces," where the people are under the very direct control of American officials.

There is not a regularly organized province in the Philippines in which the towns are as clean as are those of Mindoro, where, until recently, we have never had a resident district health officer.

I believe that nowhere in the tropics can there be found native towns which are cleaner or more healthful than are those of Bukidnon, inhabited in some instances by people who have literally been brought down out of the tree-tops within the last two or three years. We have never had a resident health officer in this subprovince.

I mention these facts not as an argument against health officers, but as a proof of what can be done without them by intelligent Americans vested with proper authority.