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Full text of "A history of Asiatic cholera in the Philippine Islands"

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A HIST( 






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SIATIC CHOLERA IN THE 
PHILIPPINE ISLANDS 



WITH AN APPENDIX 



BY 

DEAN G. WORCESTER 

SECRETARY OF THE INTERIOR 



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Manila 
bureau of printing 

1909 



IN MEMORIAM 
BERNARD MOSES 





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http://www.archive.org/details/asiatichistoryofOOphilrich 



A HISTORY 



OF 



ASIATIC CHOLERA IN THE 
PHILIPPINE ISLANDS 



WITH AN APPENDIX 



BY 

DEAN G. WORCESTER 

SECRETARY OF THE INTERIOR 



78079 



MANILA 
BUREAU OF PRINTIN 
1909 






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SERIVARD fi,!cvr, 



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TABLE OF CONTENTS. 



Page. 

INTRODUCTION 7 

THE OCCURRENCE OP CHOLERA DURING THE SPANISH REGIME 7-19 

Statistics furnished by Dr. Fernando Calderon 7 

Information from other sources 12 

Church statistics 16 

THE CHOLERA EPIDEMIC OF 1902-1904 IN MANILA 19-24 

Table showing the cases and deaths in the city of Manila, by months 20 

Measures adopted in 1902 to hold cholera in check 21 

DiflSculties encountered 22 

A new Commissioner of Public Health appointed 23 

THE CHOLERA EPIDEMIC OF 1902-1904 IN THE PROVINCES 24-31 

Tables showing the cholera cases and deaths in the provinces during the 

epidemic of 1902-1904 25 

Criticism of the 1902 cholera campaign 28 

Table showing the order in which the provinces became infected and the 

prevalence of cholera in each province 30 

THE MANILA CHOLERA EPIDEMIC OF 1905 31-40 

Table showing, by months, the cases and deaths from cholera in Manila during 

the epidemic of 1905 32 

Vicious attitude of a portion of the public press 33 

"El Soberania Nacional" compelled to retract false statements 33 

Filipino physicians appointed to San Lazaro 39 

SUBSEQUENT EPIDEMICS IN THE PROVINCES 41-48 

Table showing the course of cholera in the provinces, by months, from August 

20, 1905, to October 19, 1908 41 

Summary of provincial epidemics which have occurred since August 20, 1905.... 43 
Table showing the proportion of cholera cases to population in each of the 
provinces infected during the epidemic of 1902-1904 and the name of the 
person or persons, if any, who held the office of president of provincial board 
of health in each province during the time when cholera was present there.... 44 
Table showing the number of outbreaks of cholera in each province in which 
cholera has occurred since August 20, 1905, with the duration of each out- 
break and the number of cases and deaths caused by it 45 

Table showing the proportion of cases to inhabitants, the number of outbreaks of 
cholera and the force employed in checking the disease in each of the present 

health districts in which the disease has occurred since August 20, 1905 47 

SUBSEQUENT EPIDEMICS IN MANILA 49-G5 

The Manila epidemic of May 11 to November 27, 1906 - 49 

Table showing cases and deaths, by months, from May 11 to November 27, 1906.. 49 

The Manila epidemic of July 13, 1907, to March 17, 1908 49 

Table showing cases and deaths from cholera during the Manila epidemic from 

July 13, 1907, to March 17, 1908 — . 49 

The present Manila epidemic 49 

Table showing cases, by days, from June 8 to October 19, 1908 50 

Fear of the San Lazaro cholera hospital diminishes 50 

Increased hospital facilities required „ 51 

Cooperation with the Bureau of Health 51 

Valuable assistance given by the police and fire departments 52 

Volunteer cholera fighters 52 

Criticism of the measures adopted for the suppression of cholera during 1908.... 53 

Reasons for changes in chief health officers „ 56 

THE BUREAU OF HEALTH CHARGED WITH RESPONSIBILITY FOR THE 

OCCURRENCE AND CONTINUED PRESENCE OF CHOLERA IN THE ISLANDS 58-65 

• Conditions favorable to the propagation of cholera in the Philippines 59 

The growth of railways a source of danger 60 

Reorganization of the Board of Health 60 

797,'592 



THE bureau' OF- H^GALTH, ETC.— Continued. Page. 

Claim that Filipinos alone should be employed to combat cholera 60 

The eoEamoD people'lack confidence in physicians 61 

The. best resulia'obtamed by cooperation between Americans and Filipinos 61 

Disinfectants ^] 

Subordinate force employed ^^ 

UNSANITARY CONDITIONS IN MANILA - 6.5-96 

Correspondence between the Director of Health, the Governor-General, the 
secretary of the Municipal Board, the Director of Public Works, the city 
engineer, and the Secretary of the Interior relative to the enforcement of 

the building ordinance 66 

Absurd contention of the city engineer relative to payment for strips of land left 

vacant for ventilation ''^ 

Shall we build a healthful city? 82 

Memorandum and recommendations relative to public pail sheds for certain 

districts of the city 83 

Bad streets an obstacle to sanitary work 85 

Needless delay in draining certain low lands 86 

Lack of streets and drains in thickly settled sections 86 

Shocking sanitary conditions of portions of the San Lazaro Estate 86 

Correspondence between the Director of Lands, the Secretary of the Interior, 
the Governor-General, the Attorney-General, and the Municipal Board 
relative to the duty of the city to construct and maintain streets through 

the San Lazaro Estate 86 

EXPLANATION OF THE CONTINUANCE OF CHOLERA 96-128 

The establishment of provincial boards of health and their failure to ac- 
complish the desired results 9" 

The abolition of provincial boards of health and their substitution by health 

districts recommended 99 

The District Health Officer Act and its effect 101 

The Burdette case 105 

Attempts to secure remedial legislation Ill 

Insufficiency of the present force ,. 112 

Table showing the occasions on which medical inspectors and sanitary 
inspectors regularly serving in Manila have been ordered to the provinces 

since July 1, 1906 113 

The force now available for health work in the provinces 114 

Present authorized force 114 

Salaries paid to Americans and Filipinos 114 

Certain deficiencies of Filipino health officers 115 

A district health officer asks for accrued leave while fighting cholera, with no 

substitute available 115 

A district health officer deserts his post at the leper colony 117 

A "cholera expert" requested when the regular district health officer was on 

duty 119 

A district health officer refuses to obey an order to go to a cholera-smitten 

town because he has the itch 120 

The "delicate health" of a district health officer interferes with the discharge 

of his duties 121 

A district health officer deserts his post upon the appearance of cholera 122 

A district health officer who did his duty 124 

A district health officer foregoes taking leave in order to fight cholera 124 

Summary of the situation as regards Filipino district health officers 124 

What the Bureau of Health has accomplished and what it has failed to ac- 
complish 126 

The scanty force of the Bureau of Health makes It necessary to call on other 

Bureaus for physicians „ 126 

Assignment of Bureau of Science men 126 

Assignment of Philippine Medical School men 127 

Resulting interruptions to work 127 

The discovery of bacilli carriers at Manila during the epidemic of 1908 127 

Is cholera endemic in the Philippines? _ 128 

Table showing the total number of cholera cases and deaths since the American 

occupation 130 

Little danger from cholera to those willing to take ordinary precautions 130 

Total number of cholera cases and deaths among Americans 130 

SUMMARY AND CONCLUSION 131-135 



TABLE OF CONTENTS OF APPENDIX. 

Page. 
THE OPINION OF THE ATTORNEY-GENERAL RELATIVE TO THE POWER 
OP THE CITY OF MANILA TO COMPEL PRIVATE OWNERS TO FILL AND 
DRAIN THEIR LOTS AND AS TO THE COURSE WHICH SHOULD BE PUR- 
SUED BY THE DIRECTOR OF HEALTH IN ABATING NUISANCES 137 

Letter to the Acting Director of Health by the sanitary engineer under date of 

October 30, 1908, and indorsements thereon 137 

Opinion of the Attorney-General under date of December 24, 1908 140 

THE FAILURE OF THE ATTORNEY-GENERAL TO CONSIDER CERTAIN PRO- 
VISIONS OF LAW IN RENDERING HIS OPINION 142 

Letter of Secretary of the Interior to Attorney-General under date of February 

9, 1909 '. 143 

Extraordinary delay of Attorney-General's Office in rendering opinion re- 
quested by Secretary of the Interior in his letter of February 9, 1909 144 

OPINION OF THE SECRETARY OF THE INTERIOR AS TO THE LAW REL- 
ATIVE TO THE CLEANSING, DRAINING OR FILLING OF LOWLANDS 144 

Paragraph (s) of section 3 of Act No. 1150 144 

Section 793 of the Revised Ordinances of the city of Manila 145 

Provisions of law clearly contemplate that action to cause the remedying of 

unsanitary conditions must be taken by City Engineer and by him alone.... 146 
CRITICISM OF THE ATTORNEY-GENERAL'S OPINION OF DECEMBER 24, 

1908 „ -. 146 

Overlooked or ignored certain provisions made by paragraph («) of Act No. 

1150 

Attorney-General suggests procedure to be followed by Director of Health 

in remedying unsanitary conditions 147 

THE DIRECTOR OF HEALTH IN ABATING NUISANCES HAS LONG FOL- 
LOWED THE PROCEDURE SUGGESTED BY THE ATTORNEY-GENERAL.. 147 

THE DUTY OF THE CITY ENGINEER 148 

THE GOVERNOR-GENERAL CALLS CERTAIN FACTS TO THE ATTENTION 

OF THE MUNICIPAL BOARD 148 

Indorsement of Governor-General under date of January 25, 1909, relative 

to putting streets through unsanitary districts 148 

A LIMITATION ON THE POWER OF THE SECRETARY OF THE INTERIOR TO 

APPROVE ORDERS FOR THE FILLING OR DRAINAGE OF LOWLANDS 148 

GENERAL DRAINAGE SYSTEMS MUST BE PROVIDED BY THE CITY 149 

THE STREETS NECESSARY FOR THE SANITATION OF THICKLY SETTLED 

DISTRICTS MUST BE BUILT BY THE CITY 150 

DUTIES OF THE CITY RELATIVE TO THE COLLECTION AND DISPOSAL OF 

EXCRETA, GARBAGE AND REFUSE 150 

Section 7 of Act No. 1150 150 

COMPLAINTS AGAINST THE MUNICIPAL BOARD AND THE CITY ENGINEER.. 151 

Municipal authorities have persistently neglected to make adequate provision 
for the collection, and disposal of excreta, garbage, refuse, etc., in certain 

districts 151 

City engineer's negligence in enforcement of building ordinances 151 

No general improvement in sanitary conditions as a result of the maladminis- 
tration of city engineer's office 152 

Practical working of the present arrangement 152 

Attitude of city authorities toward constructing necessary streets and drains 

on San Lazaro Estate 153 

Excerpt from opinion of Attorney-General Araneta as to duty of city relative 

to building streets on San Lazaro estate 153 

Indorsement to Municipal Board by Governor-General, under date of October 17, 
1907, relative to making arrangements for carrying out proposed improve- 
ments on San Lazaro Estate ., 154 

City promises on February 8, 1908, that "The street areas within this zone 

will receive attention in the near future" 154 

Members of Municipal Board disclaim knowledge of Attorney-General's opinion 

relative to their duty in improving conditions on San Lazaro Estate 155 

Letter of Governor-General to Municipal Board under date of December 23, 

1908 _ 155 



COMPLAINTS AGAINST THE MUNICIPAL BOARD AND THE CITY ENGINEER— 
Continued. 

Letter of Director of Lands to Municipal Board under date of February 10, 
1909, relative to condition of Calle Timbugan, San Lazaro Estate, and first, 
second, third, fourth, fifth, sixth, seventh, eighth and ninth indorsements 

thereon 

Municipal Board has signally failed to discharge its duty relative to the im- 
provement of sanitary conditions on the San Lazaro Estate „ •„... 

EPIDEMICS ARE EXPENSIVE 

Cost of recent cholera epidemic in the city of Manila both to the Insular and 

city governments 

A WORD OP WARNING 

SOME ACTUAL PROGRESS MADE 

Projects for improvement of some of the worst unsanitary districts in Manila.... 
APPOINTMENT OF THE SPECIAL COMMITTEE OF CITIZENS AND OFFICIALS.. 

Executive Order No. 3 

E.xecutlve Order No. 14, amending Executive Order No. 3 

Specific embarassing positions in which Secretary of Interior has found himself 
in exercising the power of approval or of disapproval of orders for filling, 

in accordance with paragraph (s) of section 3 of Act No. 1150 

THE WORK OF THE SPECIAL COMMITTEE OP CITIZENS AND OFFICIALS.... 
Communication of city engineer to subcommittee of special committee, includ- 
ing outline of plans for sanitary improvements 

Criticism of the proposed procedure outlined in above communication of city 

engineer to special committee 

COMPLETION OF THE NEW WATERWORKS 

NUMBER OF PUBLIC CLOSETS INCREASED „ 

UNSANITARY BUILDINGS VACATED OR REMOVED 

THE EFFORT TO PROVIDE SANITARY BUILDING SITES 

As long ago as 1902 Municipal Board was urged to interest itself In the con- 
struction, on city or Insular Government land, of sanitary tenements for 

the poor 

DRAINAGE WORK 

EXTENSION OF WATER SYSTEM 

Places where additional water hydrants have been installed 

RECOMMENDATIONS 

ANOTHER WORD OF WARNING 

ADDITIONAL HISTORIC DATA AND REPORTS CONCERNING CHOLERA 

ADDENDUM 

Second, third and fourth indorsements forwarding opinion of Attorney-Gen- 
eral, which finally reached the Secretary of the Interior on April 17, 1909, 

in response to request made on February 9 

Letter of the Attorney-General communicating his opinion, dated April 3, 1909.. 

Comment on above opinion of Attorney-General 

EXHIBIT "A."— LETTER OF SEnOR EPIFANIO DE LOS SANTOS 

EXHIBIT "B."— "THE SUPPRESSION OF A CHOLERA EPIDEMIC IN MANILA," 

by THE ACTING DIRECTOR OF HEALTH 

EXHIBIT "C."— SUPPLEMENTARY REPORT ON THE CHOLERA EPIDEMIC OF 

1908 IN MANILA, BY THE ACTING DIRECTOR OF HEALTH 

EXHIBIT "D."— "INDICATIONS FOR TREATMENT OF ASIATIC CHOLERA," BY 

DR. RICHARD P. STRONG, CHIEF OF THE BIOLOGICAL LABORATORY 

EXHIBIT "E."— "THE TREATMENT OF CHOLERA, A SUMMARY OF THE EX- 
PERIENCES OF THE PHYSICIANS AT THE MARY JOHNSTON CHOLERA 
HOSPITAL," BY HENRY T. NICHOLS, LIEUTENANT, MEDICAL CORPS, U. S. 

ARMY „ ^ 

EXHIBIT "F."— "A SUMMARY OF THE RESULTS OBTAINED IN THE BAC- 

TEUIOLOGICAL DIAGNOSIS OF CHOLERA," BY MOSES T. CLEGG 

EXHIBIT "O."— REPORT OF THE SPECIAL COMMITTEE OF THE MANILA 

MERCHANTS* ASSOCIATION 

EXHIBIT "H."— COMMENT ON REPLY OF MEMBER MCDONNELL OF THE 
MUNICIPAL BOARD TO CERTAIN STRICTURES OF THE COMMITTEE 
RELATIVE TO CERTAIN UNSANITARY CONDITIONS IN THE CITY OP 

MANILA _.. 

EXHIBIT "I."— "ALWAYS PERSECUTED," COPY OF AN ENGLISH TRANSLA- 
TION OF AN ARTICLE WHICH APPEARED IN A FILIPINO PAPER 




A HISTORY OF ASIATIC CHOLERA IN THE 
PHILIPPINE ISLANDS. 



INTRODUCTION. 

Manila, November 5, 1908. 

Gentlemen: Twice during the past year the presence of cholera in 
Manila has seriously interfered with important public events, necessitating 
the postponement of the Carnival and seriously interfering with the 
reception to the United States Battle-ship Fleet. 

These two occurrences have served to attract widespread attention 
abroad to the continued existence of cholera in the Philippines, while in 
Manila, if not throughout the Archipelago generally, there has been an 
awakening to the fact that the system at present in vogue for the sup- 
pression of contagious diseases leaves much to be desired. Simultaneously 
with this aw^akening has come a demand that the responsibility for the 
present situation be fixed and that existing conditions be radically im- 
proved. I am of the opinion that this demand is entirely just. 

In view of numerous misstatements, many of which doubtless have been 
made in good faith, concerning the relative frequency and importance 
of cholera epidemics during the Spanish and the American regimes, it 
has seemed to me desirable to begin by reviewing the facts so far as they 
are obtainable. 

THE OCCURRENCE OF CHOLERA DURING THE SPANISH REGIME. 

Not only are the records of the occurrence of cholera during the period 
when the Philippine Islands were under Spanish rule of a very frag- 
mentary character, but so far as they continue to exist at all they are 
scattered through the archives in such a way as to make it extremely 
difficult to refer to them. The following facts are taken from a memo- 
randum very kindly prepared for the Director of Health by Dr. Fernando 
Calderon, who spent much time in searching the archives and in com- 
piling such infomiation as he was able to obtain therefrom. 

There is a difference of opinion as to the date on which cholera first 
occurred in the Philippines. Dr. Francisco Masip y Vals, medical direc- 
tor of the Civil Hospital of Manila, states that its first appearance was 
in 1817 and that it then came from India. Don Benito Francia, in 
writing concerning the cholera epidemic of 1888, says that cholera existed 
only in India in 1817 and that it was not until the 4th of October, 1820, 

7 



that there were observed upon the banks of the Pasi^Jiver 
cases that occurred in the Philippines. 

Fernando Casas, professor of the Eoyal Armada, and first physician of 
the hospital at Manila, in his memoir, the third edition of which was 
printed in 1832, states that the epidemic recurred in 1821, 1822, 1823, and 
1830. 

Senor Francia also states that cholera occurred in 1821, 1822, 1823, 
and 1830, in 1854, from 1863 to 1865, and in 1882, 1883, and 1888, the 
epidemic of the latter year being the principal subject of his memoir. 
The epidemic which began in 1888 officially terminated in 1889. 

Don Jose Montero y Vidal, in his "Historia de Filipinas," and Pad 
Buceta, in his "Diccionario Geografico," refer to the cholera epidemic 
1820. Don Felipe Govantes, in his "Compendio de la Historia de Fill 
pinas," refers to the occurrence of cholera in 1822, and his statement 
agrees with that of Senor Francia as to the continuance of the disease 
in the successive years. 

Don Jose Montero y Vidal, in speaking of its first occurrence in 182 
says that the natives attributed its origin to the poisoning of water by 
foreigners and that as a result they murdered twenty-seven foreigners 
and a large number of Chinese. During recent epidemics evil-mindei 
persons have circulated stories that the Americans were poisoning 
wells and streams; employees of the Bureau of Health have been kill 
and thus history has repeated itself after so long a time. 

Dr. Calderon states that from the data available it can be said with 
certainty that there were under the Spanish regime seven periods of attack 
from cholera, namely from 1820 'to 1823, 1830, 1842, 1854, 1863 to 186 
1882 to 1883, and in 1888. 

None of the authors cited make any statement as to the total number 
of cases and deaths during any of the first five periods, but Seiior Francia, 
referring to a statistical table published in 1862 by the subdelegate of 
surgery, Senor Antelo, states that there were 5,413 deaths in the city of 
"^f anila and 13,377 in the province of the same name during this epidemic. 

Senor Francia combined in his memoir various statistical tables show- 
ing the number of cases which had occurred in different provinces but 
reserved the privilege of correcting them later when the epidemic shou! 
have terminated, which he would not seem to have done. 

According to these incomplete figures there were in the province and 
city of Manila, between the 15th of August and the 1st of October, 1888, 
1,970 cases with 1,028 deaths, and during April and the first fifteen days 
of May, 1889, there were 1,375 deaths, giving a total of 2,403 deaths tSM 
the province and city of Manila. ■■ 

In the Province of Pangasinan there were 978 deaths in 1888 and 
2,127 during April, 1889, giving a total of 3,105. 



H 



i 

lers 

i 



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li 



9 

In Nueva Ecija there were 2,170 cases and 1,946 deaths between Jan- 
uary 1 and April 30, 1889. 

In the district of Morong from the 12th of September to the 11th of 
October, 1888, and from tlie 23d of March to the 30th of April, 1889, 
there were 122 cases with 108 deaths. 

In the Province of La Laguna there were from September, 1888, to the 
30th of April, 1889, 921 deaths. 

In Cavite there were 440 cases and 292 deaths from August, 1888, to 
the 18th of March, 1889. 

In Bataan there were 600 cases and 442 deaths during September, 1888, 
and April, 1889. 

On the Island of Corregidor there were 83 cases and 18 deaths. 

In Tayabas there were 253 cases and 129 deaths up to the 30th of 
April, 1889. 

In Tarlac between March 20 and April 30, 1889, there were 515 cases 
and 440 deaths. 

In Bulacan there were 3,492 cases and 1,985 deaths during the year 
1888 and between January 1 and April 30, 1889, there were 1,009 
deaths, making the total deaths in this province 2,994. 

In Pampanga there were 3,678 cases and 2,748 deaths between Sep- 
tember, 1888, and April, 1889. 

In Zamboanga, between the 26th of January and the 30th of April, 
1889, there were 2,271 cases and 1,120 deaths. 

From these very fragmentary statistics it would appear that during 
the epidemic of 1888 and 1889 cholera occurred in thirteen of the forty- 
one provinces into which the Archipelago was then divided, and caused 
the death of 16,666 persons; but as will be shown later the epidemic 
was really far more widespread and serious than Senor Francia's account 
would lead us to believe. 

The epidemic of 1882 is said to have had its origin at Maybun on the 
Island of Jolo, being brought by the steamer Johk-ang. Two hundred 
persons died at Maybun in forty days. The epidemic spread to Zam- 
boanga and was brought to Manila by the steamer Francisco Reyes. 

With respect to the origin of the cholera epidemic of 1888, Senor Fran- 
cia says that during July the first suspicious case occurred at the quar- 
antine station at Mariveles* although no 'previous cases had been noted 
either at the quarantine station or on the vessels entering it. During 
August it appeared at Taytay although there had been no communication 
between this place and Mariveles and there was no evidence that cholera 
had been imported to this place. 

Seiior Francia calls attention to the fact that Taytay was out of the 

* The italics throughout this report are supplied by the writer. D. C. W. 



10 



I rack of steamers, difficult of access and sitimted almost in the interior 
and draws the conclusion that the Taytay case arose spontaneously! 

Dr. Calderon has furnished two tables of deaths during the epidemic of 
1888 and 1889, the first taken from the memoir of Don Benito Francia 
and the second from information given b}^ provincial chiefs and found 
in the archives of the Insular Government. This information is here 
embodied in a single table : 

Table of deaths from cholera during the years 1888 and 1889. 



I 



Province. 



Manila 

Pangasinan 

Nueva Ecija _. 

La Laguna 

Cavite 

Bataan 

Corregidor 

Bulacan 

Pampanga 

Zamboanga.__ 
Morong 



Sr. 

Fran- 

eia's 

figures. 



2,403 

3,105 

1,946 

921 

292 

442 

18 

2,994 

2,748 

1,120 

108 



Fig- 
ures 
from 
ar- 
chives. 



17,916 



1,142 



3,917 
1,134 



Province. 



Tayabas 

Tarlac 

Hollo 

Mindoro 

Zambales 

South Camarines . 

Capiz 

Bohol 

Benguet 



Total. 



Sr. 
Fran- 
cia' s 
figures. 



129 
440 



16,666 



Fig. 
ures 
from 
ar- 
chives, 



2,254 



27,217 
1,190 
2,276 
2,650 
6,727 
1,183 
6 



67,612 



* 



A comparison of these two columns will show the very unsatisfactoi 
nature of the statistics with which we have to deal. Senor Francia gives 
figures for seven provinces and one island (Corregidor) for which no 
records have been found in the archives. 

So far as his figures can be checked with the figures in the archives, 
which are doubtless the more nearly correct, they are far too low, while 
in the archives there have been found figures for seven provinces n||| 
mentioned by him. ^1 

If we accept the figures in the archives for the provinces for which 
the record has been found and add these to Senor Francia's figures for 
the remaining provinces mentioned by him, we arrive at a total of 67,612 
and there is good reason to believe that this total is far below the actual 
one. mw 

In this connection the following facts are of interest. There are in tfl| 
archives formal official declarations of the cessation of the cholera 
epidemic in the following provinces on the dates named: 



Leyte July 18, 1889 

La Union Sept. 2, 1889 

Cebu Aug. 26, 1889 

Antique Aug. 27, 1889 






There were then at least four provinces to which the epidemic must 
have extended for which we have no statistics whatever. 

If the figures for the comparatively recent epidemic of 1888-89. 
unsatisfactory those for the epidemic of 1882-84 are still more so. 

Dr. Calderon has found tables purporting to give the number of cases 



ust 

I 



J 



11 



and deaths for tlie four days from August 28 to August 31, 1882, the 



totals being as follows : 





Month. 


Cases. 


Deaths In— 




Hospitals. 


Houses. 


August 28 




470 
125 
106 
134 


51 
70 

58 
65 


167 


August 29 . _ _ 




August 30 




August 31 > 









It will be observed that on only one day during this period is there 
any attempt made to give figures for deaths outside of hospitals. 

The following table, compiled from figures gatherd by Dr. Calderon, 
shows the number of burials of supposed cholera victims in the cemeteries 
of Paco, Tondo, Santa Cruz, La Loma, Sampaloe, Ermita, Malate, and 
San Fernando de Dilao : 



For period of twenty-four hours 
ending September — 


Number. 


For period of twenty-four hours 
ending September — 


Number. 


2 


233 
170 
161 

186 
125 
122 
115 

85 
84 
87 


12 


64 


3 


13 _ . 


71 


4 __. 


14 


40 


5 . 


15 . _ _ 


45 


6 _. 


16 


56 


7 __ 


17 _ 


28 


8 , . 


18 


27 


9 


19 


28 


10 


Total 




11 


1, 727 









At this time, so far as the cemetery records in the archives are con- 
cerned, the epidemic would seem to have ceased with miraculous 
suddenness. 

Tables have also been found showing that thirty-one towns were 
attacked in the Province of Capiz during 1882 with a mortality of 9,256 ; 
that twenty-seven towns were attacked in the Province of Pangasinan 
during 1882 and 1883 with a mortality of 24,187 ; also that in the towns 
of Zamboanga, Maria, Tetuan, Las Mercedes, and Ayala, all in the im- 
mediate vicinity of Zamboanga, there were 3,954 cases with 1,719 deaths. 

From statistics published in the Official Gazette it would appear that 
there were 2,108 deaths in Manila between August 29 and September 29, 
1882. 

There are in- the archives records of the declaration of the cessation of 
the epidemic in only nine provinces as follows : 

Pampanga • Feb. 2, 1883 

Zambales Jan. 19, 1883 

Cotabato and District of Rio Grande de Mindanao Jan. 18, 1883 

Bulacan Jan. 29, 1883 

South Camarines Feb. 6, 1883 

South Ilocos Feb. 17, 1883 

Cagayan Mar. 2, 1883 

Pangasinan Mar. 16, 1883 

Western Negros Mar. 28, 1883 



12 



1 

slandff. 



Yet we know that this epidemic invaded every province in the Island?, 
reaching Cebu last of all. 

It is evident from the fact that 470 cases of cholera were recorded on 
August 28, 1882, that the epidemic was in full swing in Manila on that 
day, although Dr. Calderon has apparently found no statistics for any 
previous day. 

Were we limited to the knowledge of this epidemic derivable from the 
statistics found by Dr. Calderon we should gain a very erroneous idea of 
its importance. Fortunately this is not the case, and I will now review 
briefly such additional information as I have been able to obtain. 

As regards the date of the first appearance of cholera in the Philip- 
pines, Dr. Francisco Masip y Vails has been good enough to lend me his 
only remaining copy of his memoir entitled, "El Colera, Desde el Punto 
de Vista de su Localizacion.^' 

On page 26, I find the statement that "so far as concerns the Philip- 
pines in part we know that cholera invaded the Islands in 1817 with 
terrific lethal force, but what we can not discuss on account of lack of data 
is the question of whether we should or should not assign to this disease 
as great antiquity in the Philippines as authors give to it in China and 
in Cochin-China." 

Dr. Masip y Vails gives a footnote in connection with tips paragra] 
which reads as follows: 



I 



"It was not enough that cholera should present itself in the Philippines sooni 
than in Europe. It would be supposed that the doctors had forgotten com- 
pletely all that concerned their scientific studies, for the reason that there is 
found but one poor memoir concerning the appearance of that epidemic in 1817, 
written by a military surgeon, who concealed his name, and printed in the print- 
ini^ office of the Franciscan Fathers of Sampaloc, in Manila." 

From this it would appear that Dr. Masip y Vails had documentary 
evidence to support the belief that cholera appeared in the Philippines at 
leafit as early as 1817. 

I am indebted to a Spanish gentleman, who was a resident of the 
Philippine Islands in 1882, for a copy of a pamphlet entitled, "Cuadros 
Grafieos del Desarrollo del Colera en Manila su Provincia y Hospitales 
de Colericos Establecidos en la Capital segun Datos de la Subdelegacion 
de Medicina, Manila, 1883." This publication gives curves showing 
the admitted cases in the city of Manila, in the entire Province of Manila, 
and those in each of the five Manila cliolera hospitals. 

From the first of these curves it would appear that cholera broke out 
in Manila on the 20th of August, 1882, on which date there were 22 
deaths; that it reached its maximum on the 2d of September with a 
total of 339 deaths, and then declined rapidly until the 22d of September 
on which date there were but 14 deaths. After this time the deaths 
remained constantly low, tlie largest number on any one day being 



ng 3^1 



13 

the epidemic terminating on the 5th of December with a total of 5,413 
deaths. 

Unfortunately, as the gentleman remarked who furnished me this 
publication, it represents the official truth and not the reah truth. A 
comparison with Dr. Calderon's statistics hereinbefore given will show the 
contradictions that exist even in such records as were kept : 



Date. 



'Cuadros 
Gra- 
ft cos," 
deaths. 




August 28. 
August 29. 
August 30 
August 31 



It will be noted that if both of these tables are correct the number 
of deaths on three days was materially in excess of the total number of 
cases ! The truth is that deaths occurred so rapidly that no record was 
kept of them except when the deceased were persons of some little im- 
portance. 

The curve giving the deaths for the Province of Manila with those 
for the city of Manila shows that the epidemic began on the 20th of 
August with 20 deaths, reached its maximum on the 4th of September 
with 619 deaths and ended on the 5th of December, and that the total 
number of deaths for the city and Province of Manila during this period 
was 13,377. 

Included within the Province of Manila were the towns of Caloocan, 
Malabon, Navotas, [N'ovaliches, San Juan del Monte, Mariquina, San 
Mateo, Montalban, San Pedro Macati, Pasig, Pateros, Taguig, Pineda, 
Malibay, Paranaque, Las Pinas, and Muntinlupa, in addition to the ter- 
ritory at present included within the limits of the city of Manila. 

Doubtless the statement fpr the province is as far below the ti-uth as is 
the statement for the city of Manila alone. 

The curves for the several hospitals show cases and deaths as foUows: 



Hospital. 


Cases. 


Deaths. 


Tondo 


490 
408 
663 
289 
213 


340 


Malate __._ 


220 


San Lazaro- 


426 


Santo Tomas _ . 


129 


Tanduav 


128 








Totals 


2,063 


1,243 





In only one instance have I succeeded in getting any check on these 
latter figures. Dr. Ariston Bautista Lin states that he was employed 
in the Santo Tomas Hospital at the time, and that according to his 
recollection during the first month there were some 600 admissions and 



14 



1 

rhicm 



400 deaths ! 1 am forced to the conclusion that the statistics on w 
these curves are based are very unreliable. 

In 1884, in describing an epidemic of beriberi which occurred at Manila 
during the years 1882 and 1883, Koeniger (Ueber Epidemisches Auf- 
treten von Beriberi in Manila, 1882 and 1883, Deutsch Archiv. fur Klin. 
Medizin, 1884, 35, 419) .incidentally refers to this outbreak and mak 
the following statement in regard to it : 

"From August to October, 1882, Manila was visited by a severe cholera 
epidemic, which there found a fertile soil, carrying off fifteen to twenty thou- 
sand victims. A panic occurred among the natives as well as among the European 
population, because cholera had not been present since 1865, and as the mortality 
was more tlian 75 per cent. After the epidemic had subsided, on October 20 a 
terrible typlioon visited the city and province and destroyed all suburban houses 
built of light materials." 



?l 



There is a rather striking difference between Koeniger's figures oi 
15,000 to 20,000 deaths and those published in the Official Gazette, whicl 
gives 2,108 as the number of deaths occurring in Manila in 1882; am 
those in "Cuadros Graficos" which give 5,413. 

I have been informed by persons living in Manila at the time that for 
considerable period deaths were believed to have occurred at the rate oj 
about a thousand per day. 

Father Chouza informs me that on a single day, when the epidemic 
was at its worst, there were 1,300 deaths; that there were not sufficieni 
persons employed at the cemeteries to bury so large a number of dea( 
and that Governor-General Primo de Rivera sent a battalion of engineer^ 
to the La Loma Cemetery to assist in the work. 

Dr. Eliodoro Mercado, who was a medical student at the time of this" 
epidemic, states that when it was at its worst one could not pass alon^ 
Calle Cervantes or through the San Lazaro estate on account of the odoi 
from decaying bodies. 

I have been informed by credible witnesses, who lived in Manila at 
the time, that the streets leading to the cemeteries were often completely 
blocked with calesins, carromatas, victorias, carts, and other vehicle 
canying the bodies of the dead. 

It is a well-known fact that under Spanish rule it was the custom 
prohibit the dissemination of information as to the prevalence of dangei 
0U8 communicable diseases. 

Much may be said in favor of such a policy, as the popular alarm 
incident to an outbreak of epidemic disease often tends to create conditional 
which facilitate its spread. In view of the determined effort so recentlj^' 
made in San Francisco to conceal the presence of bubonic plague in that 
city, Americans certainly can not afford to be hypercritical in considering" 
the policy pursued by the Spanish Government in these Islands relative 
to the making known of the truth in regard to the prevalence of cholera. 

However, as our own policy has always been to publish the exact trutl 



itP' 
eril 



15 

so far as obtainable, relative to the prevalence of communicable diseases, 
it must be clearly remembered that no direct comparison between the 
Spanish health statistics and our own is possible. 

Familiar as we are with the general policy pursued by the Spanish 
Government in this matter, it becomes important to ascertain whether 
there was any deviation from it in connection with the epidemics which 
began in 1882 and 1888, respectively. I am informed by reliable Spanish 
citizens who were present in the Philippines at the time and whose 
oflBcial position was such that they were necessarily cognizant of the facts, 
that there was no such departure. It is commonly stated that the great 
typhoon which occurred on October 20, 1882, terminated the epidemic 
which began in that year, but this is not the case. It is doubtless true 
that the number of cases had become greatly diminished at the time of 
tliis storm and advantage was taken of this fact and of the occurrence 
of the storm to state that the epidemic had ended and to assign a cause 
for its cessation which would appeal to the imagination of the common 
people. 

The truth is that the Governor-General gave orders that after a certain 
date no more cases of Asiatic cholera should be reported as such but that 
they should be called " enter o-coUtis," "g astro-enteritis/' or ''cholera nos- 
tras" and this was done. A special ward was set aside at the San Juan 
de Dios Hospital for the continued treatment of cholera cases which were, 
however, diagnosed as directed by the Governor-General. 

The policy of concealing the existence of cholera in Manila and of 
reporting deaths from it as having been occasioned by other diseases was 
steadily followed until the cases again became so numerous in 1888 that 
further concealment was hardly possible. At this time certain Spanish 
physicians of the city, being convinced of the imperative necessity for 
taking active measures for holding the disease in check, appointed one of 
their number to call on Governor- General Weyler and inform him that 
cholera was present and that the number of cases was such as to offer a 
very serious menace to the public health. The gentleman thus delegated 
to visit the Governor- General is to-day a resident of the city of Manila 
and informs me that the Governor-General, after listening to him, replied 
that he knew why he had come to him; that what he really wanted 
was eight hundred or a thousand pesos a month as additional salary to 
divide with his colleagues ; that he would not give them a cent ; and that 
there was no cholera in the city! On being interrogated as to what name 
should then he assigned to the "prevailing ailment" he made the inquiry; 
"Why do I have doctors?" In this case a word to the wise was naturally 
sufficient and the unfortunate envoy wag elected by his colleagues to take 
charge of the cholera ward at the San Lazaro Hospital where the victims 
of the disease were entered as suffering from other complaints. 

Later when it suited the purpose of the Governor-General to discredit 
the chief health officer and when, indeed, cases had become so numerous 



16 



that concealment was no longer possible, the presence of cholera was 
^rnnounced, and the chief health officer was savagely assailed for having 
allowed it to enter the Islands, although in point of fact it is well knoww 
to have originated in the vicinity of Taytay. W 

In view of these facts it seemed to me very important, in attempting 
to trace the history of cholera in the Philippines, to ascertain the number 
of deaths ostensibly due to "entero-colitis," "gastro-enteritis" and "cholera 
nostras" under which headings cholera deaths were entered. fl 

Through the courtesy of the Most Eeverend Jeremiah J. Harty, Arch- 
bishop of Manila, all existing church records of deaths in the city from 
1883 to 1897, inclusive, have been placed at my disposal, and with the 
kind and invaluable assistance of Father Chouza, who has supervised 
the compiling of statistics therefrom, the following facts have been 
ascertained : 



Year and 
month. 


"Ente- 
ro-coli- 
tis"and 
"gas- 
tro-en- 
teritis" 


"Chol- 
era." 


Total 
deaths 
from 
chol- 
era. 


Total 
deaths, 

all 
causes. 


Year and 
month. 


"Ente- 
ro-coli- 
tis"and 
"gas- 
tro-en- 
teritls" 


"Chol- 
era." 


Total 
deaths 
from 
chol- 
era. 


Total 
deaths, 

all 
causes. 


1883. 

January 

February 

March 


29 

116 

118 

120 

212 

87 

104 

28 

20 

25 

11 

8 


♦ 13 

68 
72 
91 
107 
62 

'^ 


42 

184 

190 

211 

319 

149 

181 

37 

20 

26 

11 

8 


1,581 
717 
675 
658 
792 
569 
584 
411 
300 
303 
319 
373 


1886. 

January 

February 

March 

April 


22 
23 
13 
12 
17 
19 
29 
15 
32 
19 
20 
19 


2 
-. 

-- 
_. 
1 


22 
24 
15 
12 
17 
20 
29 
15 
33 
19 
22 
20 


200 
207 
206 
162 


May 


May 


147 


June 


June . 


180 


July 


July 


213 


August 


August 

September 

October 

November 

December 

Total 

1887. 

January 

February 

March 

April 


205 


September 

October 

November 

December 


235 
263 
257 
267 


Total 


878 


500 1 1,378 


7,282 


240 


8 


248 


2, 542 


1884. 

January 

February 

March 


2 
9 
8 
1 
3 
6 
8 
7 
11 
5 
4 


i" 


2 
9 
8 
2 
4 
8 
8 
7 
11 
5 
4 
6 


455 
561 
787 
394 
286 
205 
272 
305 
365 
402 
356 
347 


13 
12 
20 
25 
23 
52 
70 
42 
19 
48 
32 
38 


1 
_- 

-- 


14 
12 
20 
25 
23 
54 
70 
42 
19 
48 
33 
38 


239 
201 
228 


At>ril 


224 


May 


May 


242 


June 


June 


324 


July 


Julv 


304 


August „ 


August 

September 

October 

November 

December 

Total 

1888. 

January 

February 

March 

April 


288 


September 

October 

November 

December 


296 
322 
423 
432 


Total 


70 


4 


74 


4,735 


394 


4 


398 


3, 523 


1885. 

January 

Febniary 

March 


4 

4 
6 
10 
4 
1 

10 
20 
13 
14 
10 
8 


.- 

2 

1 


4 
4 
7 
10 
4 
1 

10 
24 
15 
15 
10 
8 


286 
250 
224 
244 
205 
176 
192 
215 
227 
220 

1H8 

234 


33 
21 
21 
29 
28 
81 
5S 
79 
72 
36 
26 
50 


._ 

.- 

12 

115 

2 

1 
1 


33 
21 
21 
29 
29 
31 
54 
91 
187 
38 
27 
51 


391 
304 
260 
274 


April 


May 


May 


316 


June 


June 


278 


July 


July- 


322 


August 

September 

October 

Nt)veml>er .. 

Dec«ml)er 


August 

September 

October 

November 

December 

Total.-.. 


362 
619 
372 
374 
365 


Total 


104 


8 


112 


2,661 


479 


133 


612 1 4,237 



17 



Year and 
month. 



"Ente- 
ro-coli- 
tis"an{i 
"gas- 
tro-en- 
teritis" 



January 

February _. 

March 

April 

May 

June 

July 

August 

September . 

October 

November . 
December. 



Total- 

1890. 

January 

February _. 

March 

April 

May 

June 

July 

August 

September . 

October 

November . 
December.. 



Total. 



1891. 
January ... 
February _. 

March 

April 

May 

June 

July 

August 

September . 

October 

November . 
December.. 



31 

14 
40 
60 
28 
34 
67 
109 
50 
22 
12 
20 



487 



15 
23 
28 
36 
35 
123 
141 
95 
29 
33 
27 
31 



Total. 

1892. 

January 

February .. 

March 

April 

May 

June 

July 

August 

September . 

October 

November . 
December- 



Total. 



January.. 
February 
March ... 

April 

May 

June 

July 



616 



42 



'Chol- 
era." 



16 

207 

288 

29 

16 

25 

10 

2 



595 



715 



40 
32 
40 
28 
70 
166 



Total 
deaths 
from 
chol- 
era. 



14 

56 

267 

316 



134 
60 
24 
12 
20 



1,082 



16 
23 
28 
36 
35 
127 
141 
96 
29 
33 
27 
31 



622 



Total 

deaths, 

all 



283 
391 
740 

875 



427 
229 
275 
223 
237 



218 
221 
249 
322 
293 
404 
432 
351 
249 
270 
351 
402 



490 



104 
53 
46 
57 
45 



715 



40 
32 
40 
28 
70 
166 



3,762 



492 
527 
503 
465 
538 
345 
407 
462 
483 
436 
352 
313 



5,323 



352 
301 
301 
317 
317 
305 
'426 
439 
356 
414 
463 
426 



4,417 



287 
379 
450 
527 
464 
592 



Year and 
month. 



"Ente- 
ro-coli- 
tis"and 
"gas- 
tro-en- 
teritis" 



1893— Cont'd 

August 

September _. 

October 

November __ 
December 

Total. 

1894. 

January 

February ._ 

March 

April 

May 

June 

July 

August 

September _ 

October 

November _ 
December. _ 

Total. 

1895. 

January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Total. 

1896. 

January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Total. 



1897. 

January 

February .. 

March 

April 

May 

June 

July 

August 

September . 

I October 

November . 
December.. 



Total. 



Ill 



703 



30 
59 
139 
108 
62 
42 
39 
57 



"Chol- 
era." 



665 



47 

35 

32 

30 

45 

163 

202 

171 

91 

56 

46 

36 



954 I 



44 

52 

51 

49 

57 

172 

270 

168 

76 

45 

71 

51 



1,106 



Total 
deaths 
from 
chol- 
era. 



Ill 
62 



703 



59 
139 
108 
62 
42 
39 
57 



665 



45 

163 

202 

171 

91 

56 

47 



955 



44 

52 

51 

49 

57 

172 

270 

168 

76 

45 

71 

51 



1,106 




78079- 



Jl 



18 

From these tables it appears that in spite of prohibitions some deaths 
were recorded as being due to cholera during each year of this period 
except 1892, 1893, 1894 and 1896, and that during these latter years the 
deaths from "entero-coUtis" and "gastro-enteritis" were 715, 703, 665, 
and 1,106, respectively. 

While it is doubtless true that some of these deaths wore due to acute 
intestinal troubles other than Asiatic cholera, such for example as cholera 
nostras, the important fact is that they were believed to be Asiatic 
cholera and that, judging from the observed facts relative to the occur- 
rence of cholera nostras, this belief was doubtless well founded in most 
cases. 

It must be remembered furthermore that the records of Malate and 
those of Binondo up to 1894 furnish no information, as no statements of 
the causes of death were given; a large number of deaths occurring in 
Intramuros were also recorded without any statement of the cause of 
death ; all of the records of the Paco Church were burned in 1889 ; and 
finally the area included within the city of Manila in Spanish days was 
materially smaller than that included within the present city limits. 

The annual death rate per thousand has steadily fallen since tl 
establishment of the Board of Health and is now certainly lower than it 
was during the period covered by these statistics. The average annual 
number of deaths for the past five years has been 9,522. When this 
total is compared with the average annual number of deaths given in 
these church records as 4,708, it is evident that considerable less than 
half of the deaths which must actually have occurred in the regie 
included within the present limits of the city of Manila are recorded. 

Supplementing these very interesting figures. Dr. Eliodoro Mercado 
has stated to me that when he was serving in the San Juan de Dios 
Hospital in 1885, five or six cases of true cholera were being brought 
to that institution daily. As usual, however, they were not entered as 
cholera cases. __ 

So far as concerns the provinces, information relative to the conceaJ| 
ment of the presence of cholera is more difiicult to obtain, but through, 
the presence in Manila of a Spanish physician who was assigned to duty 
in the Province of Cagayan in 1884, I have learned that there was an 
epidemic there during that year. It was not so widespread as the . 
previous one, nor was the infection so virulent, nevertheless the loss of 
life was considerable. All of the precautions which would naturally be 
taken in dealing with cholera were adopted, hut it was deemed best to 
conceal the true nature of the disease. 

Let us have done then with idle talk about the good old days when 
cholera did not prevail in the Islands to any such extent as at present. 
Let us remember that there was one day in 1882 when the number of 
deaths from cholera in Manila was thirty-four times the largest number 
that has occurred on any one day since the American occupation! Let 
us not forget that the epidemic which is variously stated to have be^ 



II 



H 



19 

in 1817, 1819, and 1820, at all events continued during the years 
1821, 1822 and 1823 and recurred in 1830 ; also that epidemics of cholera 
occurred in 1842, 1854, 1863-1865, 1882-1885, 1888 and 1889; that 
the officially admitted mortality for 1888 and 1889 in the city of Manila 
was 2,403 and in only a portion of the provinces to which the disease 
is known to have extended at that time was lQ,Q>Qt^', that a reliable 
German physician places the mortality in Manila during 1882 alone 
at 15,000 to 20,000, and that very incomplete figures for the provinces 
during the years 1882 and 1883 give the deaths at 76,884; and finally 
that cholera cases occurred at Manila during 1886, 1887, 1890, 1891, 
1892, 1893, 1894, 1895, 1896 and 1897, the least recorded number 
during any one of these years being 248 in 1886 and the greatest 1,106 
in 1896. 

THE EPIDEMIC OF 1903-1904. 

On March 3, 1902, the attention of the Chief Quarantine Officer of the 
Philippine Islands was called to the existence of Asiatic cholera in Can- 
ton, China. Five days later it was reported to be in Hongkong. Manila 
had been depending largely upon Canton for* green vegetables. Notice 
was at once sent to the officer of the United States Public Health and 
Marine-Hospital Service at Hongkong that all vegetables not certified by 
him would be refused admission, and on March 19th an order was issued 
to the Chief Quarantine Officer of the Philippine Islands forbidding the 
further importation of green vegetables, while as an additional precaution 
the Commissioner of Public Health instructed his subordinates to report 
immediately all cases of persons suffering from bowel trouble of a 
suspicious character. 

On March 20, at 2.30 p. m., it was found that two patients in the 
San Juan de Dios Hospital were developing symptoms of cholera. Speci- 
mens of their dejecta were taken by the Director of the Biological Labora- 
tory, cultures were immediately prepared therefrom and on the following 
morning it was definitely known that the disease was truly Asiatic cholera. 
Later in the day on March 20 two additional cases developed. On the 
21st there were 6, on the 22d, 4, on the 23d, 8, and on the 24th, 14. 
Thus the cholera epidemic of 1902-1904 began. 

Very energetic measures were immediately adopted to prevent the 
spread of the disease. These measures aroused hostility, and the officers 
of the Board of Health, as well as the Secretary of the Interior, were 
savagely attacked in the public press for saying that the disease was Asiatic 
cholera. Re^_^table_ghy§ician&. who had lived in the country for years 
insisted that it was not, stating that a similar disease came every year just 
before the rains or at the time of harvesting the new rice; that it was due 
to climatic conditions or to the eating of rice not fully matured, and that 
it was not contagious. 

•^As to the origin of this epidemic, it is definitely known that a quantity 
of condemned Chinese vegetables were thrown overboard from a steamer 
in the bay, in violation of orders, and were in part washed ashore in the 



20 

Farola district of Manila, and it seems probable that some of these were 
eaten without being properly cooked by the people of that district, where 
the first cases appeared. 

However, in view of the emphatically reiterated statements of local 
physicians that a disease identical with that which presented itself at this 
time, and which proved to be Asiatic cholera, had occurred annually for 
many years there would seem to be good reason for believing that cholera 
of a mild form had been endemic in the Islands and that this epidemic 
was merely a recrudescence. 

In order to convince the public of the true nature of the disease and 
of the necessity of vigorous and radical measures if a general epidemic 
was to be avoided, the official statement of the Director of the Biological 
Laboratory was widely published but this, too, failed of its purpose and 
for several months there were not lacking intelligent laymen and even 
physicians who insisted that there was no cholera in the Islands. Un- 
fortunately, their belief was ill founded and the epidemic which began on 
March 20, 1902, did not terminate in Manila until February 29, 1904, 
prior to which time there were 5,581 cases and 4,386 deaths, while in the 
provinces it lasted until March 8, 1904, with 160,671 cases and 105,075 
deaths. 

In considering the spread of the disease I shall trace its course, first, 
in Manila, and then in the provinces. 

THE EPIDEMIC IN MANILA. 

The cases and deaths were as follows : 



Month and year. 


Total 
cases. 


Deaths. 


Month and year. 


Total 
cases. 


Deatfl 


1902. 
March 


108 
586 
550 
601 
1,368 
720 
273 

87 
336 

35 

7 
2 
6 


90 
406 
442 
492 
1,053 
581 
179 

57 
236 

24 

4 

1 
6 


1903— Continued. 
April 


33 

230 

39 

42 

89 

290 

127 

31 

14 

4 
3 


97 


April 


May 

June _ 


212 


May 


38 


June 


July 


38 


July 


August 


72 


August 


September _ 


263 


September 


October 


118 


OctolK-'r 


November 


26 


November 


December 


13 


December. 


1904. 
January ___ 




1903. 


5 


Januarv 




3 


February 

March 


Total 




5,581 


4 386 









On March 23, 1904, the Board of Health adopted the following 
resolution : 

Whereas the last case of Asiatic cholera occurred in the city of Manila on 
February 29, 1904, there having been but four positive or suspected cases of 
Asiatic cholera in the city of Manila since January 6, 1904; and 

Wliereas the provinces adjacent to Manila have been free from cholera during 
the present year: On motion 

Resolved, That the city of Manila is, and is hereby declared, free from the 
infection of Asiatic cholera. 



Jl 



21 

MEASURES ADOPTED IN 1902 TO HOLD CHOLERA IN CHECK. 

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 21 I informed General Chaffee that four 
cases of cholera had occurred in Manila and requested that an adequate 
military force be dispatched to the valley of the Mariquina Eiver to 
protect the city water supply from possible contamination. 

This request was promptly acceded to and the guard thereafter main- 
tained 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 the people to bathe and wash their clothing in its waters. 

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 restric- 
tions, believing as many of them did 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 
w^ork 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 he 
cholera, as if it were there would be a thousand deaths a day! 

(An educational campaign was immediately begun and simple directions 
for" avoiding cholera were published and scattered broadcast. Distilled 
water was furnished gratis to all who would drink it, stations for its dis- 
tribution being established through the city, supplemented by large water 
wagons driven through the streets. The sale of foods likely to convey 
cholera was prohibited. Large numbers of emergency sanitary inspectors 
were immediately appointed and every effort was made to detect alLcases 
as soon as possible. A land quarantine was established about the city;! 

In anticipation of a possible extensive outbreak of contagious disease 
a detention camp capable of accommodating some 2,500 people had been 
established on the San Lazaro grounds, and to this place were taken the 
cholera "contacts." A cholera hospital was also established on these 
grounds and the sick were rernoved to it from their homes as speedily as 



22 



T! 



possible, the buildings which they had occupied being thoroughly 
infected or burned when 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 not only "contacts" 
but the sick as well 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 clamor a hospital under strictly Filipino ma~ 
agement was opened in a nipa building in Tondo. Interest in it soon 
flagged and the Government found itself with this institution on its 
hands. ^1 

DIFFICULTIES ENCOUN'TERED. S 

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 so many 
reputable medical men that the disease was not cholera at all were suf- 
ficiently great, but they were enormously increased by false and malicious 
tales 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" and instantly dropped dead, that the distilled water distributed 
free of charge was poisoned, and that the Americans were poisoning the 
wells. 

The necessaiy 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. fl 

These silly tales were widely circulated and quite generally believSr 
and as a result of the fear thus engendered, and of the desire on the 
part of relatives and neighbors of the sick 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. 

The maximum number of cases for any one day in March was 15. 
In April it was 38, this number occurring on the 30th of that month. 



23 

On tlie 1st and 14th of Ma}^ 38 cases were again recorded and there then 
began a rapid and quite steady decline. On the 24th there were 6 cases, 
on the 28th, 5, and on the 31st, 5. 

In June, however, the number began to creep up again reaching a 
maximum of 42 on the 30th. During July it grew steadily larger and 
on the 25th of that month there were 91 cases, the largest number which 
has ever occurred in Manila on any day since the American occupation. 

A NEW COMMISSIONER OF PUBLIC HEALTH APPOINTED. 

Throughout the early months of the epidemic Major Maus had labored 
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 and it 
became evident that while he was quick to throw an organization into 
the field he easily became discouraged and then wanted to smash his 
machine and build a new one to take its place. 

He had applied for leave of absence and advantage of this fact was 
taken to arrange for his successor. On May 17 orders were received from 
the Adjutant-Generars Office providing for his relief on or about July 
30, and stating that Maj. 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. 

It was known that he would arrive early in August and the original 
intention was to have him substitute Major Maus as soon after his arrival 
as he could become familiar with his duties, but the startling increase 
in the number of cholera cases during July coupled with the fact that 
Major Maus was obviously upon the verge of a nervous breakdown, led 
the Acting Civil Governor to accept his resignation on the 31st without 
waiting for the arrival of his successor. 

Dr. Frank S. Bourns, who had been a major of Volunteers in the 
Army Medical Corps, and had refused appointment as Commissioner of 
Public Health when the position was offered to him by Governor Taft 
prior to the appointment of Major Maus, was urged to give up his private 
business and take charge temporarily until the cholera situation in 
Manila was again brought under control. 

Up to that time the cases by months had been for March (twelve days 
only), 108 cases; April, 586 cases; May, 550 cases; June, 601; July, 
1368, and the average for the week preceding the acceptance of Major 
Maus' resignation had heen 61 per day, a figure never once reached 
since. 

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 



24 



1 



was left free to carry out the special work for which he had been ap- 
pointed. 

This he did with promptness and dispatch, the number of cases for 
August being but 720 as against 1,368 for the previous month. On 
the 8th of September, having brought the situation well in hand he 
insisted on resigning in order to attend to his private affairs, which we™j 
suffering from neglect, and his resignation was reluctantly accepted. 

Dr. Bourns' remarkable success in dealing with a very bad situa- 
tion was largely due to his readiness to adopt measures which, while 
thoroughly effective, were less harsh and irritating to the public thaJHI 
were those which had been employed by his predecessor. " 

The policy which he had inaugurated was followed by his successor 
with the result that the cases fell to 275 in September and 88 in October. 
In November there was a slight recrudescence, the total number of cases 
reaching 341, the maximum number on any one day being 44, but the 
disease did not again threaten to escape control and in February 
practically disappeared there being but two cases during the entire month. 

In March there were six cases, in April 32, and in May, possibly 
owing to the unfavorable climatic conditions which occur during that 
month and which, according to Spanish and Filipino physicians, had 
favored the development of the disease resembling cholera during 
previous years, there were 230 cases. In June the number fell to 3SH| 
In July it was 42; in August, 89; in September, 290; October, 127™' 
November, 31 ; December, 14 ; January, 4 ; and in February the number 
was 3. In March there were no further cases and thus the epidemic of 
1902-1904 ended in Manila with 5,581 cases. 

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. Ml 

At the beginning of the epidemic the detail of medical officers fron^ 
the United States Army was requested, and within ten days thirty-one 
were assigned to duty with the Board of Health. During the first two 
weeks of the epidemic 1,500 men, nearly all Americans, were employed 
and the number of employees was subsequently increased until it reached 
about 5,000. 



THE EPIDEMIC OF 1902-1904 IN THE PROVINCES. 



4 



'_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 Presidents of Provincial 



25 

Boards of Health, aided, when practicable, by medical inspectors from 
Manila. 

The following table gives the results in summary form : 

Table showing in summary form the cholera cases and deaths in the provinces during 
the epidemic of 1902-1904. 



Month and year. 



1902 

April 

May 

June 

July 

A\igust 

September 

October 

November 

December 

1903. 

January 

February 

March 

April 

May 



Number 
of cases. 



1,927 

2, 407 

5,204 

7,757 

11,247 

43,346 

30,837 

12,353 

5,918 



4,921 
2,997 
1,903 
1,772 
1,402 



Num- 
ber of 
deaths. 



1,417 
1,631 
4,097 
5,807 
7,874 
27, 410 
18, 572 
6,681 
3,583 



2,757 
2,009 
1,124 
1,147 



Month and year. 



1903— Continued 

June 

July 

August- 

September 

October 

November 

December 

1904. 

January 

February 

March 

April 

Total 



Number 
of cases. 



3, 554 
4,167 
10,212 
4,613 
2, 531 
1,119 
364 



160, 671 



Num- 
ber of 
deaths. 



2,945 
2,806 
7,406 
3,672 
1,969 
937 
270 



105,075 



Table shoicing, by 7nonths, the provinces infected by cholera, icith the total 
number of cases and deaths during each month. 



Month, year, and provinces. 


Cases. 


Deaths. 


Month, year, and provinces. 


Cases. 


Deaths. 


1902. 

April: 

Bulaean 


1, 927 

J 

■2,407 
■5,204 


1,417 

1,631 
4,097 


1902— Continued. 

July— Continued. 
Zambales 


1- 7,757 

11,247 

J 


5,807 


Rizal 




Cavite _ __ 


Ilocos Sur 




Bataan._ __ _„_ 


Cebu 




Camarines __ 


Ilocos Norte 




Pampanga . 


Sorsogon 




Pangasinan _ 


Bohol 




Tarlac __ 


August: 

Bulaean .__ 




May: 




Bulaean 


Rizal 




Rizal 


Cavite 




Cavite _ 


Bataan 




Bataan _ 


Camarines 




Camarines 






Pampanga . 


Pangasinan 




Pangasinan __ 


Tarlac 




Nueva Ecija 


Leyte 




Levte 


Batangas 




Batangas __ 


Laguna 




Laguna __ 


Samar 




Samar 






June: 


Tavabas 




Rizal 




7 874 


Camarines 


Union 




Pampanga _ _. 






Laguna _ 


Cebu 




Mindoro 


Ilocos Norte 




Tayabas. __ 






July: 


Bohol 




Rizal 


Albay 




Camarines 


Negros Occidental 




Pampanga 


Iloilo 




Tarlac 


Benguet 




Laguna 


Masbate 




Marinduque 


Cagayan 






26 



Table showing, by months, the provinces infected by cholera, vnth the total 
numb&r of cases and deaths during each month — Continued. 



Month, year, and provinces. 


Cases. 


Deaths. 


Month, year, and provinces. 


Cases. 


Deatb 


1902— Continued. 

September: 
Rizal 


43,346 

1 
30,837 

1 
12,353 

• 5,918 
4,921 


27,410 

18,572 

6,681 
3,583 

2,757 


1903— Continued. 

February— Continued. 

Zambales 


2,997 

1 

• 1,903 

1,772 
1,402 

3,554 






Cebu 






Sorsogon. _ _ 




Tarlac 


Bohol 


2 a 


Laguna 

Union 


Albay _. 




Negros Occidental 






Surigao 




Ilocos Norte - 


Capiz 






Romblon 




Bohol 


Antique 


» 


Albay 

Iloilo „ 


Misamis 




Masbate 




Benguet 


March: 

Camarines 








Capiz 


Nueva Ecija 




Leyte 






Samar 




October* 


Zambales _ 




Rizal 


Cebu 




Camarines 


Sorsogon 


1 ] 


Tarlac 


Bohol 




Laguna 

Union 


Negros Occidental 




Capiz _ 






Antique _ 




Ilocos Norte 


Misamis 




Sorsogon 


Masbate 




Bohol 


April: 

Rizal 




Iloilo 




Benguet 

Rnmblon 


Camarines 




Pampanga 






Leyte 




Misamis 


Samar 

Zambales 




Masbate 




November: 


Cebu _ _ 




Rizal 


Sorsogon 




Camarines 


Bohol 


1,- 


Tarlac 


Albay 




Ilocos Sur 


Negros Occidental 




Ilocos Norte , 


Surigao 

Capiz __ 




Sorsogon 

Bohol 




Negros Oriental 




Iloilo 


Misamis 




Benguet 

Surigao 


Cagayan 

May: 

Bulacan 




December: 




Camarines 


Rizal 




Ilocos Norte 


Cavite 




Sorsogon 

Bohol. 


Camarines 




Pampanga 




Iloilo ,. 


Leyte ,.— 




1908. 


Laguna 

Samar 




January: 


Cebu 




Rizal _ 




( 


(Camarines 


Sorsogon _ 

Bohol 

Albay 

Negros Occidental 

IloDo.. 

Capiz 




I'ampanga - 




NiK'Vtt Ecija 




Leyte 

Baungas 




Samar 




Zambales 

Cebu iniliri"..™!"" 


Misamis 

Masbate 




Soraogon 


Cagayan _ 

June: 

Bulacan 

Rizal 




Bohol.. 

Albay 




Negro* Occidental 




Cavite 




S^r.::;::-:---:: 


Camarines 

Pangasinan 




AnUque 


Levte - 




Mtaamta 

Maabate 

February: 


Batangas 

Laguna 

Samar 




riirnarincs ——«..._ 

lumpanga , 


Cebu... _ 

Ilocos Norte 


2.9^ 


Nufva EclJa 

Leyte — _- --_-^.. 

Baiangas 


Sorsogon 

Bohol 

A 1 bay 


J 



d 



27 



Taile showing, by months, the provinces infected by cholera, tvith the total 
number of cases and deaths during each month — Continued. 



Month, year, and provinces. 


Cases. 


Deaths. 


Month, year, and provinces. 


Cases. 


Deaths. 


1903— Continued. 

June— Continued. 
Negros Occidental 


1 
4,167 

■10,212 
. 4,613 


2,806 

7,406 
3,672 


1908— Continued. 

September— Contl nued . 

Union 


2,531 

1,119 
364 

}. 

■ 61 

} - 

1 




Iloilo 


Cebu 

Ilocos Norte. 




Caplz 

Misamis 




Bohol — _ 

Negros Occidental 




Masbate 






Iloilo 




Romblon 

Isabela 


Surigao 

Capiz 




July: 

Bulacan 


Antique.. 




Misamis 




Hizal 






Cavite 


Isabela 






October: 










Rizal 






Cavite . „ 






Bataan 




Batangas ' 


Camarines _ 






Tarlac 






Nueva Ecija 




Union 


Leyte 




Cebu 






Ilocos Norte 


Laguna 






Tayabas 




Albay 


Zambales 


1 969 




Union 




Iloilo 


Ilocos Sur 

Cebu 








Capiz 


Bohol 

Negros Occidental 




Antique 

Misauiis 




Iloilo _- 




Masbate 


Surigao 




Cagayan 


Capiz . . 




Nupva VizoftVR 


Antique 




August: 
liulacan 






Isabela 




Rizal - — — 


November: 

Bulacan . 




Cavite 






Rizal.. _ . 




Camarines 


Cavite _ _ __ 






Bataan 




Pangasinan 


Camarines 






Tarlac 






Nueva Ecija 




Leyte 


Ilocos Sur __ 


937 


li a tan gas 


Cebu 




Laguna 


Bohol 




Samar 


Negros Occidental 




Mindoro 


Iloilo 




Tayabas 


Surigao - 




Marinduque 


Capiz 






Antique 




Union 


December: 

Bulacan 








Cebu 


Rizal 






Cavite 






Bataan 




Bohol 


Tarlflc 




Albay 


Nueva Ecija 


270 




Ilocos Sur 


Iloilo 


Bohol 




Benguet 


Negros Occidental 






Iloilo 




Misamis 


Capiz 






Antique 




Cagayan 


1904. 
January: 

Nueva Ecija 




September: 
Bulacan 




Ri/al 




Cavite 


Cebu.. .. 


24 




Negros Occidental 






February: 

Negros Occidental 






42 


Nueva Ecija 


Iloilo 


March: 

Cebu 






10 




Capiz 


Marinduque 


April: 

Not stated 
















28 

CRITICISM OF THE 1902 CHOLERA CAMPAIGN. 



I 

iiis 
mt 

I 



During the period from March 20 to July 31, 1902, the campaign 
against cholera in Manila was under the immediate control of Maj. Louis 
M. Maus, of the United States Army Medical Corps, who was President 
of the Board of Health and Commissioner of Public Health for t 
Philippine Islands. 

However, the Commissioner of Health was under my control a 
the plan of campaign followed by him was adopted with my knowled 
and approval. In criticising it I am, therefore, in many instances, criti^ 
cising myself as well as him and shall endeavor to assume my full share 
of responsibility for the undoubted mistakes which were made. 

^he most serious blunder was the attempt to establish a land quaran- 
tine around the city of Manila for the protection of the neighboring 
provinces. This effort resulted in imposing serious and useless annoy- 
ance upon a very large number of persons and was entirely futile. It 
would have taken a good-sized army of soldiers to make it really effective, 
and even then cholera victims would probably have been smuggled out 
of the city by water at night. 

At the outset the cases seemed to be strictly confined to the Farola 
district, a small triangular area at the mouth of the Pasig Eiver, bounded 
by that stream, by Manila Bay, and by an estero or canal connecting the 
river with the bay. As soon as it became apparent that the disease w 
localized there I suggested that this district, which was covered for t] 
most part with filthy and almost worthless shacks, be burned over and tha' 
its inhabitants be ti-ansferred to the detention camp. The Commission 
of Health deemed it sufficient to guard it with a view to preventing 
escape of any of its inhabitants, removing the sick to the cholera hospita" 
and the "contacts" to the detention camp. On the second day I renewed 
my suggestion with emphasis, and on the third day embodied it in tlie 
form of a specific verbal order. This order was carried out, but un- 
fortunately the guard had proved insufficient to prevent the escape of 
a number of persons actually sickening with cholera who had scattered 
through the city and now began to start new foci of infection. I am 
of the opinion that if all the inliabitants of the Farola district had been 
removed at the outset to the detention camp and the district swept by 
fire and then drenched with disinfectants, the epidemic of 1902-1904 
might have been avoided. 

As it was, the detention camps at San Lazaro and Santa Mesa 
accomplished no good at all commensurate to the expense involved in 



ii 



29 

their maintenance and the popular prejudice produced by transferring 
to them the supposed cholera "contacts." 

The nipa barracks of the San Lazaro camp were barely completed 
when the epidemic broke out, and had not been furnished. It was neces- 
sary to equip tlnm very hastily and at the same time to provide com- 
missary facilities for a large number of people, and as a result the 
persons first sent to this camp suffered some material discomfort which 
added to the prejudice against the Board of Health. 

The tent hospital on the San Lazaro grounds was located in a shady 
place and served its purpose fairly well but the one at Santa Mesa was 
exposed to the blazing sun, and a tent hospital maintained under such 
climatic conditions as prevail in the lowlands of the Philippines is at 
best a very unsatisfactory affair. It would have been far wiser to 
secure at the outset a suitable building, like the convento ultimately 
occupied on Calle Herran. 

The cremating of so many of the dead, while from a strictly sanitary]/ 
point of view an admirable method of disposing of them, provoked much/ 
hostility and was, under the circumstances, a mistake. 

There was at the outset altogether too much destruction of property. 
Thorough disinfection should have taken the place of much of the 
burning that was indulged in. 

'Some abuses were perpetrated by sanitary inspectors and disinfectors. 
The guilty were severely punished whenever detected. It is doubtless 
true that not a few of them escaped detection but the responsibility 
for this must rest upon those who failed to make complaint rather than 
on the Commissioner of Public Health, who caused all complaints to 
be investigated promptly. 

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

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 at 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 the these resolutions to the honorable the Secretary of the Interior, 
the Municipal Board, the United States Marine-Hospital Service, and the Collector 
of Customs. 



30 



The following teble shows the order in which the provinces became 
infected and the prevalence of the disease in each : 



il 



Province. 



Rizal 

Bulacan 

Cavite 

Bataan 

Caniariiies... 
Panipanga — 
Pangasinan . 

Tarlac 

Nueva Ecija. 
Leyte 



Batangas 

La Laguna .. 

Samar 

Mindoro 

Tayabas 

Marinduque. 

Zambalcs 

La Union 

South Ilocos- 
Cebu 



North Ilocos. 

Sorsogon 

Bohol 



Albay 

Occidental Negros 

Iloilo 

Benguet (cholera got among the wild people of Ben- 

guet and the number of cases is not known) 

Surigao 

Capiz . 



Oriental Negros . 

Romblon 

Antique 

Misamis 

Masbate 

Cagayan 

Nueva V^izcaya.. 

Isjibela .* 

Miscellaneous—. 



First case. 



Mar. 23 

do_ 

Mar. 27 
Mar. 28 
Mar. 30 
Apr, 



1902 



Apr. 20 
Apr. 28 
May 8 
May 9 
May 20, 
May 23! 
May 29, 
June 10, 
June 13 
July 1 
July 3, 
July 6, 

July «: 

July 14, 
July 24, 

do_ 

July 29, 
Aug. 15. 
Aug. 18: 
Aug. 24, 



1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
1902 
190-2 
1902 
1902 
1902 
19J2 

1902" 
1902 
190i 
1902 



Sept. 5, 
Sept. 8, 
Sept. 29, 
Sept. 30, 
Oct. 2, 

do- 

do- 
Apr. — , 
July -, 
Sept. — , 



1902 
1902 
1902 
1902 
1902 



1903 
1903 



Last cas-a. 



Dec. 
Dec. - 

do 

do 

Nov. - 
Aug. - 
Sept. - 
Dec. - 
Jan. - 
Oct. - 

do 

do 

Aug. - 

do 

Oct. - 
Sept. - 
Oct. - 

do 

Dec. - 
Mar. - 
Sept. - 
Mar. - 
Dec. - 

do 

Feb. - 
do 



i, 1903 
-,1903 



,1903 
,1903 
,1903 
,1903 
,1904 
,1903 



,1903 



1903 
,1903 
1903 



,1903 
,1904 
,1903 
,1903 
,1903 



1904 



Nov. 

Mar. 

Apr. 

June 

Dec. 

Sept. 

Aug. 

Oct. 

July 

Oct. 



-, 1903 
-, 1904 
-,1903 
-, 1903 
-, 1903 
-, 1903 
-, 1903 
-, 1903 
-, 1903 
-, 1903 



Total 



1,263 

1,823 

876 

1,267 

1,403 

1,209 

7,771 

986 

1,905 

1,445 

3,433 

2,981 

1,391 

308 

376 

608 

2, 161 

3,874 

1,584 

14,210 

1,694 

542 

2,706 

1,142 

8,564 

26, 427 

1 

1,022 

4, 650 

1,136 

200 

2, 485 

4,621 

497 

980 

1 

82 

53, 047 



760 

1,363 

634 

917 

1,045 

860 

5,478 

718 

1,514 

1,098 

2,718 

2,399 

1,345 

279 

246 

532 

1,412 

2,883 

1,067 

9,983 

1,228 

255 

1,877 

1,049 

2,553 

19, 095 

1 

749 

3,016 

861 

74 

1,798 

2,477 

291 

672 

1 

43 

31,78 



ll 



The total number of cases in the provinces was 160,671 and the total 
population for the infected provinces was 6,872,309, giving for the 
provinces infected one case to each 42.7 inhabitants, as compared to one 
case for each 45 inhabitants in Manila. 

It will be noted that cholera reached every province in the Islands 
except Abra, Lepanto-Bontoc, and Palawan. Abra, Lepanto-Bontoc, and 
Nueva Vizcaya (which had but a single case) all escaped when cholera 
was raging in neighboring provinces on account of their isolated position, 
which made it possible to maintain a thoroughly effective land quarantine 
on the few trails by which alone they could be reached. MM 

Palawan, on account of its isolated position, also escaped. " 

In Benguet the disease worked up the partially completed road to 
Camp Five and from there was scattered through the province by escap- 
ing Igorot carriers. As the people of this province were almost entirely 
non-Christians and as there was no health service among them, the 
number of cases and deaths was not ascertainable but it is known to 
have been considerable. 



31 

In most cases the presidents of provincial boards of health showed 
themselves entirely incapable of coping vrith cholera during this ejpidemic. 
Whenever thoroughly trained men could be spared from Manila they 
were sent to assist them, and demonstrated over and over again the 
quickness and certainty with which a provincial town may be rid of 
cholera by the local officials when working under competent direction. 
In case after case American medical inspectors went into towns where 
the deaths were running from 50 to 75 per day upon their arrival and 
within a week or two stamped out the disease completely. But the 
supply of such competent medical officers was wholly insufficient to meet 
the demand in the provinces, where as a rule matters were of necessity 
left entirely in the hands of the provincial and municipal boards of 
health. The epidemic finally wore itself out, ending quite suddenly. 

THE EPIDEMIC OF 1905. 

After a respite of nearly fourteen months, cholera, which had disap- 
peared in Manila on April 27, 1904, reappeared on August 23, 1905. 
In this instance there was no evidence that the disease was brought to 
the Philippines from any foreign country ; . on the contrary, like the 
epidemic of 1888, it appears to have originated in the vicinity of Taytay, 
Jalajala, and other towns on the Laguna de Bay. For several weeks 
prior to the outbreak there occurred at Manila a number of suspicious 
cases which clinically resembled cholera, but this diagnosis could not 
be confirmed bacteriologically. On August 23 the first typical case 
developed and curiously enough it occurred in Bilibid prison. Of this 
occurrence the Commissioner of Health said: 

"A case in an institution which is practically cut off from the remainder of 
the world; where all foodstuffs are permitted to enter only after the most rigid 
inspection; where all food served that could likely convey cholera is cooked at all 
times, and, on account of dysentery, it is said that all drinking water was 
sterilized; it would seem that the routine precautions thus taken should also 
have afforded protection against the cholera. The commencement of an outbreak 
in this insidious manner was most puzzling to the sanitary authorities, and the 
prospects of combating a disease who^e origin was so obscure were not 
encouraging." 

Later it was certainly shown that the disease had appeared at Jalajala 
on the Laguna de Bay, Province of Eizal, on August 20, while there 
was strong presumptive reason for believing that it had occurred at 
Taytay and several other lake towns on or before this date, and through 
the fault of local health officers had remained unreported. 

On August 25 an American woman residing at the Grand Hotel in the 
Walled City was attacked and on the same day an American man residing 
in a section of the city nearly 2 miles from this place was also attacked. 



32 



1 



Xo connection could be traced between these two cases nor could any 
history be obtained showing that the same articles of food likely to 
convey infection had been eaten by these two victims. 

At the end of the second week, beginning August 23, there had been 
137 cases, as compared with 125 for the same period during the epidemic 
of 1902-1904. 

However, the conditions for combating cholera were now far more 
favorable than in 1902. Maj. E. C. Carter, who succeeded Major Maus, 
had at his own request been relieved from duty as Commissioner of 
Public Health and Dr. Victor G. Heiser, passed assistant surgeon of 
the U. S. 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 24 medical inspectors, of whom 19 were Americans and 
5 were 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 
(there was one stray case in March), with a total of 283 cases and 243 
deaths. 

Table showing the cases and deaths from cholera in Manila during 
the epidemic of 1905: 



Month and year. 



August, 1905 

September. 1905 
October, 1905 — 
November,1905. 
December, 1905. 
January, 1906— 
February, 1906.. 
March, 1906 

Total 



51 

147 

31 

18 

3 
12 
15 

1 



278 



Deaths. 



46 
126 

29 

17 
8 

12 
4 
1 

243 



The first case occurred on August 23, 1905, and the last case on 
March 21, 1906, and between February 21, 1906, and May 8, 1906, there 
was but one case. 

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 build- 
ing with its cool wards and attractive surroundings made it possible to 
give cholera victims the best of care. The methods followed in this 
institution are fully given in a letter hereinafter quoted. (See p. 31.) 

While the disinfection carried out under the direction of Dr. Heiser 
was very thorough, it was conducted in such a way as to impose a 
minimum of inconvenience and property loss on private individuals. 



Jl 



33 

VICIOUS ATTITUDE OF A PORTION OF THE PUBLIC PRESS. 

There was at the outset little or no fear of the 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 American occupation 
has never let pass any opportunity to make trouble. As usual, tlie 
medium of attack was the local press. "Soberania Nacional" published 
a most extraordinary article painting in vivid colors the alleged horrors 
of the San Lazaro Hospital and stating among other things that the 
naked bodies of the dead, tagged and ivith the feet tied together, lay 
about the entrance of that institution. A more viciously 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 neighboring provincial towns. 

I sent the editor of this paper a courteous invitation to call at my 
office, believing that he must have been misled by some wild canard. 
He made no response. 

The following correspondence ensued : 

To the Editor of El SoBEBANf a Nacional, 

Manila, P. I. 

Sir: In your issue of the 7th of July there appeared a paragraph embodying 
a shameful libel on the administration of the San Lazaro Hospital, which 
reads as follows: 

•*Un cuadro verdaderamente aterrador es el que presenta el patio del Hospital 
de San Lazaro. Los fallecidos por la enfermedad del colera, son expuestos des- 
nudos en el atrio de dicho Hospital con un cartel atado en los pies con la 
inscripcion de sus respectivos nombres." 

This statement was so grossly and ridiculously false and at the same time so 
extremely harmful in its effect as to bring you fairly and squarely within the 
reach of the law. 

Yesterday morning I sent you a courteous letter requesting you to come to my 
office, purposing to discuss the affair with you in a friendly manner, and hoping to 
find that the statement referred to had been prepared by some irresponsible 
subordinate and published through oversight. 

As, however, you have neither acceded to my request for a conference nor 
had the courtesy to reply to mj letter, I now have the honor to forward you 
herewith a communication which embodies a reply to the false statement above 
referred to and at the same time conveys information as to what is actually 
being done at the San Lazaro Hospital. I request that you give this letter 
immediate publicity through your paper, and in the editorial columns or else- 
where in some conspicuous place retract immediately and fully the libelous 
statement relative to the exposure of the dead, above referred to. 

Kindly advise me of your intention in the matter. The bearer of this commu-. 
nication has instructions to wait for your reply. I shall interpret failure to! 
hear from you by return messenger as refusal to retract this slander and to 
publish the enclosed communication, and shall act accordingly. 
Very respectfully. 

Dean C. Worcester, 
Secretary of the Interior. 
78079- 3 



34 

[Soberania Nacional and Kapangyarihan ng Bayan, Independent Philippine newspaper. 

Mr. Dean C. Worcester, 

Secretary of the Interior, Manila, P. I. 

Sir: I have the honor to acknowledge the receipt of your letter dated the IS 
instant, and in doing so, I take pleasure in informing you that the letter to which 
you refer has unfortunately not reached me, 

I am very sorry that a lack of courtesy has been attributed to me because 
of no reply from me having been received; but in view of my not having learned 
of the existence of this letter for me, I was hardly able to guess what you told 
me in the same, and I therefore protest against the charge of discourtesy made in 
your letter. 

I am the first to desire that matters of the sort which gave rise to our report 
of the 7th of July should be taken up with the authorities in a friendly manner, 
because I believe that this is the most efficacious means of correcting iniquities or 
of ascertaining the real truth of the matters. 

This is the first time that I receive an authorized rectification of what we 
published in our edition of the 7th instant, and I shall take great pleasure in pub- 
lishing the same in our edition of to-day. 

When I brought to the knowledge of the public that which our service of 
information had furnished to us, on the 7th of July, it was not my intention to 
liold up the managers of the San Lazaro Hospital to ridicule before the public, 
but merely to give a signal of alarm to the authorities, in order that a remedy 
be immediately provided, in the event of it being true, by the authorities concerned, 
and for the best of the people, as the Government does not spare any sacrifice iwm 
the latter. 11 

I wish to make it known by these presents that our object in publicly commenting 
upon or denouncing the news received by us is not to defame the government or 
certain persons, but to redeem our pledge toward the people that we would work 
for its welfare. To prove this assertion, I should like to have you read what wc; 
published on the lltli of July, 1906, under the heading "A visit to the San Lfizaro 
Hospital." 

We desire the truth, and to this we consecrate all our energy, even though it 
necessary to make sacrifices. 

I am convinced that under the protection of the principles which exalt 
American people, the Filipino may communicate to his representatives in these 
Islands, tlirough the press, all that is liable to redound to the detriment of both 
peoples. Jl 

Lastly I will state that in compliance with your request, and in honor of tflP^ 
truth, I shall publish the letter which I am now answering at a prominent place 
in our edition of to-day, but this does not mean that we shall not publish everythii 
sent to ua in refutation thereof. 
Very respectfully, 

Pedro Guevara, Manager^ 



I 



Sefior Pedeo Guevara, 

Director, "Soberania T^acional," Manila, P. I. 

Sir: I have the honor to acknowledge receipt of your letter of July 12, 1900. 
Pveferring to your statement that you did not receive my letter of the 10th instant 
I have the honor to advise you that 1 hold the receipt of Seuor Hugo Manfis, 
the same. 

I note that you will publish my letter of the 11th instant, as requested 
your issue of to-day. 

I also note that you have ignored my query as to whether or not you would 



1 



Jl 



35 

publish in a conspicuous place in your paper a retraction of a statement referred 
to in that letter which reads as follows : 

"Un cuadro verdaderamente aterrador es el que presenta el patio del Hospital 
de San Liizaro. Los fallecidos por la enfermedad del colera son expuestos desnudos 
en el atrio de dicho Hospital con un cartel atado en los pies con la inscripciOn de 
sus respectivos nombres." 

This statement is an infamous libel. I do not desire to discuss with you your 
motives in publishing it. It embodies a positive statement which is unqualifiedly 
false. 

I have read the articles referred to, in your issue of July 11, and do not find 
that either in this article or anywhere else in your paper you have ever retracted 
this statement. You must retract it fully and completely and apologize for 
having published it. Your retraction must be given a conspicuous heading and 
placed in a conspicuous part of your paper, in your issue of to-morrow, so that it 
can not escape the attention of any reader. 

I regret to be forced to state matters thus plainly, but your action in com- 
pletely ignoring my request for information as to whether you would or would not 
retract this article leaves me no other course. By its publication you have 
done incalculable harm. The least that you can now do is to publisli an explicit 
denial in the form above specified. -^ 

I presume that I need hardly suggest to you that the alternative is immediate / 
criminal prosecution upon a serious charge. 

Kindly advise me of your decision in the matter by this messenger, who is 
instructed to await your reply. 

Very respectfully. Dean C. Worcester, 

Secretary of the Interior. 

In response to this communication, there appeared in Soberania 
Nacional the following: 

We are exceedingly glad to affirm in the honor 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 favor that the public should appreciate 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. 

Letter which the editor of Soberania Nacional was required to 
publish : 

THE TRUTH ABOUT THE GOVERNMENT CHOLERA HOSPITAL. 

To the Editor, Soberania Nacional, Manila, P. I. 

Sir: I beg leave to call your attention, and through your valuable paper, the 
attention of your readers, to the statement which appeared in your issue of 
Saturday, July 7, under the heading "Escenas Dolorosas." I take it for granted 
that the statement referred to did not come to your notice before publication or 



n 



36 

you would hardly have allowed it to appear in your columns without investiga- 
tion, and the most superficial examination would have showed it to be utte; ' 
false. 

The following is the statement referred to: 

"A truly terrifying sight presents itself at the doorway of the hospital of 
San Lazaro. Those who have died of cholera are exposed naked, in the hospital 
square, each with a ticket tied to his feet, bearing the name of the dead person." 

Nothing could be more untrue or more fantastically absurd. No dead person 
was ever, imder any circumstances, exposed naked in the "atrio" of this hospital, 
nor in the wards, nor in the passages leading to the wards, nor in any other 
place connected with the hospital, under any circumstances whatsoever. Even 
where it is necessary to expose portions of the bodies of the living in treating 
them or bathing them, their beds are shut in by screens. 

It is difficult to understand how such a statement could have crept into your 
journal. The cholera hospital is a public place. It is visited at frequent inter- 
vals, not only by myself and by the Director of Health, but by reputable Spanish 
and Filipino physicians, by high dignitaries of the Holy Roman Catholic Church, 
and by the immediate relatives of the sick. Such a horrible condition of affairs 
as the author of the statement referred to has represented to exist there would 
not be tolerated for an instant by the authorities of the Government, much less 
would it be endured in silence by physicians not connected with the Government, 
by representatives of the church, or by relatives of the inmates, to say nothing 
of the four American ladies constantly employed there as nurses, every one of 
whem would doubtless instantly leave the place were there any needless exposure 
of the bodies of the living or the dead. 

In ]X)int of fact, .those who die in the hospital are immediately removed 
decently covered, in a closed vehicle to the morgue. 

In view of the extremely important part played in protecting the health of 
nila by this hospital which is doubtless not fully appreciated by many of you 
readers, it is greatly to be regretted that a statement of this sort, which can not 
fail to cause great alarm and deep distress to many worthy people, should appear 
just at a time when the reappearance in Manila of cholera, unfortunately of 
very malignant type, renders of utmost importance the hearty cooperation of all 
who are genuinely interested in promoting the welfare of the Filipino people. 
I take it for granted that you will be glad to do what you can to repair the 
damage already done by aiding in making known to the public the truth about 
this institution which has done in the past, and will do in the future, such 
valuable and humane work. 

Tlie cholera hospital is anything but the doleful place it has been represented 
to be. It is surrounded by beautifully kept grounds; all parts of the buildings, 
including the wards, are immaculately clean; wide porches keep the direct ray 
of the sun away from the windows; the type of construction, which is on the 
pavilion plan, admits air from all four points of the compass to each of the 
three buildings which are connected with each other and with the administration 
building by wide, roofed walks that afford an admirable place for the convales- 
cent to get the benefit of the cool breezes and open air without exposure to the 
rays of the sun. 

A thoroughly trained American physician and an adequate number of highly 
trained American ladies, who act as nurses, are on hand night and day, but 
any person received at the hospital is at perfect liberty to summon his own 
physician, and in the event that he does so the prescriptions which such physi- 
cian writes are accurately filled at Government expense and the r6gime which 
he prescribes for the patient is strictly carried out. 

In the event, as often happens, that a patient is a Filipino and has no family 



41 

vour 



37 

physician, but prefers to be treated by a Filipino doctor, he may enjoy this 
privilege instantly, as a competent Filipino physician, employed at the expense 
of the Insular Government, is always on duty. 

Nor do the sick lack the consolations of the church. The kindly interest 
taken by His Grace, the Archbishop of Manila, in the people of his diocese is 
too well known for it to be possible for any one to believe tliat he would for a 
moment forget the sick, and priests are constantly at hand to give to the sick 
and dying the consolations of the Church. 

The utmost care is given to that most important matter, the preparation of 
the food of the convalescents, and neither trouble nor expense are spared in 
making it as suitable as possible. 

If any person can suggest practical means of increasing the comfort of the 
sick or improving their chances of recovery, he will confer a great favor upon 
the Director of Health and upon myself by so doing; but in view of the fact 
that under the present arrangement the inmates may employ their own physi- 
cians and have the regime prescribed by such physicians strictly carried out, 
or may have the services of either the Filipino or the American physician 
employed by the Insular Government free of charge,- and taking into account 
the ceaseless and excellent care given patients by the nurses, the character 
of the food furnished, and the admirable sanitary condition of the whole insti- 
tution, it is diflScult to see how more could be done for the unfortunate victims 
of this terrible disease than is being done at the present time. 

And what are the results? Very far from those represented. Complete figures 
to date are not available, but from the beginning of the present epidemic 
(August 23, 1905) to the date of my last annual report, for instance, there 
were 178 cases of cholera in the city of Manila. Of this number 83 were 
taken to the hospital and 95 remained at their homes throughout the course 
of their disease. Of the 95 who remained at their homes 95 died, a mortality 
of 100 per cent. Out of the 83 persons taken to the hospital, many of whom 
were in a dying condition when received there, 63 died, a mortality of 75.9 per 
cent. Since the last cholera outbreak in the city of Manila, on June 20, 78 
persons were taken to the hospital, of whom 57 died, a mortality of 80.1 per 
cent. Of the 101 known cases not taken to the hospital during this same 
period 101 have died, a mortality of ICO per cent. 

It is a hard fact, and a fact which the newspapers of Manila ought to make 
known to the public, that cholera patients taken to the cholera hospital have 
far more chance of recovery than have those treated in their homes, and this 
is due to the existence at the hospital of extraordinary facilities for treating 
them, facilities which can not be duplicated in any private residence. 

In these days one often sees applied to the present policy of the health 
authorities the expression "compulsory hospitalization." Tliis expression is 
misleading. From it one would suppose that every person smitten with cholera 
was forced to go to the Government hospital, but this is far from being the 
case. 

It is for the Director of Health and his duly authorized agents to decide 
in each instance whether the local conditions are such that the patient may 
safely be treated at home, or are such that it is necessary, in order properly 
to safeguard the health of the community at large, to take him to the hospital. 
The unquestionable fact that the patient's chances of life will, on the average, 
be increased by his removal to a place where he may have the best of care, 
while an important consideration, is not the determining factor. We might and 
doubtless should hold that so far as his own life is concerned the responsibility 
rests upon him, and were there no other considerations his individual preference 
would be determining. Even now his individual rights are respected by allowing 




> 



38 

him to select his own physician whether that physician be the most competent 
or the most incompetent representative of the medical profession in the city of 
Manila, and to have the remedies which that physician prescribes irrespective 
of whether they are or are not the most suitable remedies in his case. 

Unfortunately, however, cholera spreads from person to person with a rapidity 
not displayed by any other disease. The ways in which it may be transmitted 
are so numerous and the precautions necessary to prevent its spread from a case 
in an ordinary household are so difficult of enforcement in private homes as to 
make the checking of an epidemic, with any possible number of health officers and 
employees, an utter impossibility if the majority of patients were to be cared 
for in their houses. Where patients can be cared for at their homes by their 
own physicians without endangering the lives of others, the Government has 
nothing to lose and everything to gain by allowing them to remain there. Where 
they can not be safely cared for at home, by their removal to the hospital not only 
are their individual chances for recovery increased but the danger of spreading 
the disease is absolutely eliminated. Proper consideration for the greatest good 
of the greatest number, which must always be the guiding principle in sanitary 
work, would in itself make it imperative that they should be so removed. hi 

JThe fear of hospitals so general in countries with a Latin civil izatioiJ| 
is a difficult thing for Englishmen, Germans, or Americans to comprehend, for 
in England, Germany, and America there exist immense numbers of these 
beneficent institutions, offering facilities for the medical and surgical treatment 
of disease which can not be had even in the private homes of the immensely 
wealthy. In these countries rich and poor alike have very generally come 
understand that when smitten by deadly diseases or when obliged to under^ 
critical surgical operations the hospital offers them the greatest hope of continued 
life and restored usefulness. They go there voluntarily, and thank God for thfll 
opportunity. ^| 

It would be too much to expect that so profound a change in public sentiment 
would come about in a short time in the Philippine Islands. It is sure to 
\prevail ultimately. The question is not one as to whether it shall ultimately 
prevail, but rather as to whether its coming shall be delayed for a longer or 
shorter time. 

When the word first spread that the Government would establish a lepe" 
colony on the island of Culion the news created great alarm among sufferers from 
this terrible disease, but when the first unfortunates had been transferred to the 
leper colony and saw w^hat had been done for them, their feelings underwent a_ 
complete change and they said that if they had known in advance what h 
before them, instead of objecting to being removed to Culion they would hal 
petitioned to be taken there as soon as possible. 

Similarly in the case of the cholera hospital, the best friends of the institutiol 
are those whose lives have been saved there. Were I myself smitten with the 
disease I should go to the hospital with the least possible delay, and so I 
believe would every intelligent and well-informed person who has taken the 
trouble to visit the institution and see for himself what are the conditions thadi 
prevail there. 11 

It should be remembered that the hospital is a public institution and as such 
may be inspected at any proper time by any person who has an adequate reason 
for desiring to go there. A representative of your paper has been invited to 
inspect it at any time and see for himself what the conditions are. I take it 
for granted that such representative will be sent by you and that you will be 
glad to make public the conditions found. 

Very respectfully, Dean C. Worcester, 

Secretary of the Interior. 



II 



b a 

1 

loiP" 



Jl 



39 

Eepresentatives of the entire press of Manila were invited to visit the 
San Lazaro Hospital, which in point of fact they might have done at 
any time, and with a single exception the papers published truthful and 
more or less full accounts of what they saw. The remaining newspaper 
was unwilling to do good by publishing the truth, so published nothing. 

Many of the newspapers printed in Spanish seemed to have learned 
for the first time on this occasion what should have been ivell known to 
them, namely, that cholera victims were allowed to have the services of 
any physician whom they desired and that a Filipino physician was 
employed by the Government to attend those who desired medical as- 
."ii.^fance from one of their own race but could not afford to pay a doctor. 

The only criticism of importance which appeared in the press as a 
result of this visit of reporters was that the Filipino doctor had a course 
of treatment laid down for him in general terms, and that he was not 
entirely at liberty to follow his own judgment in the matter. This was 
strictly true, the general lines of the treatment which gave the best 
results having long before been ascertained and laid down, the necessary 
variations to adapt it to individual peculiarities being, of course, duly 
allowed for. 

FILIPINO PHYSICIAN APPOINTED TO SAN LAZARO. 

I offered control of the treatment of all Filipinos at the hospital to 
two of the most distinguished Filipino physicians in this city, retaining 
an American physician for those who might prefer his services. These 
gentlemen kindly accepted appointment. 

Orders were given that all their prescriptions should be filled without 
question and that all orders issued by them as to the treatment of 
patients should be carried out to the letter. x4Lt the outset they introduced 
some important variations in treatment but the resulting death rate 
was apparently not satisfactory to them. At all events, they gradually 
changed their treatment until it became practically identical with that 
which had been employed prior to their taking charge, the death rate 
falling, simultaneously, to substantially its previous figure. 

There followed a demand in the Spanish and Filipino press that the 
entire personnel of the hospital should be Filipino. Dr. Heiser im- 
mediately informed the physicians in charge of his willingness imme- 
diately to relieve all the American trained nurses and attendants, who 
were badly needed elsewhere, and to appoint the Filipino substitutes 
whom they should name, but for some reason those gentlemen, on luhom 
the responsibility for results now rested, did not adopt the view of this 
matter which had been set forth in the Filipino press, but on the contrary 
vigorously objected to the suggested change in the force. The organ- 
ization was accordingly left undisturbed. 

The Filipino physicians continued to serve faithfully until near the end 
of the epidemic. Their presence at the hospital undoubtedly went far 




40 

toward allaying the ill-founded fears which had been aroused in the 
minds of the ignorant and I have always felt deeply indebted to them 
for sacrificing their private interests and coming to the assistance of 
the Bureau of Health at this critical time. 

This is only one of numerous instances which might be cited of the 
vicious influence of a part of the public press of Manila. This influence 
has been and, I regret to say, still remains one of the most serious 
difficulties which confronts the officials responsible for the sanitary 
condition of the city. These men are ridiculed, slandered, and libeled 
from the beginning of an epidemic to its end. If cholera appears in 
the city they are blamed for its occurrence. If it does not appear they 
get no credit for keeping it out. If they attempt to establish a land 
quarantine they are cursed for needless and useless interference with 
business interests. If they deem such quarantine inadvisable and fail 
to impose it they are charged with criminally neglecting to enforce the 
necessary measures for safeguarding the public health. No matter how 
competent or successful they may be, the measures which they adopt 
are constantly attacked and they themselves are continually accused of 
being grossly incompetent. All of this has a deplorable effect on the 
more ignorant Filipinos, who fail to realize that it is only politics. 

During the present epidemic, for instance, the little handful of highly 
trained medical inspectors in Manila, under the able leadership of the 
Acting Director of Health, have made a most extraordinarily successful 
campaign. To any one familiar with existing sanitary conditions ijr 
Manila, many of which, by the way, the Bureau of Health is absoluteBl 
without authority to remedy, it seems almost unbelievable that the 
maximum number of cases for any one day should have been held down 
to sixty, yet certain newspapers printed in the Spanish language have 
been howling for the removal of the Acting Director of Health because 
of his incompetence I 

Mistakes can be remedied and abuses corrected if brought to till 
attrition of the proper authorities, and newspapers or individuals who 
bring to the attention of such authorities the mistakes and shortcomings 
of officers or employees of the Bureau of Health confer a favor and aid 
in the work of safeguarding the public health; but newspapers or in- 
dividuals that misrepresent the facts and persistently endeavor to dis- 
credit faithful and efficient employees of the Government, and circulate 
lying tales calculated to alarm the ignorant and superstitious, leading 
them to hide away their sick, thus preventing them from receiving 
medical attention which might save their lives and insuring unnecessary 
dissemination of infection which endangers the lives of others, are 
guilty of homicide on a very large scale and should be dealt with ac 
cordingly. 



41 



SUBSEQUENT EPIDEMICS IN THE PROVINCES. 

In the provinces the story was a far less satisfactory one. 

No attempt was made to establish a land quarantine about Manila, 
and every energy was concentrated for a direct attack upon the infection, 
but the lack of adequate personnel was woefully evident from the start. 
An effective marine quarantine was maintained, and the disease was for 
a long time kept within a radius of 75 miles of Manila, largely through 
the effective work of worn-out men sent from Manila even while still 
needed there. The disease spread to the north along the line of the 
railway and to the east as far as the Province of La Laguna and thence 
south by way of a newly constructed highway to Lucena and Pagbilao 
in the Province of Tayabas. The latter town is the point of departure 
for a road which extends across Luzon^ to Atimonan on the Pacific 
coast and is also a port of departure for numerous small vessels, so that 
for a time there was great danger of a general epidemic, but a very 
determined and successful effort was made to check cholera at Pagbilao. 

Dr. Jose Mascunana, the president of the provincial board of health 
of Tayabas, had incurred the ill will of the inhabitants, who stubbornly 
refused to obey his orders. Two of the best men in the service. Dr. 
John D. Long and Dr. Vicente de Jesus, were hurried to the scene. Dr. 
Long taking charge. 

These men had the active and cordial assistance of Governor Quezon. 
Dr. Jesus immediately secured the confidence of the people, who cheerfully 
followed his directions, and the disease was completely and promptly 
stamped out in Pagbilao and immediately thereafter in the towns along 
the route it had followed in invading the Province of Tayabas. 

The result in this instance shows conclusively what may be done toward 
checking cholera, under adverse circumstances, if the work is in the hands 
of capable and energetic men who are able to secure a reasonable degree 
of cooperation from the people. A pleasant feature of this case was that 
each of the three men who contributed to bringing about a most satis- 
factory issue gave all of the credit to the other two. 

The following table shows in summary form the course of cholera in 
the provinces by months from August 20, 1905, to date : 



Month and provinces. 


Cases, 


Deaths. 


1905. 

August: 

Rizal 


} '" 

I 334 

}- 358 
1 


63 
252 

249 


Cavite ___ _ __ 


September: 

Rizal 


Cavite ^ 


Pampanga 


Bulacan 


La Laguna 


October: 

Rizal - 


Cavite 


La Laguna 


Tayabas 



Month and provinces. 



1905— Continued 

November: 

Rizal 

Cavite 

Pampanga 

Bulacan 

La Laguna 

Tayabas 

Batangas. 

December: 

Rizal 

Cavite 

Pampanga 

Bulacan 

La Laguna 

Batangas 



Cases. 



483 



387 



Deaths. 



42 




Month and provinces. 


Cases. 


Deaths. 


Month and provinces. 


Cases. 


Deaths, 


1906. 
January: 

Rizal 


1,106 

■1,845 

J 
. 288 

■ 56 

44 

265 

2,145 
2,045 

777 
11,234 


809 

1,417 

* 225 

48 
33 
155 

1,541 
1,585 

625 
903 


1906— Continued. 

October— Continued. 

Tayabas 


■ 558 

• 60 

I 100 
I 124 

}■■ 

15 



7 

1 101 
} 40 

} ^ 
1 118 

206 

513 

203 

90 




Cavite 






Tarlac 




'RnlAr>An 


Nueva Ecija 




La LaBuna 


Pangasinan 




Bataan 


Iloilo 




Tarlac 


November: 

Rizal .._, 








February: 

Rizal - — 


Pampanga. 




Tarlac 




Cavite 


Nueva Ecija 




Pampanga 


Iloilo 


6S 


Occidental Negros 






Capiz _ _ __ _ 




Bataan 


Moro __ __ 






December: 

Rizal- _._ 








March- 


Cavite 




Cavite _ __ 


Occidental Negros 


'■ 


Pampanga 


Capiz 






1907. 
January: 

Occidental Negros 




La Laguna -- 




Bataan 




April: , 






Capiz 










Samar __ _ . 










j February: 

! Occidental Negros - 












Bataan 


1 Capiz 








May: 


1 Samar 






March: 
1 Occidental Negros 




Cavite 










Capiz 










Samar 








June: 

Rizal _ 


April: Occidental Negros 

May 


1 








' June _ 










July: Leyte 

August: 

Leyte 




Bulacan 

La Ijaguna. 




July: 

Rizal 




Masbate _ _ 


S 


September: 

Leyte 




Cavite 










Masbate 




Bulacan 




October: 
i Bulacan 




La I>aguna 




Tavabas _ 




Masbate _ _ 




Tarlac 




November: 

Pampanga 




Nueva Eclja 




Pangasinan 












August: 

Rizal 


1 December: 

Rizal 




Cavite 




Pampanga 

Bulacan 


Bulacan 


1^ 


Batangas 




La Laguna 




1908. 

January: 

Rizal 




Tayabas 




Batangas . 




Bataan 

Tarlac 




Nueva Ecija 


Cavite 




Pangasinan 


Pangasinan 




Benguet 




4H 


September: 


La Laguna 




Rizal 


Bataan _ 




Cavite 

Pampanga 


February: 
Rizal 




Bulacan 


Cavite 




lA Laguna 


Pampanga 




Tayabaa 




19 


Tarlac 


Bataan 




Nueva Eclja 






Pangairinan 


Zam bales 




Iloilo 


March: 

Rizal 




October: 




Rizal 


Pampanga 




Cavite 

Piimpanga 


Tarlac 1 

Pangasinan 


1 


Bulacan 


Zambales _ 




La laguna 


Mindoro ._ _. 





43 



Month and provinces. 



1908— Continued. 

April: 

Rizal _.. 

Panipanga 

Pangasiuan 

Capiz 

La Union 

May: 

Rizal. _ 

Bulacan 

Pangasinan 

Capiz 

June: 

La Laguna 

Tarlac -__ 

Nueva Ecija 

Pangasinan _ 

Capiz 

La Union 

South Ilocos 

July: 

Rizal 

Cavite 

Pampanga 

Bulacan 

Tarlac 

Nueva Ecija 

Pangasinan 

Benguet 

Iloilo 

Capiz 

La Union 

South Ilocos 

Misamis 

Bohol 

V Nueva Vizcaya 



Cases. 


Deaths. 


r23 


92 


749 


538 


2.616 
) 


1,690 


■5,202 


8,141 


J 





Month and provinces. 



1908— Continued. 

August: 

Rizal 

Pampanga 

Bulacan 

Tarlac 

Nueva Ecija 

Pangasinan 

Benguet 

Iloilo 

Occidental Negros__ 

Capiz 

La Union 

South Ilocos 

Misamis 

Bohol and Antique . 

September: 

Rizal.. 

Cavite 

Pampanga 

Bulacan 

La Laguna 

Batangas 

Tarlac 

Nueva Ecija 

Pangasinan 

Benguet 

Iloilo 

Occidental Negros .. 

Capiz 

La Uni6n 

South Ilocos 

Misamis 

Antique 

Palawan _ 



Total 34, 



Cases. 



Deaths. 



4.744 



3,081 



6,494 



22,938 



From this table it appears that during the months of May and June, 
1907, the provinces of the Philippine Islands were free from cholera so 
far as is known. 

The provinces of Luzon were clear of cholera during January, Feb- 
ruary, March, April, May, June, July, August, and September, 1907, and 
the new epidemic beginning in the provinces in 1905 was confined to 
Rizal, Cavite, Pampanga, Bulacan, Pangasinan, Tarlac, Nueva Ecija and 
Benguet during August, September, October, November and December of 
1905, and January, February, March, April, May, June, July and August, 
1906. 

On September 1, 1906, an epidemic began at Iloilo. It was confined 
to that province until November 1, when it extended to Occidental Ne- 
gros. It ultimately reached Capiz, Samar and the Moro Province and 
continued to prevail in the Visayan Islands until April, 1907. The entire 
archipelago then remained apparently free from cholera for more than two 
months but in the following July, August, September and October there 
occurred a comparatively insignificant epidemic in the Visayan Islands 
with a total of 154 cases and 133 deaths. Cholera disappeared in the 
provinces outside of Luzon in October and did not reappear there until 
March, 1908, since which time it has been continuously present. It 
reappeared in Luzon on October 6, 1907, and has been continuously 
present ever since. 



44 



1 



If we consider the occurrence of cholera in the provinces as a whole 
we must therefore recognize three epidemics; that of March 23, 1902, 
to March 8, 1904; that of August 20, 1905, to April 29, 1907, and that 
of July 22, 1907, to date. 

But if we consider the provinces as divided into two groups, namely 
the provinces of Luzon and those outside of that Island, we shall note 
that after the general epidemic beginning March 23, 1902, there were, 
a Luzon epidemic from August 20, 1905, to December 28, 1906 ; a second 
Luzon epidemic from October 6, 1907, to date; and three Yisayan Island 
epidemics which occurred from September 1, 1906, to April 29, 1907, 
from July 22, to October 1, 1907, and from March 17, 1908, to date, 
respectively. ■! 

The following table shows the proportion of cholera cases to popula- " 
tion in each of the provinces infected during the epidemic of 1902-4, 
and the name of the person or persons who held the office of president 
of provincial board of health in each province during the time wheni 
cholera was present there: 



Province. 


Propor- 
tion of 
cases to 
inhabit- 
ants. 


Presidents of provincial boards of health. 


lloilo 


1-15 
1-33 
1-36 
1-36 
1-38 
1-46 
1-49 

1-50 

1-50 

1-51 

1-54 

1-70 

1-75 

1-88 

1-93 

*l-97 

1-99 

1-106 

1-112 

1-113 

1-119 

1-122 

1-123 

1-138 

1-191 

1-128 

1-154 

1-171 
1-177 
1-185 

1-210 
l-2frl 
1-269 

1-407 

1-«2M1 


Dr. Pablo Araneta. 




Dr. Luis Caballero. 


Occidental Negros 


Dr. Mariano Yulo. 




Dr. M. de Castro (removed), Dr. A. Olba. ^^M 


Misiimis 


Dr. Francisco Xavier. ^^H 




Dr. JosC' Mascufiana, Dr. James W. Smith. ^KM 


Zain bales _ _ _ 


Dr. Mariano Felizardo (1 month), Dr. Aquilino Calvo (Hj 




moved). | 
Dr. Telesforo Ejercito. J 


(;apiz_. 


Dr. Paulino Quisumbing. 1 
Dr. John T. Slater (9 months), Dr. V. de Jesus (9 months)! 
Dr. Donato Montinola. 1 
Dr. Justo Panis. J 


Aiili(jue 

.1 Ecija 


ijijas 


Dr. Jos6 Losada. . jfl 


ute 


Dr. Gavino Vinluan. M 


la . 


Dr. B. Toribio. ^^^| 


iduque 


nr Tnun Ricintnon j^^^l 




Dr. Rafael Villafranca. ^^H 


- Norte 


nr Tiion Pnrnnprofion ^^^H 


HO 


Dr. Victorino Crisologo. ^^H 

nr Antnnin ITornonHn ^^^H 




Dr. Sixto Angeles. ^^H 


ii^on 


Hr Tiilin Wnw ^^^^^| 


1 < an 


Dr. Felix Bautista. ^H^ 




Dr. Santiago Icasiano (3 months). Dr. Andres Catanjal 


Ml mar 


(17 months). 
Dr. G. I. Cullen (appointed after epidemic was well under 

way). ^ 
Matthew I^ffeere (for last 7 of the 14 months of thi 

epidemic). 
Dr. T. Ejercito (for 9 months), Dr. M. Felizardo (for 2! 

months). 


Mindoro.. 


Cavite 

Amboa Canuirlnes 


Oriental NegT»i 


Dr. H. W. Langham. 

Dr. Manuel Liongson (removed early in epidemic), Dr. 

M. dc Mey. 
Dr. Augnstiii Scarella. ' 
Sebastian de Ca.stro. , 
Dr. D. Santos (removed), Dr. Jos(5 Mascufiana. Dr. H. H 

Baker. 
Dr. V. de Jesus (first 4 months), Dr. A. H. Eber, Dr. H. H 

Baker. 
Dr. Segundo Isaac. 


I'ampanga 




Men 


Tayaban... 

Nueva Vlxcava 





• In the case of Marinduque the proportion of deaths to inhabitants is given. 



45 

The aTerage proportion of persons attacked to the number of inhabit- 
ants in the infected provinces as a whole during the period was 1 to 65. 

But one case of cholera is officially recorded from Benguet but it is 
well known that the disease got among the wild people of that province 
and caused a considerable mortality the extent of which it will never be 
possible to ascertain. There was no president of the provincial board 
of health in this province at the time. In one small province, Marin- 
duque, the record of cases was not kept and we have only the record of 
deaths. 

The provinces which escaped during this epidemic were Abra, Lepanto- 
Bontoc and Palawan. Nueva Vizcaya with but a single case may also 
be said to have practically escaped. There were some cases in the 
Moro Province but the Government of this Province being practically 
separate the Bureau* of Health has no statistics covering tlie cases and 
deaths there. 

The following table shows the number of outbreaks in each province 
in which cholera has occurred since August 20, 1905, with the duration 
of each outbreak and the number of cases and deaths caused by it : 



Province. 


First case. 


Last case. 


Cases. 


Deaths. 


Nueva Ecija i 


Jan. 11,1906 
July 6,1906 
June 19, 1908 


Mar. 6,1906 
Nov. 12,1906 
Oct. 11, 1908 


158 

765 
387 


107 




546 
313 


Total __ 


1,310 


966 




July 16,1906 
Jan. 26,1908 


Oct. 19,1906 
Oct. 12, 1908 




Pangasinan 


85 
5,644 


65 
3,389 


Total 


5,729 


3 454 




Aug. 15,1906 
June 11, 1908 


Aug. 15,1906 
Sept. 21, 1908 




Benguet 


1 
27 


1 




21 


Total 


28 


22 




Sept. 16, 1906 
July 24,1908 


Nov. 27,1906 
Still present. 




Hollo 


1,798 
5,060 


1 319 




3,183 


Total 


6,858 


4,502 




Nov. 1,1906 
Aug. 27,1908 


Apr. 29,1907 
still present. 


Occidental Negros 


92 
2,030 


64 




1,415 


Total 


2,122 


1,479 




Nov. 3,1906 
Apr. 27,1908 


Mar. 29,1907 
Still present. 


Capiz 


260 
834 


156 




614 


Total 


1,094 


770 




Nov. 13,1906 
Jan. ? 1907 


Nov. 30, 1906 
Mar. 22,1907 




Samar 


29 
51 


27 




42 


Total 


80 


69 




Nov. 20,1906 
July 22,1907 
Aug. 9,1907 
Jan. 24,1908 
Feb. 3, 1908 

Apr. 17,1908 
June 19, 1908 


Nov. 20,1906 
Sept. 13, 1907 
Oct. 1,1907 
Mar. 20,1908 
Mar. 17, 1908 

Apr. 30,1908 
Still present. 




Moro Province 


9 

96 

53 

220 

32 


y 


Levte. 


87 


Masbate 


42 


Zambales 


156 


Mindoro 


20 






La Union 


6 
1,154 


5 




806 


Total 


1,160 


811 











46 




, 


Tj 


Province. 


First case. 


Last case. 


Cases. 


Deaths. 


Ilocos Sur 


June 16, 1908 
July 6,1908 
Julv 26,1908 
July 20,1908 
Aug. 30, 1908 
Aug. 31,1908 
Sept. 14, 1908 

Aug. 20,1905 
Apr. 2, 1906 
Dec. 23,1907 


Still present. 

'Aug. 13,'f908' 
Julv 20,1908 
Still present. 
Oct. 13,1908 
Still present. 

Feb. 15,1906 
Dec. 28,1906 
Still present. 


2,005 

1,095 

4 

1 

497 

43 

39 


1,459 

345 

4 



206 

23 

36 


Misamis 


Bohol - - 




Antique - - 








Rizal 


728 

1,036 

508 


536 
776 
398 




Total 


2,272 


1,710 




Aug. 20, 1905 
Jan. 21,1908 
Apr. 2, 1908 
Aug. 20, 1908 


Oct. 14,1606 
Feb. 25,1908 
Apr. 8,ly08 
Still present. 


Cavite . _ _ _ — 


1,315 

22 

4 

40 


977 

20 

4 

22 




Total _ 


1,381 


1,023 




Sept. 1,1905 
Nov. 6,1905 
Nov. 14,1907 
July 9, 1908 


Sept. ? 1905 
Nov. 18,1906 
Mar. 12,1908 
Still present. 




2 

1,847 

379 

97 


1 

1,380 

313 

70 




Total 


2.325 


1,764 




Sept. 4,1905 
Nov. 1,1905 
June 29, 1906 
Oct. <•), 1907 
May 11,1908 
July 17,1908 


Sept. 25, 1905 
April 17, 1906 
Oct. 21,1906 
Feb. 29,1908 
Mav 11,1908 
Still present. 


Bulacan . 


2 

1,179 

1,296 

176 

1 

309 


2 
909 
927 
131 


217 




Total . 


2,963 


2,186 




Sept. 7,1906 
June 20, 1906 
Jan. 1, 1908 
June 15, 1908 
Sept. 7,1908 


Mar. 30,1906 
Oct. 30,1906 
Jan. 24,1908 
June 15,1908 
Still present. 


La Laguna 


576 

405 

3 

1 

12 


434 
356 

2 

1 
4 




Total 


1,057 


797 




Oct. 12,1905 
July 25, 1906 


Nov. 10,1905 
Oct. 14,1906 


Tayabas _._ 


5 
132 


5 
112 




Total 


137 


117 




Nov. 20,1905 
Aug. 7,1906 
Sept. 17, 1908 


Dec. 11,1905 
Aug. 15,1906 
Oct. 13, 1908 


Batangas 


12 


7 
1 
4 




Total ._ 


21 


12 




Jan. 4,1906 
Aug. 16, 1906 
Dec. 10,1907 


May 28,1906 
Aug. 16,1906 
Feb. 10,1908 


Bataan 


355 

1 
23 


261 



20 




Total 


379 


281 




Jan. 6, 1906 
July 25, 1906 
Mar. 16, 1908 
June 28, 1908 


Mar. 18,1906 
Nov. 22,1906 
Mar. 23,1908 
Aug. 28,1908 




34 

91 

10 

393 


27 

78 

8 

297 




Total 


528 


410 
















i 



47 

The following table shows the proportion of cases to inhabitants, the 
number of outbreaks of cholera, and the force employed in checking 
it in each of the present health districts in which the disease has occurred 
since August 20, 1905, when cholera first reappeared after the close of 
the epidemic of 1902-1904. 

The figures are brought up to October 19, 1908 : 



Health district 



Pangasinan. 



Bulacan 



Rizal, Cavite, and 
Bataau. 



Pampanga . 



Nueva Ecija 



Iloilo, Capiz, Antique- 



La Laguna. 



Negros Occidental 

La Union and Zam- 



1-72 



1-76 



1-82 



1-112 



1-115 



1-141 



1-152 



1-166 



Out- 
breaks. 



Force employed. 



Dr. Luis CnbaUero, 1). H. O., in charge, aRslsted by: C. 
Brantigan, S. 1., Fob. C, 1908; iJr. P. Clenu'nUs, M. I., 
Juno 9 to Julv 31, 1908; Dr. H. O. Jones, M. I., June 11 to 
July 9, 1908; Dr. Lui.s Abella, M. I., June 11 to Aug. 20, 
1908; Dr. Andres Catanial, June 9, 1908; Dr. B. L. Bur- 
dette, M. I., June 10 to July 19, 1908; C. Brantigan, S. I., 
Juno 9, 1908; Dr. V. de Jesus, D. H. O., June 8 to Sept. 8, 
1908. 

Dr. F. liautixta, D. H. O., in charge; Dr. M. C. Terry, M. I., 
temporarily in charge from July 2 to July 13, 190(>; Dr. 
P. Clements, M. I., temporarily in charge from July 15 
to July 29, 1906; C. Brantigan, S. I., Nov. 15, 1907, to Feb. 

3 1908 

Dr! Mariano Felizardo, P. P. B. H., of Cavite; Dr. Ricardo 
Ferramon; Dr. Julio Ruiz, P. P. B. H., of Rizal; Dr. M. Fe- 
lizardo, in charge of district since its establishment, 
assisted by: Dr. Luis Abella, M. I., July 10, 1906; Dr. P. 
Clements. M. 1.. July 1, 1906; C. Brantigan, S. i., Julv 26, 
1906; Dr. P. Clements. M. I., Aug. 21, 1906; Dr. Luis 
Abella, M. I., Oct. 3, 1906; Dr. P. Clements, M. I., Jan. 

4 to Jan. 5, 1908; O. R. Dexter, S. I., Jan. 5 to Jan. 31, 
1908; Dr. Luis Abella, M.I., Feb. 24 to Feb. 25, 1908; Dr. P. 
Clements, M. I., Mar. 27, 1908; O. R. Dexter, S. L, Mar. 
8, 1908; Dr. V. de Jesus, D. H. O., Sept. 8, 1908. 

Dr. F. W. Dudley, P. P. B. H.; Dr. M. V. Terry, D. H. O., in 
charge July 2, 1906, to Dec. 24, 1906; Dr. S. V. del Rosario, 
M. I., Oct. 27 to Dec. 24, 1906; Dr. Justo Panis, D. H. O., 
temporarily in charge from Dec. 24, 1906, to Feb. 4, 1907; 
Dr. S. V. del Kosario, M. I., temporarily in charge from 
Feb. 4 to Feb. 23, 1907; Dr. A.Catanjal, D. H. O., tem- 
porarily in charge, Feb. 23 to Mar. 15, 1907; Dr. J. Mas- 
cunaua, D. H. O., in charge Apr. 5, 1907, assisted by: C 
Brantigan, S. I., Nov. 15 to Dec. 23, 1907. 

Dr. Justo Panis, P. P. B. H., in charge; Dr. M. C. Terry, 
D. H. O., July 2, 1906, temporarily in charge; Dr. Justo 
Panis, D. H. O., in charge July 25, 1906, to Mar. 8, 1907; 
Dr. H. Jacinto, D. H. O., Mar. 8, 1907, to Mar. 17, 1908, 
assisted by: Dr. F. Bautista, D. H. O., June 8, 1908; Dr. 
Luis Abella, M. I., June 11, 1908, to Aug. 20, 1908; Dr. A. 
Catanjal, D. H. O.; Dr. V. de Jesus, D. H. O., Sept. 20, 
1908. 

Dr. P. Araneta, D. H. O., in charge; Dr. P. Clements, M. I., 
Sept. 12, 1906, to Feb. 12, 1907; Dr. Z. Laughlin, M. I., 
Aug. 13, 1906; Dr. D. Montinola, July 26, 1906, to Sept. 17, 
1907, D. H. O. for Antique; Dr. D. Montinola, D. H. O., 
on cholera duty in Antique, Aug. 17, 1908; Dr. P. Qui- 
sumbing, D. H. O., for Capiz, July 25, 1906, to Mar. 23, 1907; 
Dr. P. Clements, M. I., Dec.—, 1906; Dr. Franci.sco Xa- 
vier, M. I., Feb. 7, 1907, to Sept., 1908; Dr. P. Quisum- 
bing, D. H. O., Sept. 3, 1908. 

Dr. F. Ampil, D. H. O., relieved July 10, 1906; Dr. W. K. 
Beatty, D. H. O., July 10 to Julv 25, 1906, temporarily in 
charge; Dr. Tcle^oro Ejercito, D. H. O.. July 25, 1906, to 
Mar. 4, 1907, in charge', Dr. Justo Panis, D. H. O., tem- 
porarily in charge. Mar. 5, 1907, to Apr. 8, 1907; Dr. N. 
Cordero, D. H. O., Apr. 9, 1907. to June 2, 1907; Dr. Luis 
Abella. M. I., June 3, 1907, to Jan. 1, 1908; Dr. D. Monti- 
nola, D. H. O., in charge, Jan. 1, 1908, to Aug. 17, 1908; 
Dr. J. Kamatoy, D. H. O., Sept. 9, 1908. 

Dr. Mariano Yulo, D. H. O., Jan. 6, 1907, to Apr. 7, 1907, in 
charge; Dr. P. Qnisumbing, D. H. O., in charge, Apr. 17, 
1907. assisted bv: O. Dexter, 8. I., Nov. 10. 1908, to May 
1. 1908; Dr. Francisco Xavier. D. H. O., Sept. 10, 1908. 

Dr. Telesforo Ejercito, D. H. O., in charge. Apr. 1.5, 1907, 
assisted by: Dr. Luis Abella, M. 1., June 9, 1908; Dr. P. 
Clements, M. I., June 9, 1908, to July 31, 1908; Dr. H. O. 
Jones. M. I., July 4 to Aug. 4, 1908; C. Brantigan, S. 1., 
Aug. 15, 1908; W. G. Hogley, S. I., Sept. 10, 1908. 



Health district. 



Ilocoe Norte, Ilocos 
Sur. 

Surigao, Agusan, and 

Misamis. 
Benguet — 



Tarlac 



Palawan 

Batangas and Tayabas. 



Mountain Province. 



Mas bate, Romblon, 
and Mindoro. 



Samar and Leyte 



Nueva VJzcaya 



Propor- 
tion. 



1-183 



1-186 
1-242 



1-2 



1-883 
1-2651 



1-3205 



1-4378 



1-3154 
1-62541 



Out- 
breaks. 



Force employed. 



Dr. C. Mora, D. H. O., assisted by: Dr. P. Clements, M. I. 

Aug. 10, 1908, to Sept. 21, 1908; C. Brantigan, S. I., A 

15, 1908. 
Dr. A. Fernando, D. H. O. 



i 



Dr. J. W. Smith, Acting D. H. O., assisted by: Harry Percy, 
S. I.; S. L. Barron, S. I. 

Dr. A. Catanjal, P. P. B. H., in charge; Dr. M. C. Terry, D. 
H. O., in charge temporarily, June, 1906; Dr. A. Catanjal, 
D. H. O., in charge July 25 to Dec. 14. 1906; Dr. L. Caba- 
llero, D. H. O., temporarily in charge, Dec. 14, 1906, to 
Feb. 9, 1907 Dr. A. Catanjal, D. H. O., in charge, Feb. 9, 
1907, to July 9, 1908. 

Dr. J. H. Biggar, Actina D. H. O., Sept. 12 to Oct. 3, 1908, 
assisted by: R. MacDonald, S. I., Oct. 12, 1908. 

Dr. J. Mascunana, P. P. B. H. and D. H. 0., in charge, 
assisted by: C. Brantigan, S. I., July 27 to Oct. 1, 1906; 
Dr. V. de Jesus, D. H. O.. July 27 to Oct. 4, 1906; Dr. Julio 
Ruiz, D. H. O., July 28 to Oct. 4, 1906; C. Palmer, S. I., 
July 21 to Sept. 18, 1906; H. Percy, S. I., Sept 18, 1906, to 
Feb. 20, 1907; Dr. J. D. Long, Assistant Director of 
Health, Sept., 1906; Dr. A. Catanjal, D. H. O., tempo- 
rarily in charge Dec. 14, 1906, to Feb 9, 1907; Dr. J. Mas- 
cunana, D. H. O., temporarily in charge Feb. 9, 1907, to 
Mar. 15, 1907; Dr. V. de Jesus, D. H. O., in charge Mar. 
15, 1907, to date; Dr. J. Losada, D. H. O., Sept. 9, 1908. 

Dr. Victorino Crisologo (suspended in early days of 
epidemic), D. H. O.; Lieut. Governor Evans; C Branti- 
gan, S. I.; C. Palmer, S. I.; Dr. Paul Clements, M. I. 

Dr. C. Mora, D. H. O., July 1, 1906, to Apr. 17, 1907, aided 
by: Dr. Luis Abella. M. I., Aug. 16, 1906, to Oct. 4, 1906; 
O. R. Dexter, S. I., in charge of cholera outbreak from 
Feb. 16, 1908. to Mar. 31, 1908. 

Dr. G. I. Cullen, D. H. O., in charge, assisted by: C. Bran- 
tigan. S. I., Aug. 17 to Sept. 28, 1907. 

No district health otficer. 



The following districts have remained free from cholera since 
epidemic of 1902-4 to October 19, 1908 : 

Health districts. , District health officers. 

Cebu and Oriental Negros Dr. Arlington Pond, D. H. O. 

Bohol Dr. R. Villafranca, D. H. O. 

Sorsogon Dr. Julio Ruiz, D. H. O.; Dr. V. de Jesus, D. 

Albay and Ambos Camarines.... Dr. W. K. Beatty, D. H. 0. 

Cagayan and Isabela Dr. F. Rieerra, D. H. O.; Dr. B. Torribio, D. 

The active infection which began to spread from towns near Manila 
in August, 1905, did not entirely disappear from the archipelago as^i 
whole until April 29, 1907, and even then the provinces remained clel| 
only until July 22, 1907. , H 

I have already called, attention to the startling difference between tflP' 
result of the campaign in Manila and that of the one in the provinces. 
The explanation is not far to seek. There was a small but very effective 
body of men available for the work in Manila while in the provinces it 
is an unfortunate fact that the body of men available was not only small 
but was on the whole very ineffective. I shall defer further discussion 
of this point until I have stated the facts as to the recurrence of cholei 
in Manila. 



49 

SUBSEQUENT EPIDEMICS IN MANILA. 

Manila remained free from cholera from March 21, 1906, to May 8, 
1906, and there was but one case between February 21 and May 11. On 
the latter date the disease reappeared, continuing until Novemebr 27, the 
number of cases by months being as follows : 



Month, 1906. 


Cases. 


Deaths. 


Mav __ 


11 

91 

393 

211 

80 
27 

7 


11 


June 


81 


julv - - - 


349 


August 




179 


September 

October 




67 




24 


November -_ - . • 


6 








Total— 


820 


717 







From November 28, 1906, until July 13, 1907, there were no cases. 
Cholera then reappeared and continued until March 18, 1908. The 
number of cases by months was as follows : 



Month. 


Cases. 


Deaths. 


iy07_July 


3 

5 

72 

76 

32 

35 

184 

14 

5 


2 




5 


September _._ 


64 


October 


65 


November 


32 


December : 


26 


1908 — January _ _ 


151 


February 


11 


March 


5 








Total 


426 


361 







The outbreaks of May 8 to November 27, 1906, and of July 13, 1907, 
to March 18, 1908, were of comparatively insignificant importance and 
were handled as a part of the ordinary routine by the Bureau of Health 
without any change in the force ordinarily employed. It was, however, 
deemed advisable to postpone the Carnival from February 8, 1908, to 
February 27, 1908, for the reason that numerous persons from remote | 
provinces were sure to attend it and it was necessary to avoid the 
possibility that some of them would become infected with cholera in 
Manila and scatter the disease when returning to their homes. 

The last case occurred on March 18, 1908, and the city then remained 

clean until June 8, 1908, when the cholera, which had meanwhile been 

raging in the provinces to the north, reappeared. From that time to 

the present Manila has been repeatedly reinfected from the provinces. 

78079 4 



50 



Again and again the infection has been stamped out only to reappear. 
Cases have occurred as follows : 



Cases 



June 8 

12 

23 

July 7 

15 

17 

22 

27 

29 

31 

Aug. 3 

4 

6 

7 

8 

10 

12 

14 

18 

21 

22 

24 

25 

27 

28 

29 

31 

Sept. 1 

2 

3 

4 

5 

7 

8 

9 

10 
11 




During the week ending September 17, the towns of Calumpit, 
lacan, Bocaue, Hagonoy, Malolos, Paombong, Quingua, Obando, Santa 
Maria, Baliuag, and Meycauayan, all in Bulacan Province, were infected. 
There was some panic among the people of that province, and the people 
of the district of Tondo state that a considerable number of persons 
from these towns fled to Manila, bringing the disease with them. It was 
during this week and the one following that conditions became threatening 
in Manila. 

Due in part to the increasing number of persons who have recovei 



51 

from cholera at the San Lazaro Hospital or who have had friends saved 
there, and in part to the more friendly attitude of some of the news- 
papers published in the Spanish language, there has been less fear of 
this institution than ever before. In consequence, the cases have been 
received earlier, on the average, and the mortality has been correspond- 
ingly low, but the presence of numerous convalescents has tended 
rapidly to fill the hospital, and this, with the sharp increase in cases 
which occurred from September 12 to September 21, made it evident 
that additional quarters must be secured. 

The first step toward meeting this difficulty was to vacate and 
thoroughly disinfect the smallpox liospital, the patients being transferred 
to a distant building. The second was to accept the generous offer of 
the authorities of the Mary J. Johnston Hospital to give the Bureau of 
Health the use of the entire lower floor of that institution, where it was 
possible to place some thirty beds, and the third was to clear both 
floors of the insane pavilion and convert it into a cholera hospital, for 
which it is admirably adapted. Overcrowding has been constantly 
avoided, although there were for several days a number of patients on 
the wide verandas of the contagious-disease hospital. Keeping them 
there was unobjectionable from a hygienic standpoint, so long as the 
weather was good, but, if continued, would have resulted in criticism 
on account of the belief prevalent among the Filipinos that night air 
is dangerous. 

COOPERATION WITH THE BUREAU OF HEALTH. 

On the very day that the use of the Mary J. Johnston Hospital was 
arranged for Msgr. Tuiion and Father Chouza called on behalf of the 
Archbishop of Manila, who was absent in the provinces, to offer the 
use of the Santa Isabel Convento in the Walled City, and of the Convento 
connected with the San Sebastian Church, for hospital purposes should 
they be needed. 

The latter building, on account of its comparatively isolated position, 
was deemed the more desirable of the two and upon inspection proved 
to be well suited to hospital purposes. The rector of Santo Tomas 
University also assured me of his confldence that the authorities of 
that institution would, if necessary, gladly offer their building for 
hospital purposes as they did in 1882. Fortunately the spread of 
cholera was promptly checked, and it was not necessary to accept any 
of these kind offers which were, however, most highly appreciated, 
especially as they were made spontaneously and were an evidence of the 
general desire on the part of the public to cooperate in the stamping 
out of cholera in the city. 

Further evidence of this desire was afforded by the prompt action of 



52 

the Camp Lawton Post of the Veteran Army of the Philippines, whose 
members promptly offered their services : 

The Acting Dibectob, Bubeau of Health, Manila, P. I. 

Sir: I have the honor to inform you, that, at a special meeting of the Camp, 
held on the evening of September 21, 1908, the following resolution was adopted: 

'^Resolved, That the commander be authorized to notify the Director of Health 
that the services of the members of this camp are at his disposal at any time, to 
aid in stamping out cholera in the city of Manila." 

All members have been requested to notify the proper authorities of all premises 
in their neighborhood which are in an unsanitary condition so that the Bureau of 
Health can take such steps as may be necessary. 

Should occasion arise requiring the further assistance of the members of the 
camp, it is requested that I be notified so that the necessary instructions may is3U(i. 
Very respectfully, 

Wm. Brook, CommanderMM 

VALUABLE ASSISTANCE GIVEN BY THE POLICE AND FIEE DEPARTMENTS. 

Of especial value has been the work of the police and fire departments. 
At frequent intervals the police have made systematic house-to-house 
inspections for cholera cases. This is work of a very delicate nature, as 
there is always danger that inspectors may be inconsiderate, rude, or even 
worse when necessarily trespassing upon the privacy of those who do not 
welcome what seems to them a needless and unwarranted intrusion. 
There has been little complaint, from responsible sources, of the manner in 
which the police have made their inspections, which have resulted in the 
early detection of numerous cases and have greatly facilitated the sup- 
pression of the infection. 

The use of chemical fire engines in disinfecting buildings and premises, 
suggested by the chief of the fire department, has proved of great as- 
sistance, making possible rapid and thorough disinfection upon a much 
larger scale than would otherwise have been practicable. Both policemen 
and firemen have often worked to the point of complete exhaustion and 
the assistance rendered by them has been invaluable. 

VOLUNTEER CHOLERA FIGHTERS. 

Doctor Nichols of the United States Army Medical Corps volunteered 
for service and was given immediate charge of the Mary J. Johnston 
Hospital. Eighteen students from the Philippine Medical School vol- 
unteered and were assigned to work as nurses and attendants at the 
hospitals. At the outset a few of these young men declined to per- 
form what they termed "menial service." The necessity for the per- 
formance of this service was fully explained to them and they were 
interrogated as to their willingness to do for people of their own race 
the work which highly educated American women were performing for 
them. It was at the same time suggested that any of them who did not 
wish to do such work might go. Thereafter they discharged their dis- 
agreeable and somewhat dangerous duties faithfully and well. 



Jl 



b6 

Twelve students of the Uiversity of Santo Toinas also volunteered for 
cholera work and on the 23d of September sent the following letter; 
through Father Velasquez, rector of the University : 

The undersigned last year students of the faculty of medicine of the iJniversity 
of Santo Tomas voluntarily offer themselves to the Government of the Philippine 
Islands to aid in the extinction of the prevailing malady in the city of Manila, 
whenever and wherever it may be opportune to use their services. 
^lANiLA, Seplember 23, 1908. 

EsTEBAN Arroyo, 
Jose Arevalo, 
Nemesio a. Badilla, 

0. Tegpaco, 
Maximo Cuesta, 
RiCARDO Molina, 
Felino Simpao, 
Anselmo Abela, 
Pedro A. Nabciso, 
Clements Velasco, 
Jose F. Quinto, 

1. e. guebara. 

This offer was accepted, and these young men rendered valuable service 
at the hospitals during the period when the number of cases was com- 
paratively large. Later it seemed desirable to assign some of the students 
of the Philippine Medical School to the work of train inspection on 
railway lines terminating at Manila, but the young men placed in charge 
of this work were recalled by the dean of the faculty of the school. 

A request was thereupon made that the Santo Tomas medical students 
take up this service, which they did, performing it in a highly efficient and 
satisfactory manner. 

It was suggested on September 22 to the young women who are 
learning the professi9n of nurse under the immediate direction of Miss 
Charlotte Layton at the Philippine Normal School that their services 
could be used to great advantage at this time. On September 26, four 
of them, in charge of Miss Layton, responded to this suggestion and 
subsequently rendered valuable assistance in caring for Filipina women. 

On the whole, it may safely be said that the hospital care given to 
cholera victims during the present epidemic has been better than ever 
before in the history of the Philippine Islands. 

CRITICISM OF THE MEASURES ADOPTED FOR SUPPRESSION OF CHOLERA 

DURING 1908. 

In spite of this fact there have not been lacking complaints as to the 
alleged unprepared condition of the San Lazaro Hospital. It has been 
said, for instance, that the institution was unscreened and that the 
work of screening it had to be undertaken after numerous cases of 
cholera were in the wards. The fact is that the screening of the hospital 
was undertaken soon after it was completed, but it was found that metal 



54 

screening rusted out very rapidW and as the hospital often remained 
unoccupied for months at a time, and even when occupied was entirely- 
free from flies, with nurses enough so that the dejecta of patients were 
instantly cared for, there was no danger of infection. Under these 
circumstances I agreed with Dr. Heiser that it would be foolish to incur 
the expense of constantly renewing this screening, especially in view of 
the fact that if an epidemic should threaten, the entire place could be 
screened with mosquito netting in a day or less. 

In point of fact, simultaneously with the increase in cholera cases 
in September came a plague of flies. The hospital was promptly screened 
as had been planned, but as, on the average, 25 per cent, of the typhoons 
of the year occur in September, it was deemed advisable to use wire 
screening rather than ordinary mosquito netting, and the work of putting 
this in place took longer and involved more confusion than would have 
been the case had ordinary mosquito netting been used. The present 
screening will rust out in a few months. It would, in my opinion, be 
wise to order copper screening from the United States, and test its 
durability. 

It should be stated, in passing, that the kitchen and dining room of 
the institution have always been kept screened. 

It has been claimed that the screening of the morgue was broken and| 
had to be replaced after the epidemic was on. The facts are as follow- : 

"The San Lazaro morgue was opened for service on May 1, 1903, and so far iu> 
records are obtainable it was then screened and has been sereened ever since. 
At various times the screening has been renewed, and about the middle of 
August it was double-screened — that is, the old screening was allowed to remain and 
new screening placed on the outside to insure that if breaks should occur in the 
old screening, the place would still be protected. It is expected to follow this 
system hereafter. At no time has the morgue been without screening. The 
report of new screening during September may have been occasioned by the 
fact that as an additional precaution during the cholera epidemic when the 
number of bodies in the morgue had increased to a considerable extent beyond 
that usually found in the morgue, and consequently persons were passing in and 
out oftener than was customary, an additional vestibule was added^ to the 
vestibule already on the morgue, making it necessary to pass through three^ 
screen doors before entering into the morgue proper; this vestibule was 
on September 22, and completed in about three days." 

It is furthermore true that the laundry facilities at the San Lazaro' 
Hospital are not thorouglily modern nor indeed adequate to meet such 
an emergency as that through which we have just passed. I must 
plead guilty of having overlooked this fact until it was brought to my 
attention by the nurse in charge of the hospital, when the epidemic was 
well under way. 

The electric apparatus for heating water on the wards was put out 
of commission by a change in the nature of the electric current supplied 
to the city and has never been replaced, its place being taken by kerosene 
heaters, which are quite satisfactory. 



three 
jazaro I 



JA 



66 

It should be remembered that it is neither wise nor necessary to keep 
a hospital which stands nearly or quite empty for considerable periods 
e([ nipped and officered in such a way that it may be instantly run at 
its full capacity without any change whatever. Supplies and apparatus 
not ordinarily necessary must for safety's sake be removed to store rooms, 
and when an emergency threatens, the necessary steps to meet it must be 
seasonably taken. This was done in the present instance, but some of 
those who saw luork going on seemed surprised that it should he neces- 
sary. 

It has been alleged that the Director of Health has pursued a niggardly 
policy and has prided himself on turning in a large surplus at the end 
of the year when the mon6y should have been spent in sanitary work. 
I shall later show that the main difficulty has been one of men rather 
than of money. Had more men been available far more money might 
very advantageously have been employed. I have never known Dr. Heiser 
to be unwilling to incur an expenditure for any needed and practicable 
improvement when funds to pay for it were available. 

It has been alleged that under orders from the Governor-General the 
situation in the Visayan Islands and that in the provinces north of 
Manila was left in the hands of the Filipino district health officers, 
in order that the people might be taught by experience a hard lesson 
which they would not be likely soon to forget. Subject to the general 
control of the Governor- General the Secretary of the Interior is in charge 
of health matters. The Governor-General has issued no such instructions 
and there is not the slightest ground for placing the blame for the 
situation in the provinces upon him. The question of further depleting 
our already weakened Manila force to recruit that in the provinces has 
been not one of desirability but one of possibility if Manila was to be 
safeguarded. If a mistake has been made, I am of the opinion that it 
has been through pending too many men from Manila to the provinces 
and thus unduly weakening the defense of the city. With the present 
force it is impracticable to operate successfully in both regions at once. 
The extent to which Manila has been stripped to help the provinces is 
shown by the table on page 113. 

As a result of the absolute lack of a sufficient number of thoroughly 
trained men it has, in point of fact, been necessary to leave the situation in 
the Visayan Islands almost entirely in the hands of the local health officers, 
but it is an ill wind that blows no one good and I respectfully suggest 
that a study of the statistical information hereinbefore submitted, in so 
far as it bears upon the course of the present epidemic of cholera in 
Capiz and its spread to Iloilo and Western Negros on the one side and 
to Antique and Palawan on the other, with a total number of cases to 
October 19 of 8,441, inculcates a lesson from which there is no possible 
escape. 



56 

REASONS FOE CHANGES OF CHIEF HEALTH OFFICERS. 

It has been said that the frequent appointment of new chief health 
oflBcers was responsible for the lack of a definite and more sucessful 
policy. 

Maj. L. M. Mans, the first Commissioner of Public Health, who was 
relieved on July 31, 1902, had long before voluntarily requested such 
relief. It had been arranged for, and his successor was on his way. 
It is true that, in the end, his resignation was insisted upon because of 
the critical cholera situation and the belief that in the physical condition 
in which he was he could not control it. Dr. Frank S. Bourns was 
therefore temporarily appointed Commissioner of Public Health until 
cholera in Manila could be brought under control. 

The acceptance of Major Maus's resignation and the appointment of 
Dr. Bourns both took place when I was ill at Baguio, a place which 
was then without any means of direct communication with Manila and 
I knew nothing of these changes until my return. I beg to say, however, 
that under the circumstances I should have favored them had I been 
in Manila. 

Dr. Bourns accepted temporary appointment reluctantly, acconxplished 
the work expected of hini in the most satisfactory manner, and retired 
as soon as Governor Taft would allow him to do so. 

Major Carter held the position of Commissioner of Public Health from 
September 8, 1902, to April 28, 1905. During this entire period he 
suffered as few Americans have ever suffered in the Philippines from 
the climate and he was ultimately relieved, at his own earnest request, 
when worn out by hard work and ill health. 

Dr. Victor G. Heiser was appointed Commissioner of Public Health 
on April 28, 1905, and later his title was changed by law to Director 
of Health. He still holds that office and I sincerely trust that he will 
long continue to do so. 

He came to the Philippines as Chief Quarantine Officer on February 
17, 1903, and at the time he sailed for the United States on August 5, 
1908, had served continuously without leave of any sort from the time 
of his arrival in the Islands. He had habitually worked until eleven and 
twelve o'clock at night and within a short period prior to his departure 
had twice been sent to the hospital after refusing to go there until he 
was literally unable to keep his feet. Even as it was he was ordered 
to the United States, not to rest but to work for the Insular Govern- 
ment, and he will return here before he has had anything like the leave 
to which he has long been entitled. 

Whether or not Dr. Heiser was disposed to desert his post may be 
inferred from the following facts. The climate of Baguio has always 
proved particularly stimulating to him and shortly after he left the 

i 



57 



ospital for the second time I urged upon him the desirability of tem- 
■orarily transferring his office to that place, but although barely able to 
eep about he strenuously objected to the suggested change on the ground 
hat he must remain in immediate personal charge of the work of his 
bureau. Finally it became necessary for me to issue to him an im- 
terative order to transfer his office to Baguio for a minimum period 
t one month. Before he had been there ten days he was begging to 
-e allowed to return to Manila in order to make a trip on a coast guard 
loat and personally to supervise and direct the collecting of a shipload 
'f lepers, and this I finally permitted him to do having first given him 
mperative instructions to return to Baguio immediately after the lepers 
rere on shipboard. 

In this connection I desire to call attention to the nature of the work 
vhich has not infrequently been performed by Dr. Heiser on these leper 
li'ollecting trips. No one who has not seen them can form the faintest 
dea of the horrors to be encountered among a shipload of leper outcasts 
gathered for transportation to Culion. Distorted and deformed by the 
nost frightful of all diseases these victims of a living death, dripping 
vith gangrenous putrefaction, stinking to heaven, and in some cases 
iterally falling to pieces when moved, present pictures which sear them- 
selves upon the very brain of him who sees them and which may well 
ippal the stoutest heart. 

When no other white man could be hired by money to touch them and 
vvhen no Filipino could be influenced by love of gain or by love of his 
3wn people to go near them. Dr. Heiser has, not once but repeatedly 
taken these poor putrefying wrecks of humanity in his arms and borne 
:hem tenderly on board the vessel that was to convey them to their final 
sarthly home, and having done this has rolled on the deck of the vessel 
Dvercome by uncontrollable nausea. These facts were not learned from 
bim, for he has never mentioned them until compelled to do so by the 
interrogations of his superiors, but from the officers of Coast Guard 
vessels and from others who have witnessed his acts. And this is the 
man who has been charged with indolence, with neglect of duty, and 
with displaying cowardice by running away from Manila when there 
were a few scattering cases of cholera there on the pretext of attending 
the International Tuberculosis Congress at Washington ! Can he afford 
to ignore the curs that yelp at his heels ? I think so. 

It is true that he really desired to go to the Tuberculosis Congress 
at Washington. Why? Was it for his own recreation or enjoyment? 
Not at all. It was because tuberculosis in these Islands claims its 
hundreds were cholera claims its scores. Even during the very worst 
years of the 1902-0 Jf epidemic the deaths from tuberculosis in Manila 
were in excess of those from cholera and this disease we practically 
ignore because, forsooth, it is always with us. There is good reason 



58 

to believe that one out of every five or six inhabitants of the Philippine 
Islands suffers from some form of tuberculosis at some period during 
his life and one of the problems which Dr. Heiser has set himself is to 
plan the most effective possible campaign against the "great white 
plague/' 

While the danger involved in allowing him to leave the Philippines 
while cholera was still prevalent in the provinces was fully realized it 
was not apparent that the situation would be materially benefited by 
killing a faithful and eflScient employee, and the hard fact is that the 
burden which has rested on Dr. Heiser and on his predecessors has been 
a killing burden. In Dr. Reiser's case it has been especially heavy 
through the cutting down of his available force of efficient subordinates. 

It should be said, however, that the only change which results from the 
sending of Dr. Heiser to the International Tuberculosis Congress, is that 
at the present time we have in general charge of the work of the Bureau 
of Health one efficient man when otherwise we should have two. Dr. 
McLaughlin, who, like Dr. Heiser, is an officer of the United States Public 
Health and Marine Hospital Service and has the training which such a 
position implies, has displayed such energy and efficiency in dealing with 
the epidemic as to leave nothing to be desired. 

THE BUREAU OF HEALTH CHARGED WITH RESPOXSIBILITY FOR THE OCCUR- 
REXCE AND THE CONTINUED TRESEXCE OF CHOLERA IN THE ISLANDS. 

Fortunately for all concerned the situation has not been without its 
humorous features. !N"ot only has the American administration been 
charged with changing the climate of the Philippines and with other 
minor offenses but it is made responsible for the coming and continuance 
of cholera, the accusation in one instance taking the following form : 

"Shortly after the establishment of the civil regime there was organized an 
office of health in the form in which it is now constituted. Ten years had 
elapsed at that time during which the archipelago had been free from cholera 
and immediately following upon such organization in 1902, there came the 
sanitary crisis which is causing such injury to commerce." 

On the same page of the newspkper which publishes this comment with 
approval, appears the announcement of a commercial house to the effect 
that on the 23d of September they began to advertise a nostrum known 
as "Ponclie Soto;" that from that time to date (October 8) they had 
sold nine hundred and forty-tlu-ee bottles, and that from the time public 
consumption of "Ponche Soto'^ had increased the number of persons 
attacked by cholera had steadily diminished. Thus the efficacy of the 
nostnim was proved, and the bad sanitary situation created by the Bureau 
of Health during six years of maladministration had been almost 
remedied, so far as the city of Manila was concerned, in the short space 



d 



69 

of thirty-one days through the sale of nine hundred and forty-three bottles 
of 'Tonche Soto." The advocates of tlie argument post hoc ergo propeter 
hoc in these two cases were at least consistent. This is the sort of reason- 
ing which we are only too often called upon to meet. 

Tlie article above referred to says tliat from the year 1902, with more 
or less brief periods of intennission, the country has suffered from a 
cholera epidemic which the methods employed by the office of health have 
not sufficed to extirpate and that this never occurred previously in the 
Philippines nor within many years in any civilized country. I liave 
already shown that it did occur from 1883 to 1897, during which period 
cholera was constantly present and conditions were far worse than at any 
subsequent time. 

CONDITIONS FAVORABLE TO THE PROPAGATION OF CHOLERA IN TTTE 

PHILIPPINES. 

Furthermore, it might well be replied that there is no other civilized 
country where the customs of the inhabitants are so favorable to the 
dissemination of cholera and undoubtedly the worst of these, universal 
among the common people and by no means confined to them, is that of 
eating with the fingers. It would be superfluous to mention the ways in 
which the fingers may readily become contaminated. Simple washing 
does not suffice to remove cholera germs and when the family, or a group 
of friends, gather for a meal and dip their fingers first into the common 
dish of rice and then into that of fish or other vianda, if one of their 
number has an infected hand others are likely to suffer. Especially is 
this true where food ever so slightly contaminated is left over and eaten 
later. Germs may then multiply with great rapidity. Drinking water 
is commonly kept in large earthen jars into which those who wish to 
drink dip cups or half cocoanut shells, and incidentally their fingers, 
and thus the drinking water, even if pure at the outset may readily 
become infected. 

Unfortunately, it is by no means certain that it will be pure. The 
drinking water of these Islands comes almost entirely from open springs 
and streams or from shallow wells into which surface drainage readily 
runs. Clothes are frequently washed at the side of the family well and 
that evil consequences follow the use of such water, even when cholera 
does not prevail, is shown by the fact that the drilling of artesian wells 
and a general use of the water from them in certain municipalities has 
sufficed to reduce their death rate fifty per cent. 

A further serious obstacle is found in the wide prevalence of foolish or / 
superstitious beliefs to the effect that the drinking of boiled water causes 
the hair to fall out ; that cholera is caused by the poisoning of wells and 
streams by foreigners, or by a black dog which runs down the street, or 
in some other equally impossible way. Finally, in common with other 



60 

tropical countries, the Philippines have a climate which favors the con- 
tinued existence of cholera germs when once they find lodgment in any 
suitable medium and thus there is an ever-present possibility that thej 
disease may become endemic in a given locality. i 

THE GROWTH OF RAILWAYS A SOURCE OF DANGER. 

One source of danger which has arisen since the last serious epidemic 
in Spanish times seems to have been generally overlooked. So long as 
inland travel was necessarily undertaken on foot, or horseback, in vehicles 
or in small boats, it was necessarily slow. The ordinary incubation period 
of Asiatic cholera in this climate is forty-eight hours and under these 
circumstances the infection could not spread very rapidly, but with the 
construction of railways a new factor was introduced. One may travel 
quite a distance in forty-eight hours even on the Manila and Dagupan 
Road, and the infection from Manila of the Provinces of Rizal, Bulacan, 
Pampanga, Tarlac, Pangasinan, La Union, Nueva Ecija, Laguna, and 
Cavite within twelve hours is now theoretically possible owing to the 
growth of railway lines. 

REORGANIZATION OF THE BOARD OF HEALTH. ^ 

It is not true that the '^office of health" was organized as it is m™ 
constituted in 1902. On the contrary it has since undergone a compl(}_ 
reorganization. The executive powers which were originally vested 
board of five members have been conferred upon a single individuS 
namely the Director of Health, while the original thoroughly trained aQ^ 
efiicient force of the board has scattered, largely as a result of the ^f 
satisfactory conditions of the service created through legislative enac 
ments. The positions formerly occupied by many of these men have 
been abolished. 



i 



THE CLAIM THAT FILIPINOS ALONE SHOULD BE EMPLOYED TO COMBAT 

CHOLERA. 



i 



The claim has been made that our difficulties in dealing with chole 
at Manila and in the provinces would speedily end were we to put all of the 
work of combating it in the hands of Filipinos, and that these difficulties 
would be greatly diminished in Manila were we to make the management 
of the cholera hospitals exclusively Filipino, the reason assigned being 
that the Filipinos better understand their own people and enjoy their 
confidence to a higher degree than do the Americans. 

The actual result of leaving the situation in certain provinces entirely; 
to Filipinos is demonstrated by the statistical tables in this report. This 
result is hardly such as to justify any extension of the policy. It is in- 
teresting to note that we have had there the same story of concealment 
of the sick and secret burial of the dead with which we are so familiar at 
Manila. 



61 

THE COMMON PEOPLE LACK CONFIDENCE IN PHYSICIANS. 

The difficulty arises not so much from the lack of confidence in- 
physicians of any particular nationality as from a lack of confidence in 
physicians as a class. 

Even in Manila, where there are far more Filipino physicians in 
proportion to the number of inhabitants than can be found anywhere 
else in the Archipelago and where a number of competent Filipinos are 
employed as municipal physicians to give gratuitous care to the indigent 
sick, not less than 50 per cent of the deaths occur without medical 
attendance, a fact which would not seem to indicate a high degree of 
confidence on the part of the Manila public at large in physicians of any 
nationality. 

THE BEST RESULTS OBTAINED BY COOPERATION BETWEEN AMERICANS 

AND FILIPINOS. 

During the present epidemic the work at the San Lazaro cholera 
hospital has been carried on under the general supervision of an American 
physician aided by two American and three Filipino physicians, by seven 
American trained nurses, by four Filipina nurses who have partially 
completed a course of training, by three American hospital stewards, by 
twelve students from the Philippine Medical School, and by twelve medical 
students from the University of Santo Tomas. It seems to me that this 
has been a most satisfactory arrangement. At all events the death rate 
has been extraordinarily low, being but 47.3 per cent, of the total number 
of cases admitted up to October 24, 1908, and this in spite of the 
fact that many of the patients were so far gone on arrival at the hospital 
as to he without pulse at the wrist. 

THE QUESTION OP DISINFECTANTS. 

It has been charged that the present epidemic found the Bureau of 
Health without a proper supply of disinfectants and that a part of those 
used during the early days of the epidemic were practically worthless. 

The following memorandum and correspondence give the facts: 

■■ """^ 

Memorandum for the honorable the Secretary of the Interior relative to dis- 
infectants. 

A table is attached to show the amount of disinfectants on hand, received, 
issued, and remaining on hand for 1905, 1906, 1907, and up to the present 
time. ♦ 

It may be stated that at no time has the Bureau of Health been without 
disinfectants properly to disinfect all cases, premises, and contacts where cholera 
occurred. 

Reference to the amounts of disinfectants for the three years will show that 
according to experience this Bureau had on hand amounts considered necessary 
as in previous years. At all times was it taken into account that the Quarantine 
Service, the Army and Navy, Japanese commercial houses, and Hongkong had 
supplies which could be drawn upon, and by no reasoning could the purchase of 



63 



extraordinary amounts, more than had been needed in previous years, be 
justified. 

The campaign this year was conducted upon different lines than years previous, 
this being due to the fact that in no previous experience in recent years had 
there been such general infection nor had the number of cases risen to the 
number per day that it did in this epidemic. The report that the Bureau of 
Health had run out of disinfectants was probably founded upon the fact that 
we were constantly requesting information as to quantities and prices obtainable, 
in order to insure a constant supply. It is true that on two days three of the 
tank wagons used electrolysed salt water which it was found would kill cholera 
bacilli promptly, but these wagons were used only for general disinfecting 
purposes, and at no time was there any danger that for actual cholera purpose's 
the supply of disinfectants would be exhausted. 

Chandler, 
Chief Clerk, Bureau of Health. 



Statements on disinfectants. 



i 





On 

hand 

Dec. 31, 

1904. 


1905. 


1906. .q 


Disinfectants. 


Re- 
ceived. 


Total. 


Issued. 


On 

hand 

Dec. 31. 


Re- 
ceived. 


Total. 


Issued. 


On 

hand 

Dec. ol. 


Bichloride kilos 




200 

24,800 
165 

100 
250 


200 

25,845 
183 

6} 

10 

114 

31 5i 

517 


94A 

23,745 
149 

6 

79' 
128} 
133 


105/, 

2,100 
34 

35 

186} 
384 


187i 

14,000 
J, 550 

10 

334i 

90 

21 

240 


293| 

16,100 
1, 584 

sm 

125 

189J 

624 


188^ 

14,600 
1,550 

119 
21i 
440 


104i 

1,500 
34 


Lime: 

Chloride pounds.. 

Rock sacks.. 

Carbolic acid: 

crude ......{Xt-- 


1,045 
18 

5i 


Crystals drums.. 

Phenol liters.. 

Formaldehyde kilos.. 


14 
65i 
517 


J - , 



Disinfectants. 



Bichloride kilos.. 

Lime: 

Chloride pounds.. 

Rock sacks.. 

Carbolic acid: 

f barrels .. 
Xgallons.. 

Crystals drums.. 

Phenol liters.. 

Formaldehyde kilos.. 

Jeye's fluid gallons.. 

Trikresol liters.. 



Crude. 



1907. 



1908. 



Re- 
ceived. 



200 



10,250 
765 



87 
"210' 



Total. 



304i 

11,750 
799 

i 
628i 



Issued. 



197 



,850 
753 



529 



233 



On 

hand 

Dec. 81. 



Re- 
ceived. 



107i 

3,200 
46 



99i 

17 

128i 

161 



131i 

2,000 
27,262 



Total. 



5,200 
27,298 



2,53U 

75 

299t 

2,270 

4,000 

4421 



2,631 
92 

427i 
2,431 
4,000 

442i 



Issued. 



165 

3,900 
27,298 



2,631 
79 

159i 
2,481 
8.360 

442i 



han<l| 
Oct. 12. 



74 
1,300 



18 

268 



64< 



Manila, August 20, 1908. 
The Purchasing Agent, Bureau of Supply, Manila. 

Sir : I have the honor to invite your attention to the fact that investigation 
by your office and this office develops the fact that there is a scarcity of carbolic 
acid in the city. Owing to the presence of cliolera in the provinces, it is deemed 
advisable to take measures immediately to assure that an adequate supply is on 
hand as soon as possible. 

Messrs. Watson & Co. wrote to their principals in Hongkong on August 12 
10 ascertain what amount could be secured there and they expect an answer by 
return mail. Local agents with Singapore and Japanese principals are also taking 
steps to ascertain amounts available. This Bureau has on hand a month's supply 



63 

for present needs and it is understood that your Bureau has some 1,200 gallons 
en route. Requisition has been made upon you to-day for 600 gallons crude and 
50 drums crystal, which it is hoped will be obtained as soon as possible, reference 
being had to the letter of Watson & Co. above mentioned. The supply likely to 
be needed by the provinces is ditiicult to estimate; llocos Sur will probably need 
200 gallons and Iloilo 200 gallons. The remaining provinces are most of them 
slightly infected and it is believed that 1,000 gallons on hand would enable you 
to fill requisitions according to present conditions. It is believed, however, that 
as a precautionary measure, steps should be taken to arrange orders for immediate 
shipment from the nearest markets in case the demand should increase. It may 
be taken into account that this disinfectant will always be in demand, does not 
easily deteriorate and that there is very little danger of overstocking. 
Very respectfully, 

A. J. McLaughlin, 
Acting Director of Health. 



Office of the Bureau of Supply, 

Manila, P. L, August 27, 1908. 
Sir: Referring to your recent communication, I have the honor to inform you 
that immediately upon its receipt, this Bureau sent a cablegram to Japan inquir- 
ing as to whether or not 50 drums crude carbolic acid could be furnished. 

A reply has been received to the effect that there is no crude acid obtainable 
in the Japanese market, but red crystals can be supplied. Please advise us at 
your earliest convenience whether or not a supply of carbolic acid in red crystals 
would be a good substitute for crude carbolic acid. 

Very respectfully, Gus Johnson, 

Assistant Purchasing Agent. 
Director of Health, Bureau of Health, Manila, P. I. 

[First indorsement.] 
Department of the Interior, Bureau of Health, 

Manila, P. /., August 28, 1908. 
Respectfully returned to the Purchasing Agent, Bureau of Supply, with the 
information that carbolic acid in red crystals will be a good substitute for crude 
carbolic acid. 

A. J. McLaughlin, 
Acting Director of Health. 



Office of the Bureau of Supply, 

Manila, P. I., September 22, 1908. 
Sir: I beg to forward the following report of the action of the Bureau of 
Supply in the matter of orders for carbolic acid since May 1, 1908, for your 
information. 



Crude 100 
per cent 
(gallons). 



Crystals 
(pounds) 



Due to 
arrive. 



Arrived. 



On hand May 31, stock 

Ordered: 

May 27, cable, Japan 

June 12, cable. United States. 
July 16, mail, United States.. 

July 16, cable, Japan 

Aug. 29, cable, Japan 

Sept. 18, cable, Japan 



1,200 



1,200 
1,200 



Sept. 24. 
Nov. 1 _. 



5,600 
11,200 
11,200 



Oct. 4- 
Oct, 4- 



. July 16. 



3,600 35,920 



359.5 drums. 



Sept. 8. 



h. 

I 



64 

Your attention is invited to the fact that the annual estimate of the Board 
of Health for the fiscal year July 1, 1908, to June 30, 1909, calls for only one 
hundred drums crystal and three thousand gallons crude carbolic acid. This 
estimate is dated July 24, reached this office July 31 and carries a chit, "Dr. 
Heiser requests that no action be taken on this estimate until he advises by 
mail from the United States." 

No advice has yet been received. What action shall we take? 
Very respectfully, 

E. G. Shields, Purchasing Agent. 

Bureau of Health, Manila, P. I. 

[First indorsement.] 

Depaetment of the Interior, Bureau of Health, 

Manila, P. I., September 22, 1908. 
Respectfully forwarded to the honorable, the Secretary of the Interior, request- 
ing that, in view of the present emergency, authority be given to disregard the 
message left by Dr. Heiser in order that the Bureau may be supplied with the 
articles and supplies necessary. 

A. J. McLaughlin, 
Acting Director of Health. 
[Second indorsement.] 

The Government of the Philippine Islands, 

Department of the Interior, 

Manila, Septemler 23, 1908". 
Respectfully returned to thie Acting Director of Health. 

In meeting the present emergency the Acting Director of Health will order 
such supplies and take such steps as he deems necessary, regardless of any 
instructions which may have been left for him. Such instructions it is presumed 
did not contemplate the arising of an emergency like the present one. 

Where it seems adviseable to go in direct opposition to instructions which 
have been left by the Director of Health, it would doubtless be well for the 
Acting Director to consult with the undersigned if there is opportunity, but the 
important thing is that what is deemed to be necessary should be done IM- 
MEDIATELY without any loss of time whatever, and the Acting Director of 
Health unll be supported in such cases by the undersigned. 

Dean C. Worcester, 
Secretary of the Interior. 

In point of fact Dr. Heiser with much difficulty and delay sometime 
since secured a kind of carbolic acid which mixed well with water, did 
not stain, and was thus of especial value for disinfecting purposes. HtJ 
ordered more of this, particularly impressing upon the Insular Purchas- 
ing Agent the necessity for obtaining the same article. 

The acid which was received on this order was not of the same color 
as that requested, it did not mix well with water and it stained badly. 
There ensued a controversy between the Director of Health, the Insular 
Purchasing Agent and the shippers of the acid over the question as to 
whether it was or was not what had been ordered, and the placing of 
larger orders was delayed pending the discovery of a suitable source of 



d 



65 

supply of the quality of acid required, which Dr. Heiser is seeking to 
find in the United States. 

Although the stock of disinfectants kept on hand has not failed at any 
lime during the epidemic to meet the needs as they arose, I am, never- 
theless, of the opinion that a full year's advance supply should be kept 
constantly on hand by the Insular Purchasing Agent to guard against 
a possible emergency. 

SUBORDINATE FORCE EMPLOYED. 

Eelative to the force of men employed during this epidemic: On 
September 15, 105 extra men were employed, and this number was 
increased until 615 natives were on the roll with 36 additional white 
inspectors who were in charge of disinfecting gangs and of men throw- 
ing lime, using water wagons for disinfectants, etc. In addition to 
these about 300 men were furnished by the city for ditching, draining, 
and general cleaning up. Some 200 Constabulary were detailed for 
quarantine guards, and the regular house-to-house inspection was made 
by policemen. All these in addition to the regular Bureau of Health 
force. 

UNSANITARY CONDITIONS IN MANILA. 

The attitude of the municipal officials has been so friendly and helpful 
throughout the present epidemic that it is with regret that I find myself 
compelled to call attention to certain particulars in which I feel that 
they have failed properly to perform their duty prior to the present 
outbreak. 

It will be remembered that under the division of powers finally 
determined upon it was intended to authorize the Bureau of Health to 
determine in general what sanitary work ought to be performed and how 
it should be done, while the city was charged with the responsibility of 
properly performing it. Under this arrangement the disposition of 
refuse and night soil was turned over to the city, and I am glad to say 
that under the supervision of the present highly competent chief of 
the department of sanitation and transportation, Mr. Mehan, this work 
has, in my opinion, been performed even better than when it was done 
by the Board of Health. I regret that I can not make a similar state- 
ment relative to the sanitary inspection of buildings under construction. 

The provisions of law intended to secure proper light and ventilation 
in and around , buildings were originally incorporated in the Sanitary 
Code and had they remained there could have been modified or repealed 
only by the Director of Health with the approval of the Secretary of the 
Interior. ' 

By mutual consent, however, they were cut out of the Sanitary Code 
78079 5 



66 

and incorporated in the building ordinance, no objection to this change 
being raised by the Bureau of Health for the reason that the provisions 
adopted were entirely satisfactory. One of them read as follows: 

Sec. 142 (Ordinance No. 78). Yard on inside lot. — Behind every building 
hereafter to be erected when on inside lot, there shall be a yard extending 
across the entire width of the lot of a width of not less than three meters. 

To anyone familiar with the horrible conditions which formerly 
existed in Manila through the crowding together of nipa shacks, or who 
realizes what destruction of buildings has been necessary in Honolulu 
and other cities, in order to get rid of bubonic plague, and why it is 
that the authorities of Hongkong must continue to face an annual 
epidemic of plague until they destroy property of enormous value,- it 
would seem axiomatic that we should guard against the creating of 
similar conditions in Manila by failure so to group and construct build- 
ings as to afford free access to those two greatest of disinfectants, 
sunshine and fresh air, yet on August 32, 1907, the Municipal Board 
finally repealed this provision. The following correspondence ensued : 

Department of the Interior, Bureau of Health, 

Manila, August 26, 1907. 
To the honorable the Secretary of the Interior, Manila. 

Sir: I have the honor to call your attention to the fact that a sanitary 
ordinance regulation for the purpose of securing light and ventilation, as ex- 
pressed in section 142 of Municipal Ordinance 78, was repealed August 22, 
1907, by the Municipal Board, without this office having been given a hearing 
or even having been notified that such was the intention, and furthermore, 
without the consent of the Governor-General, who, by inference, under the 
provisions of Act No. 1150, is arbiter in such cases. 

While the section cited is not in the Sanitary Code, it is none the less 
most important sanitary regulation, and was omitted from the former by mutual 
consent, as well as other similar regulations, in order to avoid unnecessary 
duplication by including such regulations in both Building and Sanitary Codes. 

Section 142 of Ordinance 78 was primarily aimed against plague and other 
filth diseases, which require light and air for their successful eradication. The 
very condition sought to be remedied by the repealed regulation is now being 
corrected by cities like Hongkong and Bombay with tremendous expense to the 
municipalities. In view of the foregoing, I respectfully protest against the 
action of the Municipal Board as being illegal and extraordinary, and at 
the same time submit the repealed section for reenactment as a sanitary regula- 
tion, in accordance with the provisions of Act 1150, for the following reasons: 

1. To secure ventilation and light, the need of which may be observed in the 
business houses on the Escolta, where tliere are no facilities for through currents 
of air. 

2. To permit the entrance of light, sunshine, and fresh air, which are the 
natural remedies against plague and similar diseases. 

3. To save the city ultimately from the expense and trouble which has been 
forced upon such cities as Naples, Bombay, Calcutta, New York, and many other 
crowded centers of population throughout the civilized world by having to make 
such changes in buildings already constructed. 

In view of the fact that the regulation referred to does not contemplate any 



II 



Jt 



67 

changes in existing buildings but simply applies to the construction which is to 
take place in the future, it is most earnestly requested that this regulation be 
forwarded to the Municipal Board, approved. 
Very respectfully, 

Victor G. Heiseb, Director of Health. 

[First indorsement.] 

Executive Bureau. 

Respectfully referred to the Municipal Board for such comment as it may 

desire to make. 

Prompt return of these papers is desired. 

J. F. Smith, Oovernor-Oeneral. 

[Second indorsement.] 

City of Manila, Municipal Board. 

Respectfully returned to the Governor-General, inviting his attention to 
sections 139, 140, and 143, and especially to the last sentence of section 139 of 
Ordinance No. 78, from which it will be seen that ample provision is made for 
light and ventilation. 

The Board considered carefully the matter before the repeal of section 142 
was effected. 

What brought the matter sharply to the Board's attention was the insistence 
on the part of the health authorities that the section should be rigidly enforced, 
and a three-meter strip left vacant behind all houses, houses being construed to 
mean, not only the main building, but the outhouses as well. A person desiring 
to build a house with a detached kitchen and a detached stable would be required, 
under the ruling of the health authorities, to leave free three three-meter strips, 
which the Board thinks is an unnecessary hardship. 

By direction of the Board : 

Jno. M. Tutheb, Secretary. 

[Third indorsement.] 

Executive Bureau, Manila. 
Respectfully returned to the Director of Health, inviting attention to the 
second indorsement. 

If the interpretation placed upon section 142, Ordinance No. 78, is correct, 
it would appear that such an interpretation would cause unnecessary hardship. 

James F. Smith, 
Acting Secretary of the Interior. 

As open violations of the Sanitary Code and the building ordinance 
continued, the Director of Health addressed a letter to me on the subject 
on May 14, 1908. This letter and its indorsements clearly exemplify 
the difficulties thrown in the way of the Bureau of Health by the city 
engineer's office, and I invite special attention thereto: 

The honorable the Secbetaey of the Interior, 

Baguio, Benguet. 
Sir: I have the honor to invite attention to the fact that the attitude of 
the Municipal Board and of its agents in permitting the erection of buildings 
and other structures in the city of Manila which are in direct violation of 
the sanitary ordinances will probably result in much hardship to persons who 
are having construction Work done and also seriously interfere with the sanitary 
improvement of the city. It will perhaps be remembered that many of the 



i 



68 

provisions which pertained to light, ventilation, and sanitary construction which 
originally were included in the Sanitary Code submitted by this oflSce, were, l)y 
mutual consent, transferred to the Building Code in order to avoid unnecessary 
duplication of ordinances, but in transferring such sections it was explicitly under- 
stood between the Municipal Board and the Bureau of Health that the latter 
did not lose any of the rights and privileges which were given to it by the 
provisions of Act No. 1150. Notwithstanding this, the Municipal Board denies 
the right of the Bureau of Health to interpret the sanitary sections of the 
Building Code. 

The attitude of the Municipal Board is probably more clearly shown by 
quoting a resolution passed by it on September 11, 1907: 

"Resolved, That it is the sense of the Board that the interpretation of 
huildiiig ordinances is the exclusive function of the Municipal Board." 
And again by the repeal on August 27, 1907, of section 142 of Ordinance 78, 
without the Secretary of the Interior or this office having been given a hearing 
or even being notified that such was the intention, and, furthermore, without 
the consent of the Governor-General, who by inference under the provisions of 
Act No. 1150 is arbiter in such cases. 

It is contended by the undersigned that a sanitary ordinance in accordance 
with existing law must be prepared in the office of the Bureau of Health, 
submitted to the Secretary of the Interior, and if approved by him it must 
be sent to the Municipal Board for enactment; but if the latter body refuses 
to enact the same, the ordinance must be returned to the Bureau of Health 
for further consideration, and if the Bureau of Health refuses to change the 
same the matter must be laid before the Governor-General for final decision. 
In view of the method of enacting an ordinance it is contended that an ordi- 
nance can not be repealed unless the same parties who are responsible for 
enactment concur in its repeal. 

In order to bring this matter to your attention in concrete form and to show 
that house owners and others will be subjected to unnecessary expense owing 
to the office of the city engineer approving plans which are in direct violation 
of the sanitary ordinances of the city, I respectfully submit the follow 
instances which have recently occurred. 

lOJt interior, Concepcion, Ermita. — Plan approved by the superintendent 
buildings, July 19, 1907. Cemented places are already badly broken, the mortar 
being largely composed of lime which is a violation of section 9, Ordinance 86, and 
also probably of section 99 of Ordinance 78. 

161 to 187 Arranque, Santa Cruz. — Plans approved by the superintendent of 
buildings July 18, 1907; modified plumbing plans approved by the city engineer 
November 27, 1907. House drain which runs through four tenements or acces- 
sories has a grade of 1 to 106, and another drain which runs through five tenements 
or accessories has a grade of 1 to 225, which is in violation of section 28 of 
Ordinance 86 (Sanitary Code) which specifically states that the grade shall not 
be less than 1 to 50. 

164 Azcarraga. — Plans approved by the city engineer December 3, 1907, show 
kitchens have head rooms of only 2i meters, which is in violation of section 146 
of Ordinance 78, which prescribes that no room shall be less than 3 meters in 
height. The above structure is now nearing completion along the above lines. 

193 Romero Aquino, San Sebastian. — Construction approved by the ^upeiin- 
tendent of buildings on August 9, 1907. The concrete floor of this building 
is on the same level or below that of the sidewalk, which is a violation of section 
1 of Ordinance 89, which states that the level of the ground below and within any 



1 



H 

oi 



Jl 



69 

building hereafter erected and intended for human habitation shall not be less 
than 15 centimeters above the established sidewalk grade at the established building 
line. 

|The foregoing are only a few of the instances which are constantly corain- 
to the attention of this Bureau, and it is obvious that the Government is placed 
in a most unenviable position when one Department approves the construction 
of a building and later when the owner has gone to the trouble and expense of 
erecting the same, to have another Department of the Government inform him 
that it does not comply with the law and he will have to make alterations, all of 
which may cost considerable sums of money and cause him unnecessary loss and 
hardship. ' 

In order to obviate conflicting constructions of this kind in the future it is 
respectfully recommended that the Municipal Board or its agents either be com- 
pelled to comply with the requirements of law or that plans and specifications of 
buildings be not sent out as approved until they have been examined and found 
satisfactory by this oflEice. Furthermore, it is also respectfully requested that the 
necessary steps be taken to declare the action of the Municipal Bpard of August 
22, 1907, repealing section 142 of Ordinance 78, illegal and restore this section 
as it originally stood. The importance of this matter ivill perhaps be appreciated 
when it is remembered that many of the large cities of the world are now engaged 
at heavy expense in providing air-spaces in crowded sections of the built-up portion 
of the cities, and that by taking the action as suggested at this time a heavy burden 
may be saved the city of Manila in the future. 

"Very respectfully, Victor G. Heiseb, 

Director of Health. 
[First indorsement.] 

The Government of the Philippine Islands, 

Department of the Interior. 

Respectfully forwarded to the Honorable James F. Smith, Governor-General, 
inviting attention to the extraordinary attitude assumed by the Municipal Board, 
as set forth in the inclosed communication from the Director of Health. 

The undersigned concurs in the opinion of the Director of Health as to the 
impropriety and illegality of the action of the Board and requests that steps be 
taken which will effectively remedy the existing condition. 

If sanitary ordinances ichich are passed at present in a manner involving 
much delay, but which allow the fullest hearing for all persons interested, are to 
be set aside in this manner by the Municipal Board, it will cease to be possible 
for the Director of Health to exercise any effective control over health conditions 
in the city of Manila. 

The conditions tending to permanent infection with bubonic plague which 
exist in the neighboring colony of Hongkong should afford a sufficient object 
lesson as to the dangers of allowing the erection of buildings in violation of the 
provisions of our Sanitary Code. This matter is of the utmost importance as 
it is easy gradually to improve conditions by proper care in connection with the 
construction of new buildings, while it is both difficult and very expensive to 
remedy bad hygienic conditions brought about by improper construction. 

We should by all means avoid cause for such radical action as was found 
necessary in Honolulu, where, as the Governor-General will remember, it was 
necessary to order the ivholesale destruction of buildings in order to eradicate the 
bubonic plague. 

Very respectfully. Dean C. Worcester, 

Secretary of the Interior. 



70 

[Second indorsement.] 

Executive Bureau, Baguio. 
Respectfully referred to the Municipal Board, requesting a report. 

James F. Smith, Governor-General. 

[Third indorsement.] 

City of Manila, Municipal Board, 

Secretary's Office. 
Respectfully referred to the city engineer, for report. 
By direction of the Board : 

G. S. Lane, Acting Secretary. 

[Fourth indorsement.] 

Department of Engineering and Public Works, 

Office of City Engineer. 

Respectfully returned to the Secretary of the Municipal Board, inviting atten- 
tion to the following facts leading up to the complaint of the Director of Health: 

On Augut 6, 1907, the Acting Director of Health requested that building permits 
be withheld until plans had been passed upon by that Bureau, and a somewhat 
extensive correspondence ensued, which led the Board to adopt the resolution of 
September 11, 1907, subject of the first complaint in the Director's letter of May 
14, 1908. 

The questions touched upon in this correspondence were all protests on the 
part of the sanitary engineer, and the Board in its resolutions showed that it 
considered the points at issue were not of sufficient importance to warrant a 
change in the wording of article 3, Ordinance 78. 

In reply to the various complaints raised by the Director against the follow- 
ing permits that have been issued by this department, I beg to call attention to 
each one specifically, as follows : 

104 interior, Concepcion, Ermita. — This department does everything possible 
to secure for the owners of buildings protection in respect to material employed 
by the contractors, but it stands to reason that a force of fifty inspectors would 
not be sufficient to enable us to place one man constantly inspecting each building 
in the course of construction. It is so easy for a contractor to substitute poor 
material in the mixing of concrete, that it would be impossible for this departm^ 
to prevent such substitution in all cases. 

161 Calle Arranque, Santa Cruz. — The plumbing plans of this building wd 
of such a nature that it was found necessary to assign an assistant engineer 
to lay out the grades for the plumbing installation, and an expert on those 
lines set tlie stakes to which the contractor conformed in the construction. The 
liou.se drain as it was staked out has not a grade of 1 to 106, as stated by the 
Director of Health, nor is there a drain with a grade of 1 to 225, as also stated 
by him. The plans submitted show clearly the elevations of stakes set; said 
elevations being referred to city datum. There is one line in which the grade 
does not quite conform to the Sanitary Code, the grade being 1 in 55. In all 
other grades in this building the grades are 1 in 50 or steeper. A copy of 
this plan was sent to the Director of Health in the usual way, with the eleva- 
tions plainly marked thereon. 

164 .^zcarraga. — A reference to the building ordinance will show that the 
3-meter head room is demanded in rooms. Section 146 and section 148, Ordinance 
89, construes the word "cubicle" or "room" to mean and include any space f 



i 






71 

occupancy or use, inclosed on all sides by walls or partitions more than 2 meters 
in height. I knew of no case in which permission has been granted to construct 
a kitchen of less than 3 meters in height, when such kitchen, by being inclosed 
on all sides, came within the above definition. It has been the custom of the 
department to consider a kitchen open on one or more sides as being outside 
of the definition of a room, and therefore not subject to the provision for the 
minimum height of 3 meters. If error has been made in this particular, the 
Bureau of Health has passed scores of such without comment. 

193 Romero Aquino. — In this case also the Bureau of Health has demanded 
something not required by the ordinance. Section 1, Ordinance 89, states: "The 
level of the ground below and within any building hereafter erected and intended 
for human habitation shall not be less than fifteen centimeters above the 
established sidewalk grade at the established building line." The building in 
question was designed, and permit issued for a tienda, with its deposito, as 
shown on the plan, copy of lohich was forwarded in due course to the Director of 
Hcalih; and, if the Bureau of Health has permitted this building to be occupied 
for human habitation, the fault lies with it, and not with this department, which 
has no authority under any of the provisions of the Building or Sanitary Code over 
the occupation of houses once constructed. In the case of certain houses erected 
on Calle Santa Mesa mezzanine floors were constructed under permit granted by 
this department, and every attempt possible was made to prevent the inmates of 
the building from using these floors for habitation. The Bureau of Health can 
inform the Board with more accuracy than I can what has been accomplished. 

// all the instances of complaint formed by the Bureau of Health are of the 
same nature as the foregoing, they icould appear to warrant but little attention, 
nor furnish ground for complaint. 

Relative to the action of the Board in repealing section 142, Ordinance 78, 
attention is respectfully invited to the fact that in each instance where protest 
was made by the owner of the premises against the action of the city engineer in 
requiring that the 3-meter strip be left vacant, the Bureau of Health was re- 
quested to signify its acceptance or otherwise of the protest. 

In the case of the building kno^vn as "La Puerta del Sol," the authority of 
the Bureau of Health permitted the occupancy of the strip in question, and the 
same was true of the extensive repairs made to the Watson building in the 
Escolta. The action of the Board was taken when it loas shown conclusively that 
the intention of the Bureau of Health was to force the city to acquire by purchase 
(its only remedy) a strip of land throughout each block in the entire city 3 
meters wide in the rear of every house. The decision of the Supreme Court 
relative to the 3-meter strip along the esteros had recently been rendered, and 
the city was confronted by the necessity of expending unlimited thousands of pesos 
to carry out the desire of the Director of Health. 

I respectfully submit to the attention of the Board the fact that such repeal 
was absolutely necessary in view of the decision of the Director to demand its 
enforcement, as outlined in the letter of the sanitary engineer, demanding its 
enforcement in the case of the property on Calle Morriones, Tondo, where the 
3-meter strip was demanded behind the stables. 

If section 11(2, Ordinance 78, is to be reenacted and enforced the city of Manila 
must be ready to expropriate a portion of every lot where it is proposed to erect 
a building in the future, and I hesitate to suggest what portion of the city's 
income would be required to stand the strain. I fear at least 100 per cent. 
Very respectfully, 

W. P. WYI.IE, City Engineer. 



72 

[Fifth indorsement.] 

:!iTY OF Manila, Municipal Board, Seceetaby's Office," 

June 27, 1908. 

Respectfully returned to the honorable the Governor-General, inviting his 
attention to the report of the city engineer given in the inclosure to the fourth 
indorsement hereon, this having been adopted as the sense of the Board, 
By direction of the Board: 

G. S. Lane, Acting Secretary. 

[Sixth indorsement.] 

Executive Bubeau, 

June 29, 1908. 

Respectfully returned to the Director of Health, inviting attention to the 

fifth indorsement. 

James F. Smith, Governor-General. 



1 



[Seventh indorsement.] 

Depabtment of the Interior, Bureau of Health, 

Manila, August 3, 1908. 

Respectfully returned to his excellency the Governor-Gteneral of the Philip- 
pine Islands, through the honorable the Secretary of the Interior, with the 
statement that as the fourth indorsement written by the city engineer (and 
adopted by the Municipal Board) in comment on a communication from tliis 
oflSce, dated May 14, 1908, addressed to the Secretary of the Interior, advances 
practically no explanation of the violations of the sanitary ordinances to lohich 
attention was called, it is deemed expedient to submit the following : 

(a) The first item, referring to 104 interior, Calle Concepcion, Ermita, is 
passed with no remark other than to say that while the mixing of cement mortar 
undoubtedly offers opportunities for substitution, there are standard methods by 
which the character of the concrete can be determined before the work is ap- 
proved. This is one of the principal reasons for expert inspections. 

(6) In further support of the contention of this office that tlie grades of the 
drains at 161 to 187 Calle Arranque, Santa Cruz, are insufficient, and do not 
conform to legal requirements, "Exhibit A" is respectfully submitted, tlie same 
being a report of a survey made by the Bureau of Public Works at the request 
of the Director of Health in order to determine whether the sanitary engineer 
of this Bureau was in error, as alleged by the fourth indorsement, in stating 
that ttie grades referred to were 1 to 106 and 1 to 225, instead of 1 to 50 as 
they should have been. It vHll be observed that this report practically confirms 
and substantiates the statements contained in the letter heretofore cited; and 
furthermore, that the drawings made by the Bureau of Public Works of the said 
premises show that in certain parts of the drain in the rear of the houses the 
water is actually expected to run uphill. That it refuses to do so has been 
attested by recent inspections which disclose that it Jkis become stagnant and 
foul in the very drains which should carry it away, yet the work has been ap- 
proved by the city engineer's office and presumably the contractor has been 
paid, thus leaving the owner no redress and restricting this office to one of two 
things, either of which would be wrong and constitute a just ground for protest — 
that is, to compel the owner of the property to have the loork done over or to 
permit a remediable insanitary condition to go unheeded. 

(c) In the matter of the 2^-meter ceiling at No. 16Jf Calle Azcarraga, instead 
of 3 meters as required by law, and which is defended on the ground that all 
sides of the room are not iticlosed by walls or partitions, it is respectfully sub- 



Jl 



73 

mitted that if it would require a force of fifty inspectors to keep the few contractors 
in the city of Manila from improperly mixing their cement, undoubtedly many 
times that number would be needed to prevent the occupants of such places as 
are here referred to from insidiously closing up the open sides of structures of 
this class. Such things do happen, and. experience has shown that the best way 
to make sure of proper ventilation is to provide for it in the first place so that 
it will not depend on a contingency. 

{d) The whole question involved in the controversy in regard to 193 Calle 
Romero Aquino depends on the construction placed on the phrase "intended for 
human habitation.^' No evidence is necessary to prove that tiendas are often 
used as places of human habitation and there is no remedy for it at present. 
Rents are high and small houses icithin the reach of the poorer classes are 
scarce; to drive the occupants from such places would simply compel them to 
seek shelter in the already overcrowded tenement houses, hence it is better to 
permit the lesser of the two evils, and hold that such struxitures are to be 
places of human habitation. 

(e) The contention of this office that the same method must be adhered to in 
repealing an ordinance coming within the provisions of Act 1150 authorizing the 
Sanitary Code for the city of Manila as is legally required in enacting the same 
has not been refuted. The Act cited is very explicit as to the course a pro- 
posed sanitary ordinance or an amendment must take before passage, and in- 
asmuch as a partial repeal often has the effect of an amendment, as it did in the 
case of section 142, Ordinance 78, it would seem that it would require more than 
a resolution stating "that it is the sense of the Board that the interpretation 
of all building ordinances is exclusively the function of the Municipal Board" 
to legalize the action to which exception has been taken. The part of the build- 
ing ordinance which was repealed was originally incorporated in the proposed 
sanitary code but was transferred to the building ordinance in order to avoid 
duplication and for convenience, it being understood at the time that the sanitary 
status of the same was to be in no wise disturbed or affected. These facts 
are submitted without regard to the merits of the repealed ordinance itself, but 
in support of the position taken by this office that the Municipal Board of the 
city of Manila can not legally repeal any ordinance passed in pursuance of Act 
1150 except such repeal shall take the course definitely prescribed by the said 
Act. If this is not true, the original law forming the basis of the Sanitary Code 
is practically rendered null and void by its own limitations. 

(/) The argument advanced by the city engineer that even if construction 
work is approved by his office, which is in violation of law, the fault does 
not lie with him, but with the Director of Health for permitting people to live 
in such buildings, after he has permitted their illegal construction, is, of course, 
so unsound as not to require any comment. As stated in the original communica- 
tion, it places the Government in a most unenviable position when one branch 
allows construction in violation of the law, and another branch of the Govern- 
ment comes along later and informs the people that the same is illegal and can 
not be permitted to stand, thereby causing unnecessary expense to persons who 
make repairs and construct new buildings in the city. 

The Director of Health desires the cooperation of the city engineer and wishes 
to cooperate with him. As is well known, it is difficult enough to carry out the 
law with regard to sanitary measures without having another official of the 
Government constantly seeking loopholes and aiding persons to evade the law. 
Only recently there was presented the anomalous spectaxile of the city engineer 
appearing in court {Municipal Court, May 9, 1908, Bureau of Health vs. Crisanto 
Bautista — Exhibit B) and testifying in behalf of a defendant against whom 



this Bureau had brought action for violation of a sanitary ordinance. Again 
in the case of a large addition which was recently built by N. T. Hashim to the 
Grand Opera House to be used as a tailor shop, the city engineer refuses to com 
pel the compliance with section 9 of Ordinance 86 and section 1 of Ordinance 
89, on the ground that the building is not used for human habitation; yet at least 
35 employees have been observed to work therein, and there is ample evidence 
that persons sleep there also. {Exhibit C.) 

This oflBce also believes that it was the intention of the Commission when it 
enacted Act 1150 that the Municipal Board through its agents should enforce 
the sanitary ordinances which pertain to construction and when they are not en 
forced that it is the duty of the Director of Health to bring the matter to the 
attention of his superiors. 

The hope of the city so far as structural sanitation is concerned lies in en 
forcing the ordinances. They may seem unnecessary and oppressive now, but 
it should be remembered that they are made for the future as well as for the 
present. It would not be so much of a hardship to require a three meter space 
around buildings being constructed at the present time as to burn the same 
buildings a few years later in combating an epidemic of plague. 

There are two old sayings that are applicable to the question of enforcing the 
laws for public sanitation; one is that the best way to secure the repeal of a 
bad law is to enforce it ; the other is that the best time to prepare for war is when 
peace prevails. 

Manila has been very fortunate in escaping a general epidemic of plague; it 
may not be always so fortunate, and the time to begin a crusade against this 
horrible disease is before it makes its appearance. If it never comes and the 
ventilation policy is adopted, the people will have all the more reason for ap- 
preciating the blessings of fresh air and unobstructed sunshine and could n 
assured that their homes would not be destroyed. 

Briefly then, in conclusion, it is believed that the facts as set forth in thesft 
papers show clearly that many sanitary ordinances are not being enforced, and 
it is hoped that it may be seen that success lies only in mutual cooperation. 

V. G. Heiser, Director of Health. 

Exhibit A. 

Department of Commerce and Police, 91 

Bureau of Public Works, 

Manila, July 28, 1908. 
Sir: In reply to your favor of the 1st instant (R. P.-210), I have the honor 
to inclose two drawings showing profile of drains at rear of houses 161 to 167 
and 173 to 187 Calle Arranque, as obtained by this Bureau. House 169 was 
unoccupied and locked and our representative was imable to get in. 

Average grade of drain behind 173 to 187 is 0.523 per cent (F. S. C), and it 
will be noticed there is a sharp turn in the drain. The drain behind 161 to 167 
has an average of 0.96 per cent. An architect's level mounted on the wall with 
a trivet was used for this work. 

Very respectfully, J. W. Beabdsley, 

Director of Public Works.] 
To the Director, Bureau of Health, Manila, P. I. 
Enc: Two drawings. 



% 

esfti 



75 
I Exhibit B. 

Department of the Interior, 
Bureau of Health for the Philippine Islands, 

Manila, August 3, 1908. 
The Director of Health, Manila. 

Sir: 1 have the honor to report that on the night of August 1, 1908, ac- 
companied by policeman No. 78, Bonifacio Mamaril, I counted seven persons 
domiciled or sleeping in the new tailor shop recently erected by Mr. Hashim, 
as an addition to the Grand Opera Houses on Calle Cervantes. On this date 
active tailoring operations had been temporarily suspended, pending the active 
commencement on a new Federal Government tailoring contract. 

The present occupants stated that when the shop was in full operation, the 
number of persons sleeping in this building ivas between 80 and 120 every night. 
They sleep on the toooden floor only a few inches above the low wet ground under 
the boards. This ground under the building presents ideal conditions for the 
breeding of mosquitoes. 

Very respectfully, Geo. H. Guerdrum, 

Chief, Division of Sanitary Engineering. 

Exhibit C. 

Manila, August 3, 1908. 
The Director of Health, Manila. 

Sir: I have the honor to report that on or about December 1, 1907, I en- 
countered approximately 40 persons domiciled and sleeping in the new tailor 
shop recently erected by Mr. Hashim as an addition to the Grand Opera House 
on Calle Cervantes. 

Very respectfully, William P. Pauly, Sanitary Inspector. 

[Eighth indorsement.] 

August 7, 1908. 

Respectfully referred to the Honorable James F. Smith, Governor-General, 
inviting especial attention to the within statement of facts by the Director of 
Health and the report from the office of the Director of Public Works, from which 
it appears that the city engineer is deliberately permitting violations of many 
existing health ordinances. 

It will be easy to convert Manila gradually into a healthful city if ordinances 
are steadily enforced. 

The continuance of such a policy as is now being carried out by the Municipal 
Board and the city engineer will result in the creation of an unsanitary city 
which will ultimately lead to a great epidemic necessitating the destruction of 
property of great value as has so often occurred in oilier cities in the past. 

This office is powerless to remedy these conditions and appeals to the Governor- 
General to inform the Municipal Board definitely as to its powers in the matter 
of repealing health ordinances and as to its duties relative to their enforcement. 

Neither the Secretary of the Interior nor the Director of Health can assume 
responsibility for health conditions of this city unless the present attitude of the 
authorities above referred to is promptly changed. 

Dean C. Worcester, 

Secretary of the Interior. 



76 

[Ninth indorsement.] 






3tary. 

i 



Executive Bubeau, 

August 12, 1908. 

Respectfully referred to the Municipal Board, Manila. Some explanation is 
desired from the city engineer touching the violation of health ordinances. It 
appears from the statement of the Director of Health, and from that of the 
Director of Public Works that the city engineer is permitting violations of these 
ordinances. If these statements are true, it discloses a most surprising con- 
dition, which may subject both the city engineer and the Municipal Board, which 
exercises immediate supervision over the city engineer, to severe criticism. 

James F. Smith, Governor-General. 

[Tenth indorsement.] fll 

City of Manila, Municipal Board, 

September 11, 1908. 
Respectfully returned to the honorable the Governor-General, inviting atten- 
tion to the inclosed reports of the committee on law and the city engineer, which 
have been adopted as the opinion of the Board. 
By direction of the Board: 

H. L. FiSHEE, Secretary 
Inclosure. 

REPOBT. 

City of IVIanila, 
Department of Engineering and Public Works, 

Office of City Engineer. 

September 3, 19081 

Respectfully returned to the Secretary of the Municipal Board with the 
following statements relative to the two remaining complaints of the Director 
of Health relative to alleged violations, by this office, of the Sanitary Code. 

Attention is respectfully invited to the fact that the personnel of this office 
devoted to the inspection of buildings, including examination of plans, e 
consists of a chief inspector {American) and four assistants (Filipinos) . 

This force during the fiscal year 1908 made inspections on 5,864 applicatio: 
of which 1,570 were for construction and 4,294 for repairs, besides 400 mis- 
cellaneous permits. In the case of construction, frequent visits are necessary 
throughout a period sometimes covering several months. 

It will, therefore, be seen that this force is taxed to its utmost, and that it 
is physically impossible to watch every move made by every contractor engaged 
on these buildings. 

In the case of the tenement buildings on Calle Arranque, the soil pipe has 
been constructed in strict conformity — the fourth herewith — and the drain men- 
tioned by the Bureau of Health and also by the Bureau of Public Works is not 
a "drain" in acceptance of the term laid down in the ordinance as requiring a 
grade of 1 in 50, but is merely an open cement-lined gutter carrying away rain 
water and such other waters as accumulate on the floors of a number of kitchens. 
Incidentally, the inmates of these premises are apparently permitted to prepare 
their food for cooking on the kitchen floor, the evidence existing in the fact of 
fish heads, chicken entrails, rice, etc., all of which comes under the head of 
garbage, for which the ordinance demands that certain tightly closed iron 
receptacles shall be provided. 

This type of tenement construction seems to be in greater demand than any 
other class of construction in the hard-material district, in view of which fact 
standard designs will be necessary, so that builders and architects may know 






77 

what is required of them, and until such types are prepared, it would seem 
that we have not given prospective builders sufficient instruction as to how these 
matters shall be cared for. 

Ordinance 86 states that drain pipes shall be of cast iron, in which case a 
grade of 1 in 50 is necessary and is required; but where an op6n gutter of 
cement, easily accessible to brooms and easily flushed, is constructed, a grade 
of 1 in 50 is not necessary, and is not demanded by the code. 

If cement-lined gutters are to be carried to a particular grade, and this 
department is to furnish the grade stakes, and see that the work is carried out 
to those stakes, a much larger personnel loill be necessary, and the force of 
inspectors must be quadrupled at least. 

Every contractor, however, who is capable of undertaking such loork as the 
construction of tenement buildings in Calle Arranque, must necessarily know 
about gutters, grades, etc., to be responsible for any faulty work of this nature 
to the owner of the premises. 

Calle Romero Aquino. — In this case, as stated in the seventh indorsement, 
the question bears upon the construction placed on the phrase "intended for 
human habitation." 

If tiendas of all classes are to be constructed with all the appurtenances of 
buildings for human habitation, it requires only a fiat to that effect from the 
Bureau of Health, and all future applications for permits to erect such tiendas 
will be accompanied by plans showing all the sanitary arrangements demanded 
by the code. 

One other explanation seems to be necessary in answer to the seventh indorse- 
ment, viz: 

The appearance in the municipal court on May 9, 1908, of the city engineer, 
testifying in behalf of a defendant against whom the Bureau had brought action 
for violation of the sanitary ordinance. When the original order was issued 
against the defendant it followed the original custom of being sent to the city 
engineer who issued it over his signature. That order called for the construction 
of a gutter or drain from the septic tank to the estero. On its receipt the 
defendant personally appeared in the office of the city engineer and showed that 
he had no legal right to construct the gutter ordered, as it would have to pass 
through the property of another party, who had absolutely refused such permis- 
sion, on the grounds that it would kill his zacate. Under the circumstances, 
there was nothing to do but withdraw the illegal order, as the city engineer 
certainly has no right to order a private individual to infringe upon the rights 
of another private individual. 

Very shortly after this action was taken the Bureau of Health recognizing 
the fact that the city engineer's office was unable to handle the enormous amount 
of sanitary orders coming in, requested that all orders pending be returned to the 
Bureau for necessary action. 

/ am not sure whether note was made in each case lohere any modification of 
an order had been made, but it was the intention and desire of this office to inform 
the Bureau of Health of the condition of each order. I am of the opinion that 
the Bureau teas notified of this action of the city engineer. 

In conclusion, I beg to state that conferences with the Director of Health 
indicate, without any doubt, that the points of difference between the depart- 
ments refer only to questions of the meaning of the ordinances. 

There has never been any desire in this office to do more than comply 
strictly with the ordinances, and interpretations are frequently requested of 
the Board and of the Director of Health. 

It would seem that instead of recriminations, harsh language, and worse 



78 

inuendoes, a simple conference between the heads of the departments would be 
productive of much more satisfactory service, to say nothing of the time wasted 
in investigating and reinvestigating, and writing indorsements on matters that 
can be settled by a five minutes' conference. Such a method will, in the future, 
be adopted by this department when a question of interpretation arises. 
Very respectfully, 

W. P. Wylie, City Engineer 



H 



i 



[In re File No. 9006, Construction of buildings in alleged violation of the Sanitary Code.] 

committee bepobt. 

September 10, 1908. 
The Municipal Board, Manila, P. I. 

Gentlemen: This matter has been referred to your committee for the si 
purposes of reporting on the legal point brought up in paragraph (e) of 
letter of the Director of Health, dated August 5, 1908. 

The Director of Health contends that Ordinance No. 78 regarding construction, 
should be considered as a part of the "Sanitary Code," and as such can not be 
amended except in accordance with the provisions of Act No. 1150. This opinion 
is based on the fact that the original draft of the Sanitary Code contained 
provisions regarding the construction of buildings — that is to say, provisions 
analogous to those in Ordinance No. 78, and which, in order to avoid a duplica- 
tion of provisions treating of the same subject, were eliminated from the Sanitary 
Code when this was discussed by the Municipal Board. 

It is a fact that, in the original draft of the Sanitary Code, there were in- 
cluded certain provisions with reference to the construction of 'buildings, anal- 
ogous to those already in force in Ordinance No. 78, and in view of this, the 
representative of the Bureau of Health, when discussing the proposed code before 
the Municipal Board, offered no objection to the elimination of said provisions 
from the Sanitary Code. 

It is, however, not a fact that the Municipal Board, or any of its members, 
or the representative of the Director of Health, present at the discussion, had 
intended that the provisions of Ordinance No. 78, either as a ichole or in 
part, should be interpreted as forming an integrant part of the Sanitary Code, 
nor that the status of said Ordinance No. 78 should be different from the status 
of any other ordinances. 

Your committee personally sustained this part of the discussion and is per- 
fectly convinced of what has just been written. This being established, it is 
only natural that the Municipal Board should be the body to whom belongs the 
exclusive right to interpret Ordinance No. 78 in all its provisions. 
Very respectfully, 

Committee on Law. 

ABSURD CONTENTION OF THE CITY ENGINEER RELATIVE TO PAYMENT FOR 
STRIPS OF LAND LEFT VACANT FOR VENTILATION. 

In the fourth indorsement on this communication the city engineer 
advances the extraordinary theory that the city might be compelled to 
pay for 3-meter strips at the backs of lots were it to forbid building 
thereon in order to prevent the creation of unsanitary conditions. This 
contention is absurd. 

The case to which he refers as decided in the Supreme Court was one 
of easement over a zone for public use^ while the case in question is 



79 

as to whether the owner of a piece of property shall be allowed to use it 
in such a way as to endanger the public health. The city could no more 
be compelled to pay for land which it obliged an owner to leave free 
from obstruction in order that light and air might enter and that the 
creation of unsanitary conditions dangerous not only to him and his 
family but to his neighbors might be avoided, than it could be com- 
pelled to pay for a lot in the center of the city because it refused to 
allow the erection of a tannery or a soap factory upon it. 

The city has a right to protect itself against the creation of unsanitary 
conditions whether there is danger that such conditions will he brought 
about hy the conducting of offensive occupations or hy the erection of 
buildings which are improperly constructed or improperly located. 

But the matter was not allowed to rest here. On August 20, 1908, 
the Director of Health wrote me the following letter : 

Manila, August 20, 1908. 
The Honorable, the Secbetaby of the Interior, 

Manila, P. I. 

Sir: I have the honor to invite attention herewith to the recent construction 
of a small hard-material house in Palomar, district of Tondo, which as a type, 
being built under a permit, with the apparent full consent and approval of 
the city building department, constitutes such a menace to the public health 
that it is believed a special protest is necessary in regard to the same. The 
various defects indicated below are appa/rently covered by legalized evasions of 
the spirit of the law. 

The building referred to is, as stated, in Palomar near the city stables 
No. 2— Permit C375, issued on June 15, 1908. 

1. The floor of the structure is unpaved and is low and damp. (Sanitary 
Code, sec. 9.) 

The very vAse provisions of the Sanitary Code, of ichich this is a violation, 
is evaded by writing on the face of the permit "Not to be used as a human 
habitation." A sanitary inspector of the Bureau of Health has already gone 
through the farce of ordering the people to vacate the house as sleeping quarters. 
If it is vacated it is only a question of time until it will be again occupied. This 
little structure was erected by poor Filipinos who probably spent their entire 
savings or are perhaps even in debt for the building, and this office should not 
in justice to the Philippine people step in now and prosecute these people for 
sleeping in a building erected in good faith and supervised and approved by 
another branch of the government. 

2. The structure is a scant 2 meters in height; if the ground surface had 
been filled in as required in section 1, Ordinance 89, the height of the building 
would be very considerably reduced. Ordinance 78, section 148, requires that 
all rooms be 3 meters in height. 

This is evaded by writing on the face of the permit "To be inclosed on three 
sides only," yet actually all that is needed to close up this fourth side, with 
the exception of a small slatted space below, is a hinged or sliding window 
across a portion of the front. 

If this class of construction is permitted to proceed unchecked, the undersigned 
maintains that it will nullify many of the provisions of the two excellent ordinances 
now in force in this city, viz: the Sanitary Code and the Building Code. If a 
person cares to, he can follow the ordinances ; if not, he may do as he pleases. 



10 

The structure opens the icay for the construction of whole barrios of small, 
squatty, ill-ventilated and muddy-floored hovels, especially in the rear and 
interiors of the premises of larger houses facing the street. These interiors are 
note one of the most difficult problems with which this office has to contend; 
unlicensed repairs and constructions are daily going on in spite of the utmost 
efforts of this office, which is not equipped with a building department, but must 
combat these constructions as a sanitary measure in addition to its other health 
duties. If this construction is now to be legalized by the erection of such houses 
05 the one on Palomar, this office will be handicapped to such an extent that 
effective sanitation and quick and rapid disinfection in case of cholera and other 
infectious diseases will be out of the question. 

This communication is submitted in addition to and in connection with the 
previous report by the Director of Health on this same general subject, as this 
case does not involve careless construction or lax inspection, but involves ap- 
proved construction, which if continued in will render two of the best ordinances 
of the city to a large extent noneffective. 

Since the first part of this communication was drafted, the structure, due to 
verbal orders from the local health station, has finally been vacated as sleeping 
quarters. It is believed, however, that this does not render any less important 
the above report. ^ , 

Very respectfully, A. J. McLaughlin, HI 

Acting Director of Health. 

[First indorsement.] 

August 24, 1908. 

Respectfully forwarded to the honorable, the Governor-General, inviting his 
attention to this further instance of the policy which is being pursued by the 
city engineer and other municipal authorities responsible for the supervision of 
building operations in the city of Manila. 

In the opinion of the undersigned no question more intimately concerns the 
present and future safety of the people of Manila than does the one raised in this 
communication and the previous one on the same general subject, which has gone 
forward to the Governor-General, as to whether the municipal authorities of 
Manila are or are not to be allowed, in effect, to defeat the provisions of exist- 
ing sanitary legislation for the city. 

The deliberate neglect of some of the provisions of this legislation, and the 
willful evasion of others, are steadily contributing to the bringing about of condi- 
tions ichich will destroy the results of the work already accomplished for the 
improvement of health conditions in Manila and will render the city unsanitary. 

The undersigned most strongly urges upon the Governor-General the taking 
of such action as will bring home to those concerned the importance of the proper 
enforcement of existing provisions of Ioav. 

Dean C. Wobcestee, Secretary of the Interior. 

[Second indorsement.] 

Executive Bubeau, 

August 25, 1908. 
Respectfully referred to the Municipal Board, Manila, in connection with 
Executive Bureau file 76352-A29, forwarded August 12, 1908. Prompt return of 
these papers with report is requested. 

James F. Smith, Governor-General. 



81 

It is presumed that the report of the city engineer under date of 
September 9 was intended as a reply to this communication. There has 
been the following subsequent correspondence on this general sul^ject: 

IMA.NILA, August 27, 1908. 
Dr. A. J. McLaughlin, Acting Director of Health. 

Sir: In accordance with your verbal instructions, after an inspection of the 
recently erected structure at interior of 87 Calle Aceiteros, San Nicolas, I have 
the honor to submit herewith the following data on the subject. 

According to building permit No. 7365 exhibited on the premises, authority 
for this construction was granted Bernardino Padolit on July 30, 1908, by the 
department of engineering and public works; the permit reading "to construct 
two secondary buildings (dos edificios secundarios) to measure 8 by 3 meters 
each, one of hard material (materialeS fuertes)." 

Just tvhy these should he called secondary buildings is not apparent, as each 
"building harbors several families and is more in the nature of a tenement house. 

In violation of the Building Code the structures are largely inclosed with 
sauali or cane matting. (Ordinance 78, sec. 80.) 

In violation of the Sanitary Code the floors are unpaved, low and damp. 
(Ordinance 86, sec. 9.) 

The occupants have no kitchens and are naturally cooking out in the open 
air. Due to the entire lack of drainage, slop water is thrown out anywhere 
on the ground and must inevitably breed very insanitary conditions. 

Some relief from this class of new construction is respectfully requested, as 
it will be impossible gradually to improve the sanitary condition of Manila if 
new construction work can not conform to modern sanitary laws. Attention 
is invited to a previous communication in regard to 'a recent similar construc- 
tion on Palomar. 

Very respectfully, Geo. H. Guebdrum, 

Chief, Division of Sanitary Engineering. 

[First indorsement.] 

Bureau of Health, 

Manila, August 2.9, 1908. 
Respectfully referred to the honorable, the Secretary of the Interior, for his 
information, in connection with the matter of interpretation of Sanitary and 
Building Codes by the authorities of the city of Manila. It is the opinion of 
the undersigned that all new construction should conform rigidly to law. What- 
ever excuse there may be for exercising leniency in the matter of already existing 
old insanitary buildings, there is no excuse for deviating from the course laid 
down by law for new buildings, and such deviation tends to perpetuate the 
problem of insanitary housing. 

A. J. McLaughlin, 
Acting Director of Health. 
[Second indorsement.] 

Department of the Interior, 

September 4, 1908. 
Respectfully forwarded to the honorable the Governor-General, for considera- 
tion in connection with other papers on this same general subject previously 
forwarded. 

Dean C. Worcester, Secretary of the Interior. 

[Third indorsement.] 

Executive Bureau, 

September 1, 1908. 

Respectfully referred to the ISIunicipal Board, Manila, requesting report. 

James F. Smith, Oovernor-Oeneral. 

78079 6 



83 

SHALL WE BUILD A HEALTHFUL CITY? 

Although we can not immediately remedy all unsanitary conditions 
arising from the low, swampy nature of much of the land in the citj 
of Manila, nor destroy all the dark, damp, ill-ventilated buildings, w( 
can strictly enforce reasonable building ordinances so as to insure the 
ultimate construction of a healthful city. 

We are not doing this at the present time. Three times, within the 
past year, I have appealed to the Governor-General, calling attention to 
the danger of our present course in the strongest language I could 
command. No relief has thus far been secured. I can only say that 
the Secretary of the Interior and the Director of Health decline to 
assume responsibility for the results of conditions which they are power- 
less to remedy. 

/With regret I express the deliberate opinion that the sanitary con- 
dition of the city has for some time been growing steadily worse owiiig 
to the lax enforcement of the building ordinance, to the repeal of one 
of its very important provisions, to the failure of the city engineer's 
ofiBce to perform comparatively inexpensive drainage work, and to the 
neglect of many of the city streets. The existence of extensive areas 
which can be redeemed only by costly filling is a condition which is 
be deplored but which can not immediately be remedied. | 

The lack of midden sheds for the poorer people of certain distri(? 
is a condition which can and should be remedied if funds are available, 
and if not available they should be provided. 

Prior to the completion of a modern sewer system the city of Manila 
is dependent upon the pail system for the disposal of human excreta. 
In fact, after the completion of the sewer system there will still remain 
some districts which it will not reach or where the inhabitants can not 
afford to install modern water-closets. 

The proper disposal of human excreta is a matter of vital importance. 
With these facts in view the Bureau of Health, while in charge of this 
work, forced the installation of midden sheds for the use of the poor 
to the limit of funds available for this purpose and repeatedly requested 
additional appropriations for this work. 

Since the city has taken charge the Bureau has not ceased its efforts 
to secure increased facilities. Complaint has been made as to the condi- 
tions which exist and the Bureau of Health has been blamed for them. 
The following memorandum, report, and correspondence will suffice to 
phow the attitude of the Bureau of Health and of the city authorities in 
this matter: 

[Memorandum for the honorable the Secretary of the Interior relative to public clo;... l^ 
and pails in the Sampaloc district] 

There are six public closets in this district, one in each of the barrios of 
Sulucan, Tuberias, Nagtajan, Lore to, Gastambide, and one at the market on 



i 



83 

Calle Alix. In two barrios there are none, viz, Mangalmn and Santa Clara. 
Both of these barrios are located so that there is no road running into them, 
and a pail wagon could not possibly reach the interior, where in one or two 
instances the barrio reaches nearly a mile from the nearest wagon road. * 

Various medical inspectors on duty in Sampaloc have endeavored to have streets 
cut in these districts, but as the opening of new streets must be considered in con- 
nection with other city necessities, this has not been done so far. Copy of a letter 
advocating a street into Mangahan is attached hereto. The medical inspector 
now on duty at Sampaloc states that the district including these two barrios 
contains a large number of individual pails, mostly in tiendas and small stores 
of different sorts. It has been possible to obtain the pails in these because of 
the licenses required — the license not being approved until the pail is installed. 
Til ilie case of the ordinary householder there is no such means to force him to 
I pail. In the cases of new constructions in the nipa district the medical 

jKctor states that he invariably recommends "proper closet facilities" before 
the permit is approved. However, this recommendation seems to be a dead letter 
as the permit is issued and the house is occupied without a pail. 

Where there are public closets installed they are used to a considerable 
extent by a select few. It can not be expected that the average nipa resident 
will walk from a hundred feet to a couple of blocks on a dark rainy night or a 
hot afternoon when there is long grass or a convenient estero near by, or he may 
use an ordinary chamber pot and throw the contents into the estero or wherever 
it is most convenient. 

This problem has occupied the attention of this office for some time, as will 
be seen from the attached statement which has been prepared to cover the 
general question of public closets. 

The number of cholera cases in the two barrios without closets were ten 
cases in Mangahan and seven cases in Santa Clara; five cases in Mangahan are 
attributed by the medical inspector to one direct infection, the remaining foci 
are scattered. 

The whole question is one of many difficulties and its solution must con- 
template a large expenditure of money for pails and closets, filling in of low 
lands, opening of streets, and, even after these are obtained, the most difficult 
problem will be to teach the people to use properly the facilities provided. 

Chandler, Chief Clerk. 
[Report] 

PUBLIC PAIL SHEDS. 

With good drainage, strict supervision of building repair and construction, 
and a complete system of public closets, the poor districts of a large city, such 
as Manila, need not cause particular concern to the health authorities, but 
with a lack of enforcement of building and repair ordinances, lack of surface 
drainage and lack of public closet facilities, the poor districts of a large tropical 
city must be at all times a distinct menace to the public health. Realizing the 
importance of this, the undersigned has many times protested against the lax 
enforcement of building and repair ordinances throughout Manila, the lack of 
surface drainage, and the insufficient public closet facilities, and has endeavored 
to correct these deficiencies in spite of the attitude of the municipal authorities, 
with reference to the light, ventilation, and drainage sections of the building 
ordinances. 

On May 15, 1906, one year before the undersigned took charge of this division, 
Dr. J. B. Long, passed assistant surgeon, U. 8. P. H. and M. H. S., then Assistant 
Director of Health, requested of the Municipal Board that a chain of some 32 



84 

public pail sheds he erected and operated throughout the various districts of 
the city. Hoioever, by July, 1901, not one of these 32 requested installations 
had been put in. 

Under date of September 27, 1907, relief was requested of the Municipal 
Board for the people living in GagalaSging, who had been ordered to supply 
themselves with pails, and who protested in a petition signed by 27 people, tl - 
they were too poor to buy the pails. 

In compliance with their request the city installed two pail sheds in Gaga la - 
uging, one at No. 133 interior and one at No. 90 interior. Under date of 
October 23, 1907, midden sheds were requested and have now been install d 
in the following places: 

District of ]\Ialate: Calle San Andres, 119 interior. 

District of Malate: Calle Leveriza, 42 interior. 

District of Malate: Calle Leveriza, 112 interior. 

Tanduay District: Calle Castellanos, 66 interior. 

Barrio of Nagtajan: 

After some eighteen months, therefore, some 7 public pail sheds of a total 
of 38 requested have been installed. 

Under date of May 29, 1908, the undersigned, realizing the pressing need o/ 
additional closets, and realizing also the difficulty of securing the erection of 
an adequate number, carefully revised the previous list made by Dr. Long, 
eliminating some of the requested installations, and adding others, and drafted 
a communication to the secretary of the Municipal Board, for the signature of 
the Director, in which the construction of 39 pail sheds was requested. Tliis 
recommendation was referred by the Municipal Board to the city engineer foi 
his consideration. Under date of August 4> 1908, this communication was re- 
ferred to the Director of Health, inviting his attention to the amount appropriated 
by the Board for the erection of these sheds, viz, 4,500 pesos, and calling 
attention to the fact that the erection of all the sheds requested would cosi 
in the neighborhood of 8,850 pesos. There being nothing else that this Bureai: 
could do but accept the reduced appropriation of the Municipal Board, th^ 
communication was returned to the Secretaiy of the Municipal Board, with t\u 
indorsement that while this Bureau regretted that all of the public closetj 
requested could not be built this year, the list was returned as requested, witl 
the most important locations checked off in red ink. 

The construction of public pail sheds is not expensive, and constitutes sucl 
an important item in the sanitation of a city that the most liberal provision* 
in this regard should be made. 

Due to lack of public pail sheds, the residents of the poor districts continuall) 
foul the esteros, construct various kinds of insanitary privy vaults, and are 
general greatly retarding the health conditions of the city. 

Geo. H. Guerdrum, Sanitary Engineer. 



Station I, Sampaloc, 

January 23, 1908. 
Chief, Division of Sanitary Engineering, 

Manila, P. I. 

Sm: I have the honor to recommend that the city engineer be requested t 

pen one or more roads or streets, through which vehicles may pass into th 

barrio of Mangahan, district of Sampaloc. 

This barrio, according to the Bureau of Health census of 1907, has a populatioi 
of 2,508 and there is no road or opening through which a vehicle of any kin 
may pass into this barrio. 



85 

The inhabitants throw their garbage and rubbish into the streets and vacant 
lots, claiming that the street cleaning department will remove them. Animals 
that die arc thrown into the rice paddies in the rear of the barrio and there 
allowed to decay for the same reason. 

In cases of cholera or other epidemic diseases, much delay has been caused 
by not being able to locate the residences, and on account of the ambulance not 
being able to pass into this barrio. 

The pail system would be a greater success at this place if a street or streets 
were opened. 

There are two places where streets could be easily opened with small cost: 
At No. 81 Calle Balic-Balic and at the continuation of Calle San Anton. 
Very respectfully, 

Benj. L. Burdette, Medical Inspector. 

[First indorsement.] 

Bureau of Health, 
Manila, P. /., January 21, 1908. 
Respectfully referred, through the Municipal Board, to the city engineer. This 
office concurs in the opinion of Medical Inspector Benjamin L. Burdette that 
a street into the barrio of Mangahan, Sampaloc, is badly needed. 

Victor G. Heiser, Director of Health. 

BAD STREETS AN OBSTACLE TO SANITARY WORK. 

Another very serious obstacle to the successful carrying on of sanitary 
work has been the condition of the city streets. 

This was necessarily bad at the time of the American occupation, 
owing to the upsetting of the municipal administration by war. The 
same cause contributed to a continuance of this condition during the 
early days of American rule and by the time it had become possible 
to repair the streets of the city the state of most of them was such as 
to make it necessary to dig them up and practically to rebuild them. 
There followed the building of a new street railway, the installation of 
underground telephone cables and the construction of new water and 
sewer systems. The result has been that the streets of the city have 
been constantly torn up and the filth which underlies them has been 
continually brought to the surface. That the digging up of the streets 
has not been an important source of active cholera infection is shown 
by the infrequency of cases among the men actually engaged in this 
work. It is nevertheless possible that the old drains which have been 
so often broken into have harbored the organisms of cholera in the form 
which they assume when the disease is endemic and that having been 
brought to the surface they have subsequently undergone the change 
necessary to make them active and virulent. 

Whether or not this has been the case the sanitary benefit which 
will accrue to the city from the installation of a pure water supply and 
an adequate system for the disposal of sewage will far outweigh any 
disadvantages which have necessarily followed the construction work 
which is now fortunately nearing completion. 



86 

However, no such justification can be found for the condition into 
which streets like the Escolta and Eosario have been allowed to fall. 
Here the numerous holes in the wooden paving have served to retain 
pools of water when it rained or when the streets were sprinkled and 
have rendered the placing of these streets in a sanitary condition 
impossible. 

NEEDLESS DELAY IN DRAINING CERTAIN L0V7 LANDS. 

It is furthermore true that numerous low places covered with filthy 
and stagnant water have recently been drained at small expense. Such 
work could and should have been done in anticipation of an epidemic 
rather than when it was upon us^, and a very large amount of it still 
remains to be done. 

LACK OF STREETS AND DRAINS IN THICKLY SETTLED SECTIONS. 

And if these conditions are objectionable, what shall we say of the 
extensive districts where there are no streets, or drains, and where filth 
must therefore accumulate? 

SHOCKING SANITARY CONDITION OF PORTIONS OF THE SAN LAZARO ESTATE. 



•Il 

1 /-vTir ■ 



Nowhere in the city are sanitary conditions worse than on cert 
portions of the San Lazaro Estate, and indeed it is difficult to see how- 
conditions could be worse. This matter was first taken up with the 
Municipal Board in 1904, and since that time the Director of Lands, 
the Director of Health, and the Secretary of the Interior have repeatedly 
insisted that the city must act. 

At one time there was hope of results, and a small amount of im- 
provement work was actually performed but it was soon discontinued 
and from that time to the present the city has persisted in its first, and 
extraordinary, attitude that the estate was private property and that 
the city could not therefore undertake improvement work on streets 
running through it, and this in spite of the fact that the Attorney- 
General decided against the contention of the city and that the Governor- 
General, in his capacity as Acting Secretary of Finance and Justice, 
approved this decision. 

The attitude of all concerned is clearly set forth in the following 
correspondence : 



4 



To the Secretary of hie Municipal Board, Manila, P. I. 
(Througli the honorable the Secretary of the Interior.) 
Sir: From all indications it is apparent that very little money will be avail- 
able during the present fiscal year for the improvements of the streets through the 
San Lazaro Estate. However, the conditions on many of these streets are intol- 
erable, and it is requested that, notwithstanding the lack of funds for the 
necessary improvement of these streets, street sweepings from at least that 
portion of the city north of the Pasig be devoted to the improvement of 
the conditions of the streets on the San Lazaro Estate. If this is done, 



87 

makeshift roadways for the accommodation of this district will result, which 
will make great improvement over present conditions. If it is not done, the 
majority of the residents are without means of reaching their homes during the 
rainy season except through mud and water. Personal observation leads me to 
believe that a great quantity of such sweepings are now being dumped in other 
portions of the city or at the Cemetery del Norte, and as this available dumping 
ground is almost a mile closer to the city, and the raising of the streets would 
result in assisting the condition of the living, this request is considered a 
reasonable one. 

Very respectfully, C. H. Sleeper, Director of Lands. 

[First indorsement.] 

Department of the Interior, Manila. 
Respectfully transmitted to the Secretary of the Municipal Board. The con- 
dition of many of the streets running through the San Lazaro Estate is de- 
plorable and it is hoped that something can be done toward improving it in the 
course of the present year. 

Dean C. Worcester, Secretary of the Interior. 

[Second indorsement.] 

Municipal Board of Manila, 

Secretary's Office, IVIanila. 
Respectfully returned to the Director of I^ands, through the Secretary of 
the Interior, with the information that since the receipt of the inclosed letter 
many improvements have been made by the city on streets of the San Lazaro 
Estate, but there are other places where the necessity for filling in with street 
sweepings is greater than the streets through the San Lazaro Estate. 
By direction of the Board: 

Jno. M. Tuther, Secretary. 
[Third indorsement.] 

Department of the Interior, 

December 17, 1906. 
Respectfully referred to the Director of Lands, inviting attention to the 
second indorsement. 

James F. Smith, Acting Secretary of the Interior. 

[Fourth indorsement.] 

Bureau op Lands, Manila. 
Respectfully transmitted to the Secretary of the Municipal Board, through the 
honorable the Secretary of the Interior, whose concurrence in the inclosed rec- 
ommendations is invited. 

C. H. Sleeper, Director of Lands. 

Department of the Interior, 

Bureau of Lands, Manila. 
To the Secretary of the Municipal Board, Manila. 

(Through the honorable the Secretary of the Interior.) 
Sir: I have the honor to acknowledge receipt of your second indorsement, 
under date of the 14th instant, upon my letter of July 26, last, concerning the 
improvement of certain streets in San Lazaro. 

As the question submitted for consideration involves the health and conve- 
nience of a large number of the citizens of Manila, it is much to be regretted that 
the honorable Municipal Board has, after lengthy consideration, refused to grant 



88 

that which in my opinion is a most reasonable request, and with a view toward 
securing a reconsideration of the matter, I will invite your attention to the fol- 
lowing facts: 

That more than one-third — perhaps 40 per cent — of the houses in this district 
are not subject to taxation, for the reason that their value is less than 1P50. 

That a great majority of the houses which are subject to taxation are built 
upon lands intersected by the established streets of this locality; 

That prior to the rearrangement of the houses into systematic block forma- 
tion, as they are now found in said district — a work planned by this Bureau, 
and put into execution through its almost unaided efforts — a very small per- 
centage of the houses then standing were subject to taxation, on account of their 
trifling value; 

That this rearrangement gave impetus to the building and improvement of 
houses in the remodeled district; a spirit of rivalry was aroused among the 
inhabitants, which impelled each of them to repair and enlarge, or build anew, 
to the extent of individual ability — a number of them, even in the nipa district, 
indulging in the luxuries of electric light and water connections — ^\^dth the result 
that immense improvements were made in the appearance, convenience, sanita- 
tion and healthfulness of the community. 

Therefore, judging the future by the past, if the present street system should 
be extended as recommended, a large tract of land now lying vacant and idle, 
would become available for building sites; old buildings would be repaired and 
enlarged and many new ones constructed, which, aside from the betterment of the 
condition of the residents, could only result in an increased revenue to the city 
of Manila from at least three sources: 

First. Increase in taxable value of the buildings. 

Second. Increase in revenues from permits to repair, enlarge, and build 

Third. Increase in revenues from licenses to carry on trades and busin( 
interests. 

In connection with the above, your attention is invited to the fact that sin 
the first of April of the present year, more than 500 permits have been issued 
for new buildings, and repairs and additions to old ones, on the San Lazaro 
Estate, of which number 85 per cent have been for the remodeled district of the 
estate. 

I am informed that during each twenty-four hours more than 100 tons of 
street sweepings are collected throughout the city (90 per cent of which are 
suitable for the proposed use) which would represent a heap at the present 
dumping ground approximately 16 by 30 by 7 feet, or 3,360 cubic feet. 

If used for filling in streets, as suggested, a monthly fill might be had of 960 
linear feet, 30 feet wide and 3i feet deep, or 480 linear feet, 60 feet wide and 3* 
feet deep. Therefore, in only a few months, the present street system might 
be extended throughout the entire district without additional cost to the 
municipality — in fact, a saving could be made, on account of the fact that tl 
distance of the haul would be reduced by about 1 mile. 

In addition to the street sweepings, there will be thousands of tons of good 
filling made available by the displacement of earth for the new sewer system. 

It is understood that the street sweepings are now being utilized for the 
filling in of the del Norte Cemetery, and while the aim of the officials in charge 
of this work is unquestionably a worthy one, / am of the opinio7i that the require- 
ments of the living should take precedence over those of the dead — that a healthy 
and convenient locality in which citizens may live is more essential than a 
beautiful place in which they may be buried, and it is probable that so many 
would not require burial at all, if the miserable conditions surrounding their 
daily lives were ameliorated. 



I 



he J 

4 



69 

Of the many works of improvement in Scun Ldzaro, claimed in your indorse- 
ment, I have only to say that careful investigation of the subject confirms my 
belief that during the past few years, only a minimum of work has been done in 
this district, and the greater part of that has been of a temporary and makeshift 
character, and frequently abandoned before completion. 

I therefore, have the honor to request that the honorable Municipal Board 
reconsider its action in the matter to the end that the urgently required improve- 
ments may be completed during the coming dry season. 

Very respectfully, C. H. Sleeper, 

Director of Lands. 
[Fifth indorsement] 

Depabtment of Finance and Justice, Manila. 
Respectfully reutrned to the Municipal Board, inviting attention to the fourth 
indorsement. 

James F. Smith, Acting Secretary of Finance and Justice. 

[Sixth indorsement.] 

City of Manila, Municipal Board, 

Secretary's Office. 
Respectfully referred to the Director of Lands (through the Secretary of 
Finance and Justice), inviting his attention to the attached committee report 
of January 14, which has been adopted as the sense of the Board. 
By direction to the Board: 

Jno. M. Tuther, Secretary. 

[Seventh indorsement.] 

Department of the Interior, Manila. 
Respectfully returned to the Director of Lands, inviting attention to the sixth 
indorsement. 

James F. Smith, Acting Secretary of the Interior. 

[Inclosure to sixth indorsement. — 27147-alO — Translation.] 

City of IVLvnila, Municipal Board. 
To the Municipal Board: 

Gentlemen: The Director of Lands insists in his extensive letter under date 
of December 19 last, that the city fill the streets in San Lazaro Estate at least 
with street sweepings collected from the districts adjoining thereto. 

The Municipal Board has resolved the first petition negatively and its resolu- 
tion should be sustained in the present case for the following reasons: 

Since by resolution of the Philippine Commission the San Lazaro Estate is 
exempt from taxes on the land, only the improvements thereon which were assessed 
at P579.404 contribute to the burdens of the city; therefore during the fiscal year 
1906 it contributed only with ^8,691 as taxes on the improvements and a little 
more than ^1,000 as miscellaneous receipts, or a total of approximately ^=10,000. 

It is not counted herein what was collected as fees for building permits in 
said estate, because such fees are estimated only to cover the expenses incident to 
the department of building inspection of private buildings. 

The following table shows the expenses incurred by the city on said estate: 

Department of engineering and public works. 

14 arc lamps P2,520 

Repairs to Calle San Lazaro, between Calle Quiricada and Calle Sangleyes.... 2,215 
Repairs to Calle Cervantes, from Calle Bilibid to Calle Quiricada 5,373 

Total 10,108 



90 
Department of sanitation and transportation. 

Maintenance of 9 public closets P=4,274 

Street cleanings 1,548 

Garbage collection 1,372 

Street sprinkling, excluding the value of water 14,024 

Total - 21,218 

The foregoing figures are sufficient to show that the San Lazaro Estate is a 
very heavy burden borne by other taxpayers, without reckoning the advantages 
enjoyed by the residents of the aforementioned estate, without paying for them, 
the safety afforded to their persons by the police and to their property by the 
fire department. 

Neither the San Lazaro Estate contributes to the general expenses for the 
administration of the city, nor for the maintenance of the department of schools. 

The surplus of earth material from street excavations by reason of the con- 
struction of the new sewer system becomes the property of the contractors for the 
work, because it was agreed upon with the contractors that they shall leave the 
streets in the same condition as they were when commencing the work and without 
obstructions; therefore the hauling of said material shall be done at their 
own expense and risk. Otherwise, the city would have to incur an important 
expenditure in the hauling of many cubic meters of earth and its means of trans- 
portation at hand would not be sufficient to do it. 

If the city were not bound to accomplish improvements urgently required by 
other districts and to effect those necessarily required for the sanitation of the 
Cemetery del Norte, which if not done would be a focus of infection of the alive, 
the objections of the Director of Lands to the action of the Municipal Board 
denying his request would be of much weight. 

The share of the Insular Government in the expenses of the city as provided 
for in the Manila Charter, is at the present time a mere compensation for tl 
reduction of its revenue because of the Internal Revenue Law, of which the presei 
Director of Lands is well convinced, as he so stated himself when he was a memb< 
of this Board. 

The action taken by the Municipal Board in filling in the north side of Call" 

Cervantes, is a proof of its good wishes to improve the San Lazaro Estate, and , 

the undersigned believes that nothing can be done further during the current yei^l 

on behalf of said estate. ill 

Very respectfully, Miguel Velasco. 



ve, 
led 

I 



The honorable the Seceetaby of Finance and Justice, 

Manila, P. I. 
Sir: I have been directed by the Municipal Board to inform you that it h 
received requests from a number of residents of the San Lazaro Estate to repair 
and drain the streets within the estate. 

The streets there are in a had condition, needing repairs, and just noiv espe- 
cially, improved drainage facilities. The Board has directed me to say, hoioever, 
that, in view of the fact that no land tax is collected in the Estate, it does not 
feel justified in expending taxes collected in other parts of the City to repair and 
drain the streets in the Estate. The Board is of the opinion that the necessary 
repairs a/nd drainage should be made, and by the Insular Government. 
Very respectfully, 

Jno. M. Tutheb, Secretary. 



I 



91 

[First Indorsement.] 

Department of Finance and Justice, Manila. 
Respectfully referred to the honorable the Secretary of the Interior. 

James F. Smith, 
Acting Secretary of Finance and Justice. 

[Second Indorsement.] 

Department of the Interior, Manila. 
Respectfully referred to the Director of Lands. 

Dean C. Worcester, Secretary of the Interior. 

[Third Indorsement.] 

Bureau of Lands, Manila. 

Respectfully returned to the honorable the Secretary of the Interior, inviting 
attention to still another petition from residents (who are also taxpayers) of 
Calles Timbugan and O'Donnell on the San Lazaro Estate. 

The ground on which the Municipal Board denies the petition of certain 
residents of San Lazaro Estate, viz, that it does not feel justified in expending 
taxes collected in other parts of the city to repair and drain the streets of the 
Estate, appears absolutely untenable, for the following reasons: 

Calles O'Donnell and Timbugan have been public thoroughfares for many 
years. These streets have been and are in a deplorable condition, which the 
Municipal Board admits, and it appears to be the duty of the Board to maintain 
the public streets of the city wherever such streets are located. The fact that 
the streets are located on the San Lazaro Estate, which pertains to the Insular 
Government, in no way justifies, the city authorities in neglecting said streets. 
The President of the Commission, when discussing the Charter of Manila, 
advanced as one of the reasons why the expenditure of Insular funds for the 
city of Manila was justifiable, the fact that the Insular Government owned 
large tracts of property in the city which were to be exempt from taxation. 
If the Municipal Board carries out the policy indicated in the within letter, 
the Insular Government may reasonably expect that the maintenance and repair 
of Plaza McKinley, the Bagumbayan and Malecon drives, and other streets and 
plazas on which are located Insular properties, or other properties exempt from 
taxation, will be discontinued, and it. will be necessary for the Insular Govern- 
ment to organize and maintain a street department, which appears ridiculous. 
It is therefore recommended that the attention of the Municipal Board be invited 
to the fact that if the reason advanced in the within letter is the only one why 
certain streets of the San Lazaro Estate are not put in proper condition, the 
reason is not sufficient; that it is not the intention of the Insular Government 
to make appropriations for the maintenance and repair of streets while the city 
of Manila is receiving the assistance from the Insular Government now provided 
by law; and, that it appears to be the duty of the Municipal Board to maintain 
and repair the streets on which the abutting property is exempt from taxation 
as much as it is on streets where the abutting property contributes taxes. 

C. H. Sleeper, Director of Lands. 

[Fourth indorsement.] 

Department of the Interior, Manila. 

Respectfully referred to the Honorable James F. Smith, Governor-General, 
inviting attention to the third indorsement hereon. 

Dean C. Worcester, Secretary of the Interior. 



92 



J 



[Fifth indorsement] 

Department of Finance and Justice, Manila. 
Respectfully referred to the Attorney-General requesting an opinion. !■ 

James F. Smith, )f 
Acting Secretary of Finance and Justice. 

[Sixth indorsement.] 

Office of the Attorney- General, Manila. 
Respectfully returned to the Honorable the Acting Secretary of Finance and 
Justice, inviting attention to the inclosed opinion of even date. 

Gregorio Araneta, Attorney-General. 



[Seventh indorsement.] I 

Department of Finance and Justice, Manila 
Respectfully returned to the Municipal Board, inviting attention to the inclos\ 
opinion of the Attorney -General which is approved hy the undersigned. 

James F. Smith, 
Acting Secretary of Finance and Justice. 

Manila. 

Sir: In response to your indorsement of August 24, 1907, I have the ho: 
to submit the following opinion: 



i6^ 



statement of facts. 



I 



The San Lazaro Estate is situated within the limits of the city of Manila. 
Public streets have been laid out and dedicated to the use of the public and have 
become public streets belonging to the city of Manila. These streets are in ba<i 
condition and need repairs, and especially, improved drainage facilities. The 
Municipal Board has decided that, in view of the fact that no land tax is 
collected on the San Lazaro Estate, it does not feel justified in expending taxes 
collected in other parts of the city to repair and drain the streets on the estate, 
and expresses the opinion that the necessary repairs should be made, aad by 
the Insular Government. 



question. 
Upon whom does the duty of repairing the streets in question devolve? 

OPINION. 






The streets now existing through the San Lazaro Estate are public streets 
belonging, as such, to the city of Manila. Section 17 of the Charter of the City 
of Manila recites, among the general powers of the Municipal Board, the following : 

"To lay out, construct, improve, and regulate the use of streets, avenues, 
alleys, sidewalks, etc." 

Section 33 of the Charter of the City of Manila, enumerating the duties of 
the city engineer, provides that: 

"He shall have the care of all public streets, parks, and bridges; shall 
maintain, clean, sprinkle, and regulate the use of the same for all purposes as 
provided by ordinance." 

It is, undoubtedly, the duty of the city of Manila to maintain and keep in 
repair any and all public streets vnthin the limits of the city. The fact 



t that,jL 

J 



93 

street is bordered hy lands exempt from taxation does not change the status of 
the street or modify the liability of the city in regard to the repair of the same. 

The general law exempts various classes of property from taxation. Religious 
and eleemosynary institutions, as well as all public buildings and property are, 
by law, exempt from taxation. Public streets adjoin or border upon many of 
these pieces of private property so exempt from taxation. Take, for example, 
the Cathedral; it is bounded on four sides by public streets of the city of Manila. 
No taxes are collected upon such property. Can it be said that the city of 
Manila is not under obligations and should not repair the streets adjacent to 
the Cathedral? There are many instances in the city of Manila where a public 
street is bounded on both sides by property exempt from taxes. These public 
streets have been maintained and kept in repair by the city of Manila without 
question. 

The fact that the San Lazaro Estate is exempt from taxation and is admin- 
istered by the Insular Government in no way affects the character of the 
public streets that pass through such estate. These streets belong to the city. 
They were opened and dedicated to the use of the general public of the city 
of ]\Ianila and their use is not confined to the residents and tenants of the San 
Lazaro Estate. The general public use the streets and have the right, as the 
citizens of the City of Manila, to demand that the streets be kept in a reason- 
able state of repair. A public street, even though laid out in a particular 
locality within the city limits, appertains to and is subject to the use of the 
general public of the whole of the city of Manila; and it cannot be said that 
the status or condition of a particular public street is fixed by the condition 
of the adjacent property. 

/ am, therefore, of the opinion that it is the duty of the city of Manila to 
maintain and keep in repair the public streets within the limits of the city of 
Manila, including those public streets which pass through the San Lazaro Estate, 
and that no distinction can or should be made because of the condition of adjacent 
property. 

Very respectfully, Gbeqoeio Araneta, 

Attorney -General. 

To the Honorable the Acting Secretary of Finance and Justice. 



The Secretary of the Municipal Board, Manila, P. I. 

(Through the honorable the Secretary of the Interior.) 

Manila, October 12, 1907. 
Sir: In a recent conversation with the Director of Health my attention was 
invited to the almost impossible sanitary condition existing in certain portions 
of the San Lazaro Estate. The cause of this unsanitary condition appears pri- 
marily to be due to the lack of drainage along the streets, and secondly, to the 
large number of water-holes, not only within the area dedicated to streets, but 
also within the area within the lots. The Director of Health considered the 
condition so serious that he urged the immediate necessity of some steps to 
improve this condition. The status of the San Lazaro Estate has now been 
determined, and that portion south of the second street north of the hospital 
(with the exception of the block containing the San Lazaro Cemetery) becomes 
the property of the Insular Government, while that portion north of the said 
street becomes the property of the Catholic Church; except that portion of the 



94 

Estate dedicated to streets and alleys, which becomes public property under the 
control of the city of Manila. It is believed that the sanitary condition of 
that portion of the Estate belonging to the Insular Goverament can be greatly 
improved if the Municipal Board will cooperate with this Bureau to that end, 
without the expenditure of any large sum of money. This Bureau has available 
for such a purpose a small appropriation, and I therefore propose for the 
consideration of the Board that a large portion of the street sweepings and 
garbage now being hauled to the Cemetery del Norte be diverted to that portion 
of the San Lazaro Estate pertaining to the Insular Government and the city of 
Manila, with the view of filling all holes and raising that portion of the estate 
which is low and badly drained (not including the low grass lands, which will be 
continued to be used as such for some time) ; the Bureau of Lands to furnish 
funds for the pajTuent of the necessary labor to back-fill, handle the earth to 
cover the garbage, etc., dig out ditches along the sides of the streets, and do 
such other work as may be found necessary; the city to undertake to furnish 
all the transportation and to supervise the work, whether in the streets or 
block areas; the department of transportation and sanitation to have control of 
the laborers and to direct their work, this Bureau being consulted only for the i 
purposes of arranging with tenants for the raising or shifting of buildings, and 
for the payment of the laborers. 

If the Board gives this proposition the consideration it appears to merit, and 
concludes to cooperate with this Bureau, it is believed that the continual com- 
plaints now being received regarding the sanitary condition will be discontinued; 
and with a small additional amount of work in surfacing the street areas, the 
condition of the entire estate will be greatly improved. 

It is desired that an estimate be prepared showing the approximate expense 
for the labor for this work which this Bureau may be called upon to bear, and 
also an approximate estimate of the time necessary, which undoubtedly will tix- 
tend over a period of many months, but the work should be so far completed by 
the beginning of the next rainy season as materially to improve the present 
condition of the estate. 

This Bureau has been at a large expense during the past year in rearranging 
the buildings on the estate so as to leave the streets and alley ways free, and to 
have the nipa buildings the proper distance apart to protect from conflagrations, 
and has endeavored in other ways to improve the condition of this estate, but 
until such a time as the city will cooperate it appears absolutely impossible, 
without a very large expenditure of money, to meet existing conditions, 
therefore urgently request your favorable consideration of this project. 
Very respectfully, 

Chables H. Sleeper, Director of Lands. 

[First indorsement.] 

Department of the Interior, Manila. 
Respectfully forwarded to the Honorable James F. Smith, Governor-General, 
requesting that early and serious attention be given this mater by the Municipal 
Board. As the status of the San Lazaro Estate has been finally determined, and 
as one of the considerations which induces the Insular Government to pay ap- 
proximately one-third of the expenses of the city of Manila is the fact that it 
owns large properties within the city limits on which taxes are not paid, it would 
seem that all excuse for the continuance of the attitude hitherto adopted by the 
city of Manila in the matter of doing necessary street work and of providing 




95 

proper light and water supply for that portion of San Lazaro Estate which is the 
property of the Insular Government had been done away with. 

Dean C. Worcester, Secretary of the Interior. 

[Second indorsement.] 

Executive Bureau, 
Manila, October 17, 1907. 
Respectfully referred to the Municipal Board with request that a conference 
he had with the Director of Lands and arrangements made to carry out the pro- 
posed improvement of the San Lazaro Estate with the least practicable delay. 

James F. Smith, Govemor-Oeneral. 

[Third indorsement.] 

City of Manila, Municipal Board, 

Secretary's Office. 
Respectfully referred to the city engineer for a statement of costs. 
By direction of the Board: 

Jno. M. Tuther, Secretary. 

[Fourth indorsement.] 

Office of City Engineer, 

Manila, February 6, 1908. 
Respectfully returned to the Secretary of the Municipal Board, with a plan 
showing the location of all the water holes complained of in the letter of the 
Director of Lands, and the information that a careful calculation of the amount 
of fill required to bring these low places up to proper grade is approximately 
17,166 cubic meters, which is believed will cost not less than ^2 per cubic meter, 
or ^34,332 in all. The chief of the department of sanitation and transportation 
informs me that at the present time he can not undertake to carry out the toishes of 
the Director of Lands. I can not see wherein the city, under these circumstances, 
can touch the question of the improvement of the estate. Estimate will shortly 
be presented by this department, to the Board, for certain work in the street 
areas in connection with the proposed expenditure of funds raised by the extra 
peso cedula tax, and in this connection I respectfully invite attention to the 
ninth indorsement on certain papers pertaining to this matter, dated September 
24, 1907. 

W. P. Wylie, City Engineer. 

[Fifth indorsement.] 

City of JSIanila, Municipal Board, 

Secretary's Office. 
Respectfully returned to the honorable the Governor-General, inviting atten- 
tion to the preceding indorsement, which shows the expense of the requested 
improvements to be so great that the city can not possibly undertake them. 
The street areas within this zone vnll receive attention in the near future. 
By direction of the board: 

G. S, Lane, Acting Secretary. 

[Sixth indorsement] 

Executive Bureau. 

Respectfully returned to the Director of Lands, inviting attention to the fifth 

indorsement. 

James F. Smith, Governor-General. 



96 

From this correspondence it appears only too clearly that for years 
the city has persisted in its refusal to perform work absolutely necessji 
to the placing of large portions of the San Lazaro Estate in a deceuL 
sanitary condition. The opinion of the Attorney- General leaves nothing 
to be said as to the legal obligations resting on the city in this matter but 
it may well be suggested that in view of the fact that the San Lazaro 
Estate is administered by the Insular Government for the benefit of the 
public, and that the income from the Estate goes to the San Lazaro Hi 
pitals in which the lepers^, the insane and the cholera victims of the ciiy 
are supported and cared for at an expense very greatly in excess of the 
total revenues derived from the estate, there is a moral as well as a legiil 
obligation resting on the city to improve conditions on this property. 

We have constantly been assured that the placing of the estate in a 
decent sanitary condition involving filling which would cost a very large 
sum. The sanitary engineer informs me that he has gone carefully 
over the ground, has found that it is from 2 to 7 feet above high tide 
and that it is entirely feasible to drain it at comparatively small expei 
by running ditches through it to the neighboring esteros. 

If there were no other reason for it than the necessity for remedying 
the indescribable unsanitary conditions prevailing on many parts of th\> 
estate this work should have been performed by the city years ago. 

In spite of the fact that the Attorney-General rendered an opinion to 
the effect that the city is under legal obligation properly to maintain i 
streets through the San Lazaro Estate, which opinion was returned to 
the Municipal Board approved by the Acting Secretary of Finance and 
Justice on September 7, 1907; and in spite of the further fact that ilie 
Director of Lands offered to share with the city the expense involv.h 
and that the Governor-General requested the Municipal Board to con I 
with the Director of Lands and arrange to carry out the proposed i 
provements on the San Lazaro Estate with the lea'st practicable del 
we find the city engineer stating under date of February G, 1908, that 
can not see wherein the city, under these circumstances, can touch 
improvement of the estate and in point of fact the pleasing assurat 
conveyed at the direction of the Municipal Board to the effect that 
street areas within this zone will receive attention in the near futun 
has never been realized. 

Meanwhile the streets continue to reek with filth unspeakable; 
the people continue to die of preventable diseases. 

EXPLANATION OF THE CONTINUANCE OF CHOLERA. 

I have thus far endeavored to give a plain statement of the facts 
to the past and present cholera situation in Manila and the provini 
and to correct certain misapprehensions which have arisen concern ii 
them. wSKm 

The conditions set forth leave much to be desired, and we mi; 



in- 



97 

jlaanifestly seek their causes if we are substantially and permanently 
o improve them. 

I will now, therefore, give such explanation of the facts as I am able 
o furnish. 

To what have the spread of cholera to the provinces, its continuance 
here, and the resulting frequent infection of Manila been due? 

Beyond the shadow of a doubt they have been due to the lack of a suf- 
ficient force of competent men with which to combat the disease. Who 
vas responsible for this lack? A conclusive answer to this question may 
)e found in a brief summing up of the record. 

The original program for improving the sanitary condition of the 
Philippine Islands included the establishment of a central Board of 
Health at Manila to have direct control of sanitary matters in that 
ity and general control over such matters in the provinces ; of Provincial 
Boards of Health, to be subordinate to the Insular Board of Health, 
and of municipal Boards of Health subordinate to the Provincial Boards 
Df Health. The establishment of the Insular Board of Health was 
provided for by Act No. 157, passed on July 1, 1901. Act No. 307, 
'Providing for the establishing of provincial boards of health and fixing 
their powers and duties," and Act No. 308, "Providing for the establish- 
ment of municipal boards of health and fixing their powers and duties," 
were passed on December 2, 1901. 

Act No. 307 provided, among other things, that there should be a 
provincial board of health in each province of the Philippine Islands, 
that it should be established at such time as the Board of Health for the 
Philippine Islands and the Secretary of the Interior thought best and 
that its president, who would be the chief sanitary officer of the province, 
should be appointed by the Civil Governor with the consent of the 
Philippine Commission. The determination of the salaries to be paid 
presidents of provincial boards of health, within certain limits fixed by 
law, was left to the Commissioner of Public Health subject to the approval 
of the Secretary of the Interior. 

In carrying out the provisions of Act No. 307 the then well established 
policy of giving to Filipinos the largest possible amount of intervention 
in public affairs, was consistently followed. I was asked by the Civil 
Governor to recommend suitable persons for appointment as presidents 
of provincial boards of health and my recommendations were in every case 
acted upon favorably by the Civil Governor and the Philippine Com- 
mission. Of the first twenty-three presidents of provincial boards of 
health appointed on my recommendation, twenty were Filipinos. In fact, 
to the best of my recollection, the number of American presidents of such 
boards of health has never at any one time exceeded three. Not one of 
the Filipinos appointed was required to pass an examination. 

I made these recommendations with full knowledge that the training 
of the Filipino physicians appointed had been such as to fit them for the 
78079 -7 



98 

personal care of the sick rather than for dealing with general problems of 
public sanitation which can be successfully solved only by specially j 
trained men possessed of a considerable degree of executive ability. It 
was, however, planned to undertake the systematic instruction of provin- 
cial and municipal health officers in their respective districts in connec- 
tion with periodic inspections of their work. Unfortunately, before the 
administrative machine thus organized was in even passable running 
order a tremendous strain was thrown upon it by the cholera epidemic of 
1902, which began on March 20, and, as has already been shown, spread 
until it had invaded thirty-eight provinces. 

The conditions which resulted, while not so bad as those which had 
prevailed during the Spanish regime, were nevertheless deplorable. The 
hard fact is that provincial and municipal health boards failed most 
signally to meet the situation and that, except in those cases where 
medical inspectors could be sent from Manila to take charge, cholera ran 
its course with little or no hindrance and was terminated in a given 
locality only by the arising of climatic conditions unfavorable to its 
continuance, or by the natural decrease in the virulence of the infection 
and the exhaustion of the supply of susceptible individuals. 

I did not feel that under all the circumstances the presidents of 
provincial and municipal boards of health had enjoyed a fair opportunity 
to demonstrate their capabilities and still hoped that they might be 
brought up to a reasonable degree of efficiency. Solely with this end in 
view it was decided to order all presidents of provincial boards of health 
on duty at Manila, one or two at a time, in order that they might there 
receive instruction in the practical application of sanitary science and 
might then return to their provinces and put in practice there the 
lessons learned at Manila. This course was followed. In a limited 
number of instances our hopes were realized and several fairly efficient 
provincial health officers were developed. In the very large majority of 
cases I regret to say that increased efficiency was not obtained. 

It eventually became painfully evident that the bitter lesson taught 
the provincial municipalities by the great epidemic of 1902-1904 was 
being rapidly forgotten. Towns which had temporarily been put in 
decent sanitary condition relapsed to their original state of uncleanliness 
and only a very limited number of presidents of provincial boards of 
health struggled successfully against the universal tendency to backslide. 
A few others did what they could to counteract this tendency but found 
themselves powerless. 

A large majority apparently viewed the situation with complete in- 
difference contenting themselves with making, in a perfunctory way, the 
inspection trips required by law without any real, determined effort to 
improve sanitary conditions. Indeed, several presidents reported that 
they had made their semiannual inspection trips and at the same time sub- 
mitted daily time records showing that they had always been present at 



I 99 



tlieir offices during regular office hours, thus demonstrating that they had 
performed the remarkable feat of being at the same time in two places 
widely removed from each other ! 

It was noted in the case of one president, who was called to Manila 
for disciplinary action, that his daily reports of the health situation in 
his province, which was critical, continued to be forwarded to Manilr», 
duly signed, during the entire period of his absence. Investigation 
showed that he had apparently deemed himself competent to foresee 
events, as he had sometime before prepared and signed a large advance 
series of reports and turned them over to a subordinate to be duly 
forwarded, neglecting to give directions for discontinuing them when he 
was called away. 

Briefly, as a direct result of the appointment as presidents of provin- 
cial boards of health of men most of whom were not adequately trained 
at the outset and were unable or unwilling to profit by the opportunities 
later given them to secure proper training, the whole system broke down 
and conditions in the provinces went from bad to worse. It was my 
opinion, and that of the Director of Health, that such a state of affairs 
ought not to be tolerated if it was possible to change it. We believed 
that it could be changed by abolishing provincial boards of health and 
grouping the provinces in health districts each to be in charge of a district 
health officer under the immediate control of the Director of Health. It 
wa.s our plan to appoint as district health officers those presidents of 
provincial boards of health who had proved capable and efficient, recogniz- 
ing meritorious service in each instance by promotion; and by transfer- 
ring to the remaining positions medical inspectors who had theretofore 
been appointed for the city of Manila but who had in reality been often 
employed in the provinces where it had been necessary to send them to 
do work which others were paid to perform. 

At my direction the Director of Health prepared a draft of ^^An 
Act abolishing provincial boards of health and substituting therefor dis- 
trict health officers, and repealing Act Numbered Three hundred and 
seven, entitled 'An Act providing for the establishment of provincial 
boards of health and fixing their powers and duties,' and providing that 
all the duties heretofore performed by presidents of provincial boards of 
health and by provincial boards of health shall devolve upon district 
health officers." This draft was duly forwarded to me, together with 
the following letter : 

Dep.vbtment of the Interior, 
• Board of Health for the Philippine Islands, 

Manila, May 6, 1905. 
To the honorable the Secretary of the Interior, Baguio. 

Sir: I have the honor to forward herewith a draft of the proposed Act with 
regard to district health officers. 

This bill is the result of the investigation which you requested he made of 
the present provincial system of boards of health. The unanimous opinion 



uar 
onfh 

I 



100 

seems to be that the present plan is ineffective and expensive. The files of the 
Board of Health contain several hundred letters which give ample evidence of 
the undesirahility of continuing provincial health administration upon the present 
basis. 

Among the advantages to be derived from the passage of the Act are the 
following: 

1. The present plan provides for thirty-one presidents of provincial boards 
of health, whose salaries amount to $37,800, U. S. currency. By the proposed 
scheme the provinces will be divided into twelve districts, and the present 
medical inspectors of the Board of Health assigned to them. Their salaries 
would amount to $24,000, U. S. currency; thus a saving of $13,800 would be 
made to the provinces. 

2. In the practical working of the present scheme, it is found to be constantly 
necessary to supplement the work of the inefficient presidents of provincial 
hoards of health, by assigning experienced officers from the central Bureau to 
assist them in their work. This is a constant drain on the funds of the Insular 
Board of Health, and in reality means that two men are being paid for what on^ 
man ought to do. 

3. The new plan would provide a more adequate treatment of the sU 
Americans in the provinces, and would serve as a nucleus for the propose 
provincial hospitals. 

4. It would facilitate provincial vaccination, and would be much more eco- 
nomical than the present plan of instructing vaccinators in Manila and then 
sending them to the provinces. , Traveling expenses between Manila and the prov- 
inces would be saved, and vaccinators could no doubt be hired cheaper whcji 
they can be secured nearer their homes. 

5. It would provide means for the supervision of veterinary sanitation. 

6. It would reduce the amount of official correspondence, and save an immei 
amount of translating and briefing. 

7. The inspections in the provinces would gradually become more unifoi 
By more central control the experience gained in one province would becoma 
available to all. 

8. It would facilitate the collection of vital statistics, and a remedy could 
be applied to correct the present inaccurate returns that are made. Mucli 
of the time in the central office is now occupied in correcting these reports. 

9. Municipal boards of health would be under better supervision, and the 
instruction which they would receive from the trained officers would be of 
real value in improving the sanitation in the provinces. 

10. The Insular Board of Health would have a much closer supervision over 
epidemic diseases. The cardinal principle in dealing with contagious diseases 
is, to stamp out the infection of the first cases. It is quite obvious, then, that 
time is an important factor, and that an officer who xcould be available at once 
and actually on the ground, is loorth a great many loho would of necessity lose 
much time in starting from Manila. 

11. It would settle the question of authority, and many of the present 
embarrassments caused to the central government would be avoided. The troul 
caused by the cemeteries in the provinces is an example. 

12. It wx)uld establish more confidence. Business enterprises would be more" 
secure, in that they would not be at the mercy of factions. 

In conclusion, attention is respectfully invited to the fact that the passage 
of the "District Health Oflicers Act" would result in a net saving of $13,000, 
U. S. currency, to the provinces,! and $24,000, U. S. currency, to the Insular 






;enc 

% 

Orel 



I 



M 



101 

Government, and at the same time substitute a system that has merit for one 
that is universally admitted to he not only useless, hut, in addition, a constant 
cause of friction and a source of much dissatisfaction. 
Very respectfully, 

Victor G. Heiseb, 
P. A. Surg., U. 8. P. H. d M. H. Service, 

Commissioner of Public Health. 

On August 1, 1905, it was forwarded by me with the following indorse- 
ment: 

[First indorsement.] 

The Government of the Philippine Islands, 

Department of the Interior, Manila. 
Respectfully forwarded to the recorder for transmission of these papers to 
the Commission, inviting attention to the accompanying communication from 
Dr. Heiser, and recommending the passage of the within Act. 

Dean C. Worcester, Secretary of the Interior. 

The act having passed a first reading, it was deemed best on account 
of its importance, to give opportunity for its public discussion, and in 
view of the fact that many of the provinces interested could not send 
representatives to be present when it was considered in public session, 
a copy of it was forwarded to each provincial board with the request 
that the board forward its opinion in writing. The large majority of 
the boards favored the bill. It is, however, only fair to say that there 
was nothing in the bill itself to show that the dropping from office of 
inefficient presidents of provincial boards of health, and their substitu- 
tion as district health officers by efficient medical inspectors sent from 
Manila, was contemplated. Had this been made plain, as it should 
have been, some of the replies received would doubtless have been of a 
different character. 

When the bill came up before the Philippine Commission for a third 
reading and passage I again called attention to the fact that if it passed, 
proper provision for carrying out the policy outlined would be inserted 
in the next appropriation bill. It was thereupon stated that Dr. Heiser 
and I were trying to make places in the provinces for a large number of 
American medical inspectors whose services were not needed either there 
or in Manila, and that the appropriation for the Bureau of Health was 
twice as large as was necessary. After protracted discussion the bUl 
was laid on the table where it remained until the Commission adjourned 
to Baguio. 

It was evident that the bill as it then stood could not pass, and I was 
directed by Governor-General Ide to meet with other members of the 
Commission and draft a hill which could pass. 1 endeavored to do so. 

The first section of the bill as originally drafted read as follows: 

Section 1. Subject to the approval of the Secretary of the Interior the Bureau 
of Health for the Philippine Islands shall divide the Archipelago into such 



102 



I 



number of health districts not exceeding eighteen as he may deem advisable and 
the Director of Health may assign thereto such number of District Health 
Officers, Sanitary Inspectors, and other agents and employees as may be necessary. 

The corresponding portion of the bill as finally passed read as follows : 

Sec. 2. Each province may have a district health officer appointed by the 
Governor-General, with the advice and consent of the Philippine Commission. 
Subject to the approval of the Philippine Commission, the Director of Health 
may increase the number of district health officers assigned to a province or 
may unite two or more provinces and assign to them a district health officer. 
He may also assign to each district such other duly authorized sanitary officers 
or employees as he may deem necessary. 

Any regularly appointed person holding the office of president of a provincial 
board of health at the time of the passage of this Act shall be eligible for 
appointment without examination to the position of district health officer during 
a period of two years from the date on which this Act becomes effective. 

Under the act as originally drafted, supplemented by the contem- 
plated provisions in the appropriation bill, district health officers would 
have been appointed by the Director of Health subject to the approval 
of the Secretary of the Interior and would have been assigned to duty 
wherever circumstances required their presence. This would have given 
a mobile force composed for the most part of men of tried and proved 
efficiency. Ordinary conditions in the provinces or in Manila could 
have been met without moving men from the one region to the other and 
in special emergencies a few men could have been spared for transfer 
from Manila to the provinces and vice versa without creating a dangerous 
situation. For purposes of discipline this force of officers would have 
been under the immediate control of the Director of Health and the 
Secretary of the Interior, and had it proved inadequate properly to 
safeguard the health of the people of the Philippine Islands respon- 
sibility for results would necessarily have rested squarely upon these 
two officials. 

The act as finally passed left the Director of Health and the Secretary 
of the Interior without authority to establish health districts or to appoint 
or to remove district health officers. At the time it was passed botli 
the Secretary of the Interior- and the Director of Health believed that it 
at least authorized the latter official to assign properly appointed district 
health officers to duty wherever their services might be needed, but in 
actual practice it was interpreted to mean that even in meeting great 
emergencies the Director of Health might not so much as temporarily 
transfer a district health officer from one district to another without 
the consent of the Governor-General and of the Philippine Commission 
first had. 

The situation might still have been redeemed, at least to a considerable 
extent, had there been inserted in the appropriation bill proper provisions 
as to salaries so as to allow the appointment as district health officers of 
the men whom it was originally intended to employ in this capacity, but 
it was understood at the time Act No. 1487 was passed that this would 



103 

not be done, but that the new positions would be filled by the more com- 
petent ex-presidents of provincial boards of health. 

In spite of this understanding Dr. Heiser was so thoroughly convinced 
of the absolute necessity of the change, if the public health was to be 
properly safeguarded, that he included in his estimate of appropriation 
required for the fiscal year ending June 30, 1907, the following provision : 

DISTRICT HEALTH OFFICERS. 

Salaries and wages. 

11 district health officers, at P=4,000 per annum P=44,000 

1 district health officer, at P=4,000 per annum (increase submitted) 4,000 

(In lieu of 1 medical inspector, at ?=3,600 per annum.) 

3 district health officers, at ^4,000 per annum (submitted) 12,000 

Total, salaries and wages 60,000 

Contingent expenses. 

Traveling expenses of district health officers 7,500 

Total, district health officers 67,500 

Note. — It will be noted that the above estimates contemplate the inaugura- 
tion of the distritct health plan as originally proposed by this office. 

In the foregoing estimate, in addition to the medical officers for the hospitals 
of the Bureau and for the prison sanitation division, there are requested five 
medical inspectors, with salaries aggregating P=23,400, for city and central of- 
fice work. This amount represents the total charge against the Insular funds 
on account of medical inspection, as against 17 medical inspectors allowed by Act 
1416 with salaries aggregating ^71,000. Tlie above amounts requested for 
district health officers will be refunded to the Insular Treasury by the various 
provinces, as provided in Act 1487. 

This would have provided fairly adequate compensation for fifteen 
district health officers and, supplemented by the other provisions of the 
estimate, would also have provided salaries for the medical officers of the 
hospitals conducted by the Bureau and for five medical inspectors for work 
in the city of Manila. 

When interrogated as to his reason for inserting such a provision in his 
appropriation estimate after a wholly different policy had been finally 
determined upon. Dr. Reiser replied that he was so firmly convinced of the 
absolute necessity of the change that he felt it his duty once more to urge 
it and that he had inserted the provision in order that if it were stricken 
out the responsibility for such action might be clearly defined. It was 
stricken out by the Commission. 

The appropriation bill as finally passed contained a further provision 
which embodied unsuspected possibilities of mischief. It had been origi- 
nally planned to change the designations of the more responsible medical 
officers employed by the Bureau of Health, making all physicians in 
charge of hospitals and also all medical inspectors district health officers, 
the object being twofold, namely, to give to the force the greatest possible 



104 

mobility so that the men might be used whenever and wherever needed 
and to open to Filipino physicians positions for which it was probable 
they could not qualify if compelled to pass civil-service examinations, 
but for which it was hoped they might, in actual practice, demonstrate 
their fitness. Act No. 1487 having contained a provision to the effect that 
any person who had held the position of president of a provincial board 
of health would be eligible to appointment as a district health officer at 
any time within a period of two years after the passage of the Act. 

The undersigned did not desire to have this privilege withdrawn from 
worthy ex-presidents of provincial boards of health and believing, as he 
did, that under the provisions of Act No. 1487 the assignment to duty of 
all district health officers was completely within the control of the Director 
of Health, raised no objection to the provision. Under the accepted in- 
terpretation afterivard put upon the provisions of this Act the Director 
of Health was deprived of all control of the assignment to duty of even 
those officers in charge of hospitals and of the men really employed as 
medical inspectors in the city of Manila. The condition thus created was 
absolutely without precedent in the administration of the Bureaus of this 
Government. The Director of Health, who is constantly called upon to 
taJce prompt and effective action in combating the most dangerous con- 
tagious diseases, teas left without power to appoint or to remove a single 
one of the numerous medical officers in the employ of his Bureau, or to 
order any such officer to duty outside of a district fixed, not by him, but 
by the Philippine Commission. 

Nor did the matter end here. By a subsequent resolution of the Co; 
mission, the list of eligibles from which it was possible to draw in appoint- 
ing district health officers was in effect limited to the five ex-presidents of 
provincial boards of health remaining after the more competent of these 
men had been given employment. 

Of these eligibles one was suffering from an aortic aneurism which 
had become so serious that he was unable to lie down; a second was af- 
flicted with dyspnoea; although a short man, he weighed more than 200 
pounds, and the climbing of an ordinary flight of stairs often made it 
impossible for him to speak for several moments; a third was at that 
time a provincial governor who had requested, and had been refused by 
the Governor- General, the privilege of acting as district health officer 
without pay, while the remaining two were believed to be deficient in 
technical training. 

One of the latter. Dr. Victorino Crisologo, was subsequently appointed 
district health officer for Lepanto-Bontoc and is now suspended pending 
his reply to the gravest charges which have ever been brought against 
a district health officer in these Islands and which if sustained should 
lead not only to his summary dismissal from the service but to a with- 
drawal of his right to practice the medical profession. 

Under the policy outlined by a resolution of the Commission of De- 
cember 20, 1906, the choice of the appointing power was clearly limited 



ji 



105 

to these five men in filling all positions of district health officer, which 
as the law then stood, included the officer in charge of the Civil Hospital, 
the officer in charge of the San Lazaro Hospital, the officer in xiharge of 
the Baguio Hospital, the officer in charge of the Leper colony, and the 
officers in charge of the sanitation of the city of Manila as well as those 
in charge of the several provincial health districts. This, too, in spite 
of the fact that not one of them had passed a civil service examination. 

THE BURDETTE CASE. 

On August 17, 1906, the Director of Health had made a request on the 
Bureau of Civil Service for the appointment in the United States of a 
district health officer at ?=3,600 per annum. This officer was desired 
to perform the work of a medical inspector of Manila, which of course 
included occasional trips to the provinces. 

Upon the passage of Act Xo. 1487 I had assured Dr. Heiser that I 
would support him in an effort to keep his Manila force intact and 
efficient, so that we might have something to fall back on in case of an 
epidemic, and the one American on the eligible list having been objected 
to by Dr. Heiser and his objection having been sustained by the Director 
of Civil Service the alternatives which were presented were to request 
the appointment of one of the five men above mentioned, or to ask for 
a man from the United States. 

Dr. Heiser chose the latter alternative and I approved his request, 
acting with a full knowledge of all the facts. Governor Ide, in whom 
was vested the power to make the appointment, subject to approval, by 
the Commission, forwarded the following cablegram: 

[Cablegram.] 

August 20, 1906. 
Secwab, Washington: 

Request William S. Washburn to select district health officer, $1,800 per annum. 

Ide. 

In accordance with this request Dr. Benjamin L. Burdette was sent 
out, and upon his arrival, his official appointment was asked for, as is 
customary. 

The Commission thereupon, on December 6, 1906, passed the following 
resolution : 

Whereas there has been presented to the Commission for confirmation in 
accordance with law the nomination of Dr. Benjamin L. Burdette to be district 
health officer at a salary of ^3,600 per annum ; and 

Whereas it appears that on August 20, 1906, Governor-General Ide, without 
reference of the matter to the Commission, telegraphed to Washington requesting 
that Dr. W. S. Washburn, Director of the Philippine Bureau of Civil Service, 
then in Washington, select a qualified person to fill the position of district 
health officer at the salary mentioned, in accordance with which Dr. Washburn 
selected Dr. Burdette, who arrived in Manila on December 3, 1906; and 

Whereas, in view of the fact that the Philippine Commission finds that there 
are available, and were available at the time the telegram was sent to the 



106 

United States for a district health ofl&cer, physicians who are eligible for ap- 
pointment under the Civil Service Act and Rules and who it is believed are 
perfectly capable of filling the position of district health officer, it seems to 
the Commission that it would be not only unjust to these men, but contrary 
to the policy of the Government to send to the United States for a person to 
fill such positions; and 

Whereas, for the reasons set forth, the Commission feels that it can not 
confirm the appointment of Dr. Burdette to the position in question, but appreciat- 
ing the fact that he came to these Islands in good faith expecting appointment 
on his arrival, it believes that it is no more than just that the Government 
should protect him from actual financial loss in the premises: Now, therefore, 
be it 

Resolved, That Dr. Benjamin L. Burdette be informed through the Director 
of Health that for the reasons above set forth the Commission can not see its 
way clear to confirm his nomination as district health officer and that if, 
under the circumstances, he desires to return to his home, the Government stands 
ready to pay him a sum equal to. compensation at the rate of ?3,600 per 
annum from the date he left his home in the United States to come directly to 
the Philippine Islands to fill the position of district health officer to the date 
of his arrival at his home in the United States on the return voyage, provided 
he takes the first available direct transportation from Manila to the United 
States and upon his arrival there the first available direct rail transportation 
to his home, and also stands ready to pay his actual and necessary traveling 
expenses from his home in Manila and return: Provided, That return traveling 
expenses and compensation for the period from the date of his leaving Manila to 
the date of his arrival at home shall not be paid until such arrival and then 
only upon such properly executed and signed vouchers as may be required 
the Insular Auditor; and 

Resolved further, That should Dr. Burdette accept this proposition the Insular 
Auditor is hereby directed to make proper settlement with him from t 
general purpose appropriation in accordance with this resolution. 



II 



H 



Later the matter was reconsidered and on December 20, 1906, the 
following resolution was adopted: 



J 



Whereas there has been submitted to the Philippine Commission the nomii 
tion of Dr. Benjamin L. Burdette for appointment as district health officer in 
the Bureau of Health at a salary of ?3,600 per annum; and ■■ 

Whereas the Commission, by its resolution of December 6, 1906, refused 'flll 
confirm said nomination on the grounds that the person involved had been 
brought from the United States without proper authority, and while there_ 
were eligibles for said position on the eligible list of the Bureau of Ci^ 
Service; and 

Whereas it is the desire of the Acting Secretary of the Interior that the Coi 
mission reconsider its resolution of December 6, 1906, rejecting the nomination 
Dr. Burdette as above stated: Now, therefore, be it 

Resolved, That it view of the expenditures already made and the obligation^ 
already incurred by bringing Dr. Benjamin L. Burdette to these Islands from 
the United States, and in view of the further fact that after exhausting the 
present list of eligibles it will still be necessary, in the opinion of the Director 
of Health and the Acting Secretary of the Interior, to fill two additional vacancies 
now existing in the corps of district health officers, the said resolution of the 
Commission of December 6, 1906, be, and the same is hereby, revoked, and the 



ere 

\ 



-II 



107 

nomination of Dr. Benjamin L. Burdette to the position of district health officer 
be, and the same is hereby, confirmed; and be it 

Resolved further, That the Director of Health be informed that the nomination 
of Dr. Burdette is confirmed solely on account of the expenditures already made 
and the obligations already incurred in bringing Dr. Burdette to these Islands 
under the circumstances above set forth, and for no other reason, and that the 
action and policy of the Director of Health in bringing from the United States 
a person for appointment as district health officer when one or more persons 
eligible for said position are on the eligible list of the Civil Service Bureau is 
hereby disapproved. 

Eef erring to that portion of the resolution of December 6, 1906, 
which reads : 

Whereas, it appears that on August 20, 1906, Governor-General Ide, without 
reference of the matter to the Commission, telegraphed to Washington requesting 
that Dr. W. S. Washburn, Director of the Philippine Bureau of Civil Service, 
then in Washington, select a qualified person to fill the position of district 
health officer at the salary mentioned, in accordance with which Dr. Washburn 
selected Dr. Burdette, who arrived in Manila on December 3, 1906. 

I find from an examination of the records that prior to this time 
no less than forty-seven officers whose appointment was necessarily made 
by the Governor- General with the approval of the Commission, had 
been brought from the United States without reference of the matter 
to the Commission, and that three such officers, including the present 
Acting Director of Health, and a district health officer, have since been 
so brought. In no other case has such action been criticised or objected 
to by the Commission. 

Referring to that part of the preamble of this same resolution which 
reads : 

Whereas, in view of the fact that the Philippine Commission finds that 
there are available, and were available at the time the telegram was sent to 
the United States for a district health officer, physicians who are eligible for 
appointment under the Civil Service Act and Rules and who it is believed are 
perfectly capable of filling the position of district health officer, it seems to 
the Commission that it would be not only unjust to these men, but contrary to 
the policy of the Government to send to the United States for a person to fill 
such position. 

I have requested from the Director of Civil Service an expression of 
opinion as to whether, in bringing Dr. Burdette to the Philippines, there 
was any violation of the Civil Service Law or Rules or of any precedent 
thereunder, and have received the following reply : 

[First indorsement.] 

The Government of the Philippine Islands, 

Bureau of Civil Service, 

Manila, October 10, 1908. 
Respectfully returned to the honorable the Secretary of the Interior. 
On August 17, 1906, the Director of Health made request on the Bureau of 
Civil Service for the appointment in the United States or one district health 



108 

oflScer at $1,800 per annum. There being but one name on the health officer list' 
of eligibles, to whose appointment objection had been made and sustained in 
accordance with civil-service rules, the request of the Director of Health was 
forwarded through the Secretary of the Interior to the Executive Secretary for 
transmission by cablegram. Cablegram was sent by Governor-General Ide on 
August 20, 1906. Dr. Benjamin L. Burdette was selected for appointment as 
health officer from the United States Civil Service Commission's register of 
eligibles, and on October 6, 1906, he signed the usual contract of appointment 
to the position of district health officer and was provisionally appointed by the 
Chief of the Bureau of Insular Affairs in accordance with specific authority 
contained in cablegram of the Governor-General of August 20, subject to all the 
provisions, requirements, and penalties contained in Act No. 1040. Dr. Burdette 
arrived in the Islands December 3 and reported to the Bureau of Health for 
duty December 4, 1906, and the Governor-General was so advised on that date. 
On December 6, 1906, the Philippine Commission passed a resolution declining 
to confirm his appointment. (See Executive Bureau file 92881.) 

Referring to this resolution, it has not been the uniform practice in making 
appointments in the United States which require confirmation for the Philippine 
Commission to secure such confirmation before the Governor-General cables the 
Bureau of Insular Affairs to make selection and appointment. For example, on 
October 29, 1906, Governor-General Smith without submitting the matter to the 
Commission, on nomination of the Director of Health and concurrence of the 
Bureau of Civil Service, requested the appointment by cablegram of Doctor Zach 
M. Laughlin as health officer at a salary of $1,800 per annum, subject to all 
the provisions, requirements and penalties of Act No. 1040. The questioning of 
the regularity of Dr. Burdette's appointment in the second paragraph of the 
resolution above mentioned is the only instance where the propriety of such 
action by the Governor-General has ever been questioned, so far as I am aware. 

Referring to the third paragraph of this resolution, the Bureau of Civil 
Service having accepted as satisfactory the reasons given by the Director of Health 
for not appointing Dr. William S. Card, the only person whose name was on 
the physician register of eligibles in August, 1906, there was nothing in the 
Civil Service Act and Rules and no precedent to prohibit the appointment of an 
eligible in the United States. Paragraph 2, section 2 of Act No. 1487, provides 
that "Any regularly appointed person holding the office of president of a provincial 
board of health at the time of the passage of this act shall be eligible to appoint- 
ment without examination to the position of district health officer during the 
period of two years from the date on which this act becomes eflfective." In this 
law no reference is made to the Civil Service Act; this paragraph does not, in 
terms at least, amend the Civil Service Act; no reference is made to civil service 
examination. The word "examination" therein might be construed to mean an 
examination held by the Director of Health. But if this provision of law was 
amendatory of the Civil Service Act, the mere fact of eligibility for reinstatement 
does not require the appointing officer to make appointment by reinstatement in 
preference to appointment from the register of eligibles. Under the law it 
appears to be entirely discretionary with the appointing officer as to which 
method of filling a position shall be adopted by him. If the provision of section 
2 of Act No. 1487 had been mandatory it would have required the appointment 
of incompetent persons to the position of district health officer. Had the 
Director of Health considered any of those whose appointment was allowable, 
but not mandatory, by law to be competent to intrust with the very serious and 
important work of sanitation in large districts, recommendation would have 
been made for their appointment instead of bringing a health officer from the 
United States. In the exercise of the power conferred on nominating and 



109 

appointing officers they appear to have been governed wholly by the interests of 
the service in bringing health officers from the United States. 

This provision of law (par. 2, sec. 2 of Act No. 1487) was probably repealed 
by Act No. 1698, effective August 31, 1907, but if not repealed it expired by 
limitation on July 1, 1908. Appropriation Act No. 1C79, effective July 1, 1907, 
appears to have re-created the position of medical inspector; since that time the 
appointments as medical inspector of Doctors Henry O. Jones and Alexander S. 
Rochester have been made by the Director of Health and approved by the 
Secretary of the Interior in accord with the Civil Service Act and Rules, no 
confirmation by the Commission being required. 

On December 19, 1906, the Commission reconsidered its resolution of December 
6 and confirmed the appointment of Dr. Burdette by another resolution. The 
action of the Director of Health in requesting the appointment in the United 
States of Doctor Burdette and others ivas perfectly regular and in accord with 
the Civil Service Act and Rules and unth precedents, and in view of the fact that 
it was not iticumhent upon the Director of Health to submit the pi-oposed appoint- 
ments to the Commission for action, it would appear that his action relating 
thereto was in no way blamable. 

The fact should not be overlooked that Doctor Burdette was entitled to 
preference in appointment under the provisions of section 19 of the Civil Service 
Act, he having been honorably discharged from the military service of the United 
States. 

Ten American medical men having a regular status in the Bureau of Health 
have resigned since July 1, 1906, while only four, as stated above, have been 
appointed in the United States since that date. 

W. S. Washbubn, 
Director of Civil Service. 

Eeferring to that portion of the resolution of December 20, 1906, 
which reads as follows : 

Resolved further. That the Director of Health be informed that the nomination 
of Dr. Burdette is confirmed solely on account of the expenditures already made and 
the obligations already incurred in bringing Dr. Burdette to these Islands under 
the circumstances above set forth, and for no other reason, and that the action 
and policy of the Director of Health in bringing from the United States a person 
for appointment as district health officer when one or more persons eligible for 
said position are on the eligible list of the Civil Service Bureau is hereby 
disapproved. 

This is in effect a vote of censure upon the Director of Health for 
an act which was performed, not by him, but by the Governor-General 
of the Philippine Islands. 

Dr. Heiser was, under the law, absolutely without power to appoint 
a district health officer much less could he bring one from the United 
States. The action censured was taken, not by him, but by the Gover- 
nor-General and it was taken with the approval of the Acting Director 
of Civil Service and that of the Secretary of the Interior. If any one 
was to be censured it should, therefore, have been the Governor-General, 
the Secretary of the Interior, and the Acting Director of Civil Service 
rather than the Director of Health who acted in this matter with the 
full approval of all his superiors. 

The Director of Civil Service in the communication above quoted 



110 J 

has clearly set forth the law, the rules and the precedents on this subject. 
Our civil-service system is supposed to be a merit system. I understand 
it to be the duty of the Civil Service Board to keep available the largest 
possible list of highly qualified candidates for positions in which vacan- 
cies exist or are likely to occur and it is required that candidates to 
certified he taken from the toy of this list, not from the bottom. 
Section 1 of rule 5 of the Civil Service Eules reads as follows : 



1 



1. The appointing officer shall make requisition upon Form No. 9 for the names 
of eligibles for the position vacant, specifying the duties of the position, and the 
Board shall certify to said officer from the proper register the three names at 
the head thereof which have not been three times certified to the office or branch of 
the service in which the vacancy exists. 

The resolution of December 20, 1906, in effect served notice on the 
appointing officer that if he did not take his nominees from the eligibles 
who had been at the very foot of a list until the list was completely ex- 
hausted, his appointments would be disapproved. 

The action of the Commission, not being in accordance with the Civil 
Service Law or Eules, was binding on the appointing officer only through 
the fact that through the arbitrary use of the power conferred upon it 
by Act No. 1487, it could approve or disapprove the appointment wA^ 
any district health officer. f | 

It would clearly have been useless to attempt to strengthen the force 
of district health officers of these Islands by bringing appointees from 
the United States after the passage of this resolution and all effort to 
do so was necessarily abandoned for the time. I have not hesitated thus 
frankly to discuss the action of the Commission in this matter for the 
reason that its resolution of December 20, 1906, was given to the public 
press. Had I been in the Philippine Islands at this time I should have 
utilized the same medium for the expression of my views on the subject. 
I am of the opinion that that portion of the Commission resolution of 
December 20, 1906, which censures Dr. Heiser for his action in the 
Burdette case was unjust and should be repealed; and that this resolu- 
tion, with that of December 6, 1906, have combined to discourage and 
drive out of the service efficient American medical officers and to prevent 
the appointment of efficient men in the their places. 

At all events there has been a steady decrease in the number of 
American physicians in the service at Manila from 1902 until the present 
time as the following table will show : 





Physicians. 




Year. 


Amer- 
ican. 

73 
19 
5 


Fili- 
pino. 


Total. 


1902 


9 
5 
2 


82 


1905-6 


24 


1908 _ _... _ 


7 



Ill 

The force of "cholera experts" at Manija (see telegram on p. 115) 
now consists of five Americans and two Filipinos. The following is a 
sample of the urgent calls for assistance that have been receivjed from 
the provinces: 

SuBiGAO, October 21, 1908. 
Shearer, Manila: 

Please advise if launch Bongao has orders to proceed Hinatuan. Letter from 
American teacher reports situation grave municipal officials panic stricken hide 
in houses refuse to issue orders or anything police abandon their posts people 
run away neglecting their sick and refuse to bury the dead. Teacher states has 
taken charge and with aid of club manages to bury dead five or six daily can do 
nothing for sick no medicines no one with knowledge cholera this being first 
appearance in Hinatuan. If can secure Bongao governor doctor and Constabulary 
guard will proceed Hinatuan with supplies and medicine other communication 
four to ten days baroto travel dangerous this season disease also spreading 
dajacent islands answer. 

Graves. 

The reply which we were obliged to send to this communication was : 

Manila, October 21, 1908. 
Graves, Surigao: 

Bongao ordered Hinatuan via Surigao. Doctor Tacloban busy cholera Leyte. 

Carpenter. 

Hinatuan is in a district which has a Filipino district health officer 
of its own and the request in this instance was that the American district 
health officer for Samar and Leyte should proceed to this place. The 
extent to which our "cholera experts" of Manila have been sent into the 
provinces since July, 1906, is shown by the table on page 109. On 
account of the very limited number of these men now in the service 
it is nevertheless usually necessary, as in the present instance, to turn 
a deaf ear to requests like this except when they come from provinces 
in the immediate vicinity of Manila, and even then the sending out of 
any one of the seven men on whom we are forced .to depend in safe- 
guarding the health of that city is often attended with serious risk. 

ATTEMPTS TO SECURE REMEDIAL LEGISLATION. 

The condition above outlined was that which confronted me upon 
return from leave of absence in the United States. Believing it to be 
intolerable, and fraught with the gravest danger I attempted to remedy 
it. The first step in this direction was to recommend to the Commission 
the reestablishment of the office of medical inspector for the employees 
in charge of hospitals or of the sanitation of the city of Manila. This 
recommendation was approved and was made effective in the appropria- 
tion bill for the fiscal year ending June 30, 1908. These positions were 
thus brought again under the control of the Director of Health and the 
Secretary of the Interior and section 1 of Eule 5, of the Civil Service 
Rules, which had in effect been annulled, so far as they were concerned, by 



112 

the resolution of the Commission of December 20, 1906, was again made 
applicable to them. However, the net result has been that of the very- 
limited number of American officers remaining^ in the service on July 
1, 1906, ten have since resigned. Four American medical officers have 
been appointed to positions thus vacated giving a net reduction of six. 

The next step was to secure an amendment to Act No. 1487, authoriz- 
ing the temporary transfer of district health officers upon approval of 
the Governor-General, and there the matter now rests. 

I have no serious objection to the leaving of the establishing of health 
districts w^here it now is, in the hands of the Commission, but do object 
decidedly to that provision of the existing law which makes it necessary 
to secure the approval of the Governor-General before a district health 
officer may be transferred from one district to another even in meeting a 
great emergency. In view of the fact that up to the present time there 
has never been a single instance in which the Governor-General has failed 
to act favorably upon the recommendation of the Director of Health and 
the Secretary of the Interior relative to the temporary transfer of a 
district health officer, it would seem that this restriction is a needless one 
and only results in a waste of time. 

The suggestion is made that the present system for the appointment 
and removal of district health officers, who are immediate subordinates 
of the Director of Health, but who may be appointed and removed onl}' 
by the Governor-General with the approval of the Commission, is noi; 
conducive to good discipline for the reason that the officer directly re- 
sponsible for our health policy and its results is without power to remove 
these subordinates and as this fact is well known to them less attention 
is paid to his instructions in many instances than would otherwise 
accorded to them. 

INSUFFICIENCY OF THE PRESENT FORCE. 

Of the Bureau of Health force regularly employed by the Insular G( 
ernment for work in the city of Manila, Dr. Victor G. Heiser, Director 
of the Bureau, and Dr. A. P. Goff, medical inspector, are absent from the 
Islands and the force actually available for duty is as follows : ^l 

Dr. Allan McLaughlin, Acting Director of Health; ^1 

Dr. H. E. Stafford, in charge of the Civil Hospital ; 

Dr. R. E. L. Newberne, in charge of the insane and lepers at Sm, 
Lazaro Hospital; Jl 

Dr. W. A. Christensen, in charge of the sanitation of Bilibid Prison; 
and Doctors A. S. Rochester, B. J. Burdette, H. 0. Jones, Paul Clements, 
Zach Laughlin, Luis Abella, and S. V. del Rosario, medical inspectors for 



I 



113 

Manila. Leaving out of account the four men whose duties confine them 
strictly to institutions, there are supposedly available for the general 
work of sanitation and the combating of epidemic disease in Manila seven 
men of whom five are Americans and two are Filipinos. 

Manila is a city of some two hundred and thirty thousand inhabitants 
and in order properly to deal with such conditions as existed during the 
last two weeks of September there should be available a force of at least 
fourteen medical inspectors, yet the fact is that not even the very limited 
force above enumerated is ever available for any length of time for the 
•reason that it has proved necessary constantly to strip Manila of its few 
effective men in order that they might perform in the provinces work 
which others are employed to do. 

The following table shows the occasions on which Medical Inspectors 
and Sanitary Inspectors regularly serving in Manila have been ordered 
to the provinces since July 1, 1906 : 



Name of health oflBcer. 



Districts sent to. 



Dates. 



Dr. Luis Abella, M. 



Dr. W4 K. Beattv, M. I .. 
Dr. B. L. Burdette, M. I . 



Dr. Paul Clements, M. I.._ 



Dr. H. W. Eliot, M. I 

Dr. H. O. Jones, M. I 

Dr. Z. Laughlin. M. I 
Dr. S. del Rosario, M. 

Dr. M. C.Terry, M.I 
C. Brantigan, S. I 



O. R. Dexter, S. I 

W. G. Hogle, S. I 

Chas. T. Palmer, S. I - 
Harry Percy, S. I 



Rizal, Cavite, and Bataan_. 

Masbate, Romblon, and Mindoro . 

La Laguna 

La Union, Zambales. 

Rizal, Cavite, and Bataan. 

Pangasinan 

Nueva Ecija. 

La Laguna 

Pangasinan 

Cavite. Rizal, and Bataan. 

Bulaean 

Capiz 

Iloilo 

Rizal, Cavite, and Bataan 

La Union, Zambales 

Pangasinan 

Mountain Province 

Ilocos Norte, Ilocos Sur 

rPangasinan 

«La Union, Zambales 

Iloilo 

Pampanga 

Bulaean 

I Pampanga 

) Nueva Ecija 

Tarlac 

Rizal, Cavite, and Bataan 

Batangas, Tayabas 

Samar. Leyte 

Pampanga 

Bulaean 

Bulaean 

Pangasinan 

La Union, Zambales 

Ilocos Sur, Ilocos Norte 

Occidental Negros 

i Rizal, Cavite, and Bataan 
Masbate, Romblon, and Mindoro 
Rizal, Cavite, and Bataan 
Occidental Negros 

La Union, Zambales 

1 Batangas, Tayabas 
Pangasinan 
Mountain Province 
Batangas, Tayabas 

Benguet 



July 10, Oct. 3, 11)06. 

Aug. 14, Oct 4, 190G. 

June 3, 1907; Jan., 1908. 

Jan., 1908. 

Feb. 24, 25, 1908. 

June 9, Aug, 20, 1908. 

June 11, Aug. 20, 1908. 

July 10-25, 1906. 

June 10-19, 1908. 

July 1, Aug. 21, 1906, 

July 8. 9, 15, 29, 1906, 

Dec, 1906. 

Sept. 12, 1907; Feb. 7, 1908. 

Jan. 4, 5, Mar. 27, 28, 1908. 

July 9-July 31, 1908. 

June 9, 1908. 

Oct. 8, 1908. 

July 25-Sept. 26, 1906. 

June 11-July 9. 1908. 

July 9-Aug. 14, 1908. 

Aug. 13, 1908. 

Oct. 27-Dec. 24, 1906. 

July 2-13, 1906. 

Julv 2-25, 1906. 

July 2, 1906. 

July 2, 1906. 

July 26, 1906. 

July 27-Oct. 1. 1906. 

Aug. 17-Sept. 28. 1907. 

Nov. 15-Dec. 23. 1907. 

Nov. 15, 1907. 

Feb. 3, 1908. 

Feb. 6-Julv 9, 1908. 

Aug. 15, 1908. 

Aug. 15. 1908. 

Nov., 1907. 

Jan. 5-31, 1908. 

Feb. 6-Mar. 31, 1908. 

Mar. 8, 1908. 

May 1, 1908. 

Sept. 10, 1908. 

July21-Sept. 18, 1906. 

July, 1908. 

Oct. 8. 1908. 

Sept. 18-20, 1907. 

July 14-Aug. 20, 1908. 



78079- 



-8 



114 



The force now available for work in the provinces is as follows : 
Dr. J. W. Smith, in charge of the Hospital at Baguio, Benguet ; 
Dr. J. H. Biggar, in charge of the Culion Leper Colony ; 
Dr. B. L. Bunnell, assistant at Culion Leper Colony ; 



and the following district health officers: 



Dr. Arlington Pond; 
Dr. W. K. Beatty; 
Dr. G. J. Cullen; 
Dr. Florentino Ampil; 
Dr. Pablo Araneta; 
Dr. P. Quisumbing; 
Dr. D. Montinola; 
Dr. Felix Bautista; 
Dr. Luis Caballero; 
Dr. Andres Catanjal; 



Dr. Telesforo Ejercito; 
Dr. Mariano Felizardo; 
Dr. V. de Jesus; 
Dr. Jose Mascunana; 
Dr. Candido Mora; 
Dr. Julio Euiz; 
Dr. A. Fernando; 
Dr. B. Torribio; 
Dr. F. Xavier; 
Dr. R. Villafranca. 



Omitting from this list the three men engaged in hospital work there 
remains in the provinces a regular force of three American and seventeen 
Filipino district health officers whose duty it is to bring about and per- 
petuate sanitary conditions among some seven and three-quarters millions 
of Christian and non-Christian inhabitants. 

PRESENT AUTHORIZED FORCE. 

Dr. Heiser inserted in his estimate of the appropriation needed for 
the Bureau of Health a request for the present fiscal year for thirteen 
medical inspectors at 1P4,000 per year each. In the compromise bill 
finally passed by the Assembly and Commission these positions were ic- 
cluded and when they have been filled there will be a fairly adequate 
force available for safeguarding the health of Manila in emergencies, 
while under ordinary circumstances several medical inspectors can be 
assigned to perform special work in the provinces or to assume the regular 
duties of district health officers. 

This fact is of especial importance as the civil service list of Filipino 
eligibles for appointment as district health officers is entirely exhausted 
and with two or three exceptions the salaries now authorized for district 
health officers are not such as to make it possible to secure eligibles from 
the United States. 



SALARIES PAID TO AMERICANS AND TO FILIPINOS. 



I 



Although the contention has sometimes been advanced that the salaries 
paid to American officers of the Bureau of Health were excessive, while 
those paid to Filipinos were inadequate, attention is invited to the fact 
that from December 2, 1901, when the Act providing for the establishing 
of provincial boards of health was passed until the present date, thirt}- 



115 

five American health officers have vohintarily resigned. There is on 
record but one case of a Filipino president of a provincial board of health, 
district health officer, or medical inspector, who has voluntarily resigned 
his position and this man resigned in order to run for governor of his 
province. I do not include as voluntarily resignations those of a few 
men who have endeavored by resigning to escape the necessity for replying 
to charges preferred against them with a view to their removal. Filipino 
district health officers and medical inspectors are in their own country 
where they can live far more economically than can Americans. They 
are without exception receiving salaries greatly in excess of any that were 
obtainable under Spanish rule. That these salaries are sufficient is shown 
by the extreme reluctance of their recipients to be parted from them. 
The inadequacy of the smaller salaries paid to American health officers 
is shown by the fact that men with families can not live upon them and 
in consequence a number of our most efficient medical inspectors have 
been lost to the service. 

CERTAIN DEFICIENCIES OF FILIPINO HEALTH OFFICERS. 

Our Filipino health officers without exception lacked, at the outset, 
the special training required, properly to prepare them for combating 
epidemics and caiTying on general sanitary work. I am glad to be able 
to state that several of them, profiting by the practical instruction that 
they have received in the provinces and in Manila, have become very 
efficient, but many of them when called upon to combat epidemic disease 
have proved completely powerless, as the cholera statistics conclusively 
show. 

Fui-thermore I regret to state that other difficulties have been expe- 
rienced in dealing with not a few of them. Their nature will be ap- 
preciated from the following correspondence : 

A DISTRICT HEALTH OFFICER ASKS FOR ACCRUED LEAVE WHILE FIGHTING 
CHOLERA, WITH NO SUBSTITUTE AVAILABLE. 

[Telegram received. (Translation.)] 

August 30, 1907. Mandaon, via Milagros, August 28, 1907. 
Health, Manila: 

Arrived 27 morning 17 deaths cholera since 9 desjre approval appointment 
sanitary officer authorized province Lucas Lagari came with me. 

Ruiz. 
9.35 a. m., 30th. 



[Telegram received. (Translation.)] 

Mandaon (via Milageos), August 31, 1907. Filed Sept. 1, 1907. 
Health, Manila: 

Days 28 one case one death; 29 no case one death; 30 two cases one death. 
Municipality does not furnish personnel vigilance impossible isolation focus. 

Ruiz. 
1.47 p. 



116 

[Telegram received.] 

Masbate, September 1, 1907. 
Heiser, Manila: 

Found Dr. Ruiz at Mandaon. Seventeen deaths to date. Barrios quarantined 
against center of town. Municipal authorities doing nothing and Ruiz not even 
furnished men to bury dead. Have shaken things up. 

Worcester. 
8.03 a. m. 



Mandaon, Sorsogon, September 11, 1907. 

Ruiz wires: 

"I rectify previous telegram. 811, 920, 1002. Municipality incompetent to 
enforce orders. There was a case yesterday in front presidencia building which 
was secreted until death. I will appreciate help of ten constabulary." 



[Telegram received. (Translation.)] 

Mandaon (via Milagros), September 18, 20, 1907. 
Health, Manila: 

16 one case one death 17 two cases one death I continue alone with provincial 
sanitary inspector for all work infected houses without guard. The quarantined 
go out for their needs. Not possible thus to localize the evil. Labors in vain. 
President does what possible but there are no people even to get water for 
disinfections. Councilors little active. If situation continues fatigue will over- 
come us. Order necessary obliging people voluntarily to aid. No one wants 
to; if they come, they soon make away. 

Ruiz. 



[Telegram received. (Translation.)] 

Sept. 24, 1907. Mandaon (via Milagros), Sept. 23, 1907. 
Health, Manila: 

18 one one. 19 two zero. Twenty two one. 21 two one. 22 nothing. Oi 
pump useless. Sublimate received is powder send tablets. 

Ruiz. 



[Telegram received. (Translation.)] 

Mandaon (via Milagros), Sept. 28-Oct. 2, 1907. 
Health, Manila: 

Five years icithout accumulated leave desire to enjoy it November. For this 
I must embark in Masbate October 16 on the Carmen the only boat ichich irill 
leave there the first. Can bring a relief. Earnestly beg your approval. Aivnit 
reply. Carbolic used up. 

Ruiz. 



117 

[Telegram sent.] ' 

Manila, Oct. 2, 1907. 
!Z, Mandaon, {via Milagros, Mashate) : 
So leave can be granted you until cholera has been completely exterminated. 

Heiseb. 
V >lficial Business. 

Victor G. Heiser, Director of Health. 



October 2, 1907. 
Julio Ruiz, 

i District Health Officer, Mandaon {via Milagros), P. I. 

Sir: I have the honor to acknowledge receipt of your telegram of September 
— \ requesting leave of absence. As this telegram concerned your personal affairs 
has been recommended to the Executive Secretary that payment from provincial 
inds be disapproved. It is not understood why you have not reported the 
holera situation in Mandaon instead of sending a rush telegram at Government 
wpense requesting permission to abandon your duties at a critical time. 
An explanation of your conduct is requested. 
Respectfully, 

[Initialed] V. G. H., Director of Health. 

In this instance the district health officer, Dr. Ruiz, applied for leave 
when combating a serious cholera epidemic with no one available to take 
lis place. The reasons assigned by him for such a course were that the 
necessity of living on chickens and hoiled rice was making him sick 
and that he had long planned to take his vacation at that time. 

DISTRICT HEALTH OPFICER DESERTS HIS POST AT THE LEPER COLONY. 

[Translation.] 

CuLiON, December 6, 1907. 
Director of the Colony. 

Sir: On the 25th of November, 1907, the Director of Health, Dr. Heiser, 
arrived in this colony, with whom I had an opportunity of conferring for the 
purpose of stating to the said doctor, as I did frankly, that it was not suitable 
to me to continue working in this colony for the salary of $1,200 a year and 
of requesting him to allow me to leave Culion the following day on board the 
Basilan, which was the steamer on which the above-mentioned Director of Health 
came, and he replied to me that I should think it over before taking the said 
determination. 

On the night of the said day, November 25, I went aboard the Basilan where 
Dr. Heiser was at the time, to communicate to him my last determination, as 
in fact I did, and which was to take passage on that steamer on the following 
day, because, I again repeated to him, it was detrimental to my interests to 
continue working in Culion for the salary paid me; to which Dr. Heiser replied 
that within ten days subsequent to my departure from Culion he would send 
another physician and that I could take passage on the same steamer on which 
the man who would relieve me was to come. On these conditions I assented to 
stay, continuing to render my services in the hospital of this colony, to the detri- 
ment of my interests on account of my being unable to leave Culion at once. 



118 

On this date, December 6, 1907, the ten days have elapsed within which 
Dr. Heiser promised me he would send a man to relieve me, and the latter not 
having arrived in this colony, I am of the opinion that from this date, the 6th, 
I am relieved from responsibility and from the services that I am rendering in 
the liospital of this capital, and I beg you, Mr. Director, kindly to take charge of 
this hospital from this date, for, in order not to continue harming my interests, 
it is my determination to depart from Culion on the first favorable opportunity 
that presents itself, to go to Manila where my wife, moreover, is in quite delicate 
health. 

Very respectfully, D. Montinola, 

District Health Officer. 
[First indorsement.] 

Culion Leper Colony Division, 

Culion, P. I., December 6, 1907. 
Respectfully forwarded to the Director of Health. 

After repeated conversations with Dr. Montinola, since the recent visit of the 
Director of Health to this colony, regarding the matter of the within communica- 
tion, he leaves his assignment here against my protest, and without permission, 
or being relieved by the Director of Health, this to the prejudice of the service. 
Dr. Montinola's services here have been exceedingly satisfactoiy, and it is with 
regret that it becomes necessary to report this insubordination, 

J. H. BiGGAR. 

Chief, Culion Leper Colony Divisi 



[Second indorsement.] 



sion« 



Manila, P. I., December 12, 1907. 

Respectfully forwarded to the honorable the Secretary of the Interior, through 
the Director of Civil Service, inviting attention to within communication and to 
the preceding indorsement. 

It is true that on November 25 the Director of Health stated to Dr. Montinola 
that he would send someone to relieve him on the first boat that sailed from 
Manila to Culion. In view of the fact that no boat has left Manila for Culion 
since this statement was made to Dr. Montinola, it is evident that he left before 
he knew whether the Director of Health would keep his promise. As a matter 
of fact, the services of Dr. G. L. Bunnell were secured, and he was actually await- 
ing transportation to Culion at the time that Dr. Montinola left. 

It might be further stated that prior to the occurrence of the foregoing incident, 
it was well known to the Director of Health that Dr. Montinola did not care to 
serve at Culion, and on this account every reasonable efi'ort was made to secure 
the services of a competent Filipino physician. Several such men accepted the 
nomination, but when the day came for the vessel to sail for Culion, they. declined 
to go. In view of these circumstances, over which the Director of Health had no 
control, the wish of Dr. Montinola that he be relieved from duty at Culion 
immediately could not be complied with. 

It is ordinarily 7iot considered very creditable for even a layman to leave a 
position of confidence and trust toithout giving adequate notice in advance; but 
it is absolutely inexcusable for a medical man to leave his post of duty, and more 
especially when by so doing he deserts a number of poor, sick unfortunates, loho 
are dependent upon him for medical care and attention. Moreover such conduct 
is a serious breach of professional etiquette. 



119 

!n view of the foregoing, it is evident that disciplinary measures are urgently 
lomanded, and therefore the undersigned recommends that one month's accrued 
ta\e be deducted from any accrued leave which may be due Dr. Montinola, and, 
!i addition, he be considered off duty without pay from the time he left Culion 
iiitil he is assigned to another station, and that no traveling expenses be allowed 

i since he left Culion. 

Victor G. Heiser, Director of Health. 



Manila, P. I., Deoemher 26, 1907. 
)i. D. Montinola, District of Health Ofjficer, Manila. 

Sir: You are hereby informed that your action in leaving the Culion leper 
3olony without permission, thereby deserting a number of sick patients of which 
70U had medical care, is considered to be a most disgraceful act and one which 
should have merited your removal from the service; but in view of your satisfac- 
tory work at Culion prior to this occurrence, I have to inform you that you will 
be given an opportunity to redeem yourself. But so flagrant a violation of pro- 
fessional conduct can not be passed by without necessary disciplinary measures, 
so that you are respectfully informed that the Director of Civil Service and 
the undersigned have recommended, and the honorable the Secretary of the 
Interior has approved, that you be granted no accrued leave of absence for any 
service prior to the time of your leaving Culion, or, in lieu thereof, that you be 
fined one month's pay, and in addition, that you receive no salary from the time 
you left Culion until you reported at your new station, and that you be not 
allowed any traveling expenses in the meantime. 

Letter directing you to your new station is forwarded herewith. 
Very respectfully, 

[Initialed] V. G. H., Director of Health. 

In this case District Health Officer Montinola, who had become panic- 
stricken from being among lepers at the Culion Hospital, deserted his 
post, leaving the hospital full of sick persons when there was not suf- 
ficient help available to give them proper attention after his departure. 

A CHOLERA EXPERT REQUESTED WHEN THE REGULAR DISTRICT HEALTH 
OFFICER WAS ON DUTY. 

[Telegram received.] 

Manila, April 23, 1908. 
Heiseb, Baguio: 

Following telegram received from provgov Capiz quote. Proboard believes 
services cholera expert necessary prevent general epidemic municipality Sapian 
forty cases twenty-nine deaths Ivisan twenty-two cases twenty deaths Capiz 
three cases two deaths. Take up with bureau health. End quote. 

Carpenter. 



April 28, 1908. 
Sir: I have the honor to quote for your information and such other action 
as you may deem necessary the following telegram just received from the 
provincial governor of Capiz, in reply to one sent to him inquiring as to whether 



120 



} 



the district health officer is unable to handle the cholera situation in the 
province in view of the request for a cholera expert: 

"[Translation.] 

"We are satisfied work health officer, but in agreement with him request chc 
expert to assist him same as other years." 

Very respectfully, F. W. Carpenter, 

Executive Secretat 
To the DiRECTOB of Health, Manila. 

[First indorsement.] 

Bureau of Health, 
Manila, P. /., April 29, 1908. 
Respectfully returned to the Executive Secretary, with the information that 
on April 26, 1908, District Health Officer Araneta was directed to proceed to 
Capiz to aid in the eradication of cholera from that place. 

Victor G. Heiser, Director of Health. 



Manila, P. I., June 5, 1908. 
The District Health Officer, Capiz, Capiz. 

Sir: It has been noted with each report that cholera still exists in your 
province and that the average number of cases reported daily in the town of 
Capiz has not varied for many weeks- An explanation is requested as to AAhy 
a more effective campaign against this disease can not be inaugurated. It 
would seem that, with the large number of men and funds at your disposal, 
better results should have been obtained to date. 
Very respectfully, 

[Initialed] V. G. H., Director of Health. 

A DISTRICT HEALTH OFFICER REFUSES TO OBEY AN ORDER TO GO TO, 
CHOLERA-SMITTEN TOWN, BECAUSE HE HAS THE ITCH. 

[Telegram sent.] 

Manila, January 17, 190^] 
Dr. Ejercito, San Fernando, Union: 

Governor Zambales reports cholera San Narciso. Proceed immediately take 
charge situation. Answer. 

Heiser, 



[Telegram received. (Translation.)] 

San Fernando, Union, January 11, 1908, 
Health, Manila: 

Am sick. Impossible for me to travel. 

Ejebcito. 



[Telegram sent.] 

Manila, January 22, 1908. 
Dr. Ejercito, San Fernando, Union: 
When will you be ready for duty? 

Heiser. 



121 

[Telegram received. (Translation.)] 

San Fernando, Union, January 23, 1908. 
)njKCTOB Health, Manila: 
Have itch; am making house my office. Shall advise when cured. 

Ejebcito. 

Comment on the action of a district health officer who refused to obey 
irders to proceed to a cholera infected town because he had the itch would 
eem to be entirely superfluous. 

?HE "delicate health" OF A DISTRICT HEALTH OFFICER INTERFERES 
WITH THE DISCHARGE OF HIS DUTIES. 

Manila, P. I., August 27, 1908. 
)r. Felix Bautista, Malolos, Bulacan. 

Sir: With regard to the matter of suppressing cholera in the Province of 
Bulacan, I have the honor to request that you employ a sufficient number of 
lanitary inspectors to accomplish this object. The provincial board has been, 
nstructed by the Executive Secretary to furnish you every assistance. 

I wish also to emphasize the necessity of impressing upon the municipal 
jresidents that any work done by the provincial inspectors is to be considered 
is a reenforcement of the work already being done by the municipal authorities; 
n other words, the municipal authorities are to continue to do all they are 
low doing, and even after the disappearance of cholera in their municipalities, 
hey must not relax their vigilance until all possibilities of reinfection have 
lisappeared. 

Very respectfully, 

[Initialed] A. J. McL., Acting Director of Health. 



Department of the Interior, 
Bureau of Health for the Philippine Islands. 

[Telegram sent.] 

ISIanila, September 8, 1908. 
Bautista, Malolos: 

Valuable time lost. Employ authorized sanitary inspectors immediately. Place 
:en Obando. Inspect each house every day. Find all live cases. You must stop 
'urther infection. Has Obando pumps and disinfectants. Your province worse 
han before. Waste no more time. Acknowledge. 

McLaughlin. 
Official business: 

A. J. McLaughlin, Acting Director of Health. 
Office Mail. Copy. 



[Translation.] 

The Provincial Government of Bulacan, 

Malolos, P. I., September 8, 1908. 
Sir: I have the honor to acknowledge receipt of your telegram received at 
:his hour, 3.50 p. m., and to inform you that already ten sanitary inspectors 
tave been assigned to Obando who will be inspecting that pueblo daily which has 



122 



I 



been divided into ten districts, one for each of the said inspectors. There is a 
large quantity of disinfectants and only a pump is needed which several weeks 
ago was ordered from the provincial treasurer; however, the lack of the pump 
has been made up for by another means. 

Rest easy that I will do all that is possible to the end that the infection in 
this province disappear within a brief space of time so that your desire may 
be obtained or realized even at the sacrifice of my delicate health. 
Very respectfully, 

FiiLix Bautista, 
Chief District Sanitary Inspector, Malolos, Bulacan. 
Hon. Acting Director of Health, Manila, P. I. 



Manila, P. I., September 9, 1908. 
The District Health Officer, Malolos, Bulacan. 

Sir: In reply to your letter of September 8 in which you speak of sacrificing 
your delicate health, you are directed to inform, this office immediately if your 
delicate health prevents the performance of your full duty, impairs your ef- 
ficiency, or is responsible for the prolonged existence of cholera in Bulacan 
Province. If you are unable to display the activity and energy necessary at 
this time, you should wire this office immediately in order that a man who is 
able to display the required amount of activity and energy may be sent in your 
stead. 

Very respectfully, A. J. Mc.L., | 

Acting Director of Healtt 

A DISTRICT HEALTH OFICER DESERTS HIS POST UPON THE APPEARANt 

OF CHOLERA. 



[Telegram received. (Translation.)] 

Tagudin, September 2, 19 



J 



Health, Manila: 

My wife seriously ill Cervantes would like to attend her. Cholera up to 
present 2 and 0. 

Crisologo^ 

4.50 p. m. 



[Telegram sent.] 

Manila, September S, 19 



A 



Crisologo, Tagudin, Ilocos Sur: 

Who is in charge of cholera work Tagudin. Maintain quarantine trails from 
Ilocos to Cervantes. Proceed Cervantes if doctor in Tagudin. 

McLaughlin. 
Official business: 

Myron H. Chandler, Chief, Clerical Division. 



[Telegram received.] 

Cervantes, September 4, 1908. 
Health, Manila: 

Sanitarios only are in charge of cholera work. 

Crisologo. 



123 

[Telegram sent.] 

Manila, September ^,1908. 
^OLOGO, Cervantes: 

5y what authority did you leave Tagudin. Return immediately take charge 
lora. 

McLaughlin. 
MFicial business: 

A. J. McLaughlin, Acting Director of Health. 



[Telegram received.] 

Tagudin, September 4, 1908. 
vLTH, Manila: 

Ivequest American doctor for Amburayan. Three townships report cholera, 
vincial doctor in Cervantes, no medicine. 

Lt. Grovemor Evans. 
11.48 a.'m. 

[Telegram sent.] 

Manila, September 4, 1908. 

vNS, Tagudin: 

Trodoctor left Tagudin without authority. Ordered return immediately. 

McLaughlin. 
Official business: 

A. J. McLaughlin, Acting Director of Health. 



[Telegram received at Manila, P. I, Rush.] 

Tagudin, September 5, 1908. 
A.CTING DiBECTOK HEALTH, Manila: 

Think you had better send someone here immediately to assist Lieutenant- 
Governor Evans in keeping cholera from spreading to Igorot barrio. Your 
liealth officer here is perfectly worthless and has abandoned his post and gone 
bo Cervantes. Suspend your health officer here and inform him that I will im- 
mediately prefer charges against him requesting his removal for cause. 

Worcester. 
8.59 a. m. 



[Telegram sent.] 

Manila, September 5, 1908. 
Cbisologo, Cervantes, Lepanto-Bontoo : 

You are suspended from duty pending immediate charges by Secretary of the 
Interior requesting removal for cause. 

McLaughlin. 

Official business: 

Myron H. Chandler, Chief, Clerical Division. 



124 

[Telegram received.] 

Cervantes, September 5, 1908. 
Health, Manila: 

Leave immediately for Tagudin. 

Crisologo. 
9.55 a. m. 

In this instance the district health officer made a false statement as to 
the cholera situation and then deserted his post without waiting for a 
reply from Manila. \^^iile it is true that his wife was ill her condition 
was not such as to justify this action on his part, 

A DISTRICT HEALTH OFFICER WHO DID HIS DUTY. 

Over against such conduct as that of this* man I take pleasure in 
placing that of Dr. Candido Mora who, although in danger of losing the 
sight of one eye for lack of the necessary surgical attention, and wretchedly 
ill from another cause, stuck to his post without complaint or request for 
relief until ten days after the occurrence of the last case of cholera in 
his district. On the strength of his record he will be promoted to a 
position as medical inspector. 



A DISTRICT PIEALTH OFFICER FOREGOES TAKING LEAVE IN ORDER TO 

FIGHT CHOLERA. 



i 



•ai 



Dr. Vicente de Jesus had come to Manila with the expectation of goi 
on leave at the time the cholera situation in Pangasinan became critic r 
He was sent first to that province and subsequently to other provin 
where emergencies existed and has performed cheerfully, faithfully, and 
efficiently the services asked of him although this special work has taken 
him outside of his health district and l^as occupied time which he liad 
planned to spend in another way. 



SUMMARY OF THE SITUATION AS REGARDS FILIPINO DISTRICT HEALTH 

OFFICERS. 



J 



When properly trained, Filipino district health officers have an i 
mense advantage over Americans on account of the familiarity which they 
usually possess with the language, customs, and peculiarities of the people 
among whom their work must be carried on. In general, however, it must 
be said, that with individual exceptions, they are deficient in energy, ex 
utive ability and in a proper sense of devotion to duty. Many of thcni 
are strongly inclined to interest tliemselves in politics to the great dotii- 
ment of their work and most of them are disinclined to obey ord 
promptly and cheerfully if directed to proceed to some province more or 
less remote from that in which they happen to wish to reside. In not a 
few instances they have displayed signal cowardice when confronted with 
epidemics of contagious disease. 

Since Dr. Montinola fled, panic-stricken, from Jiis post it has proved 



125 

impracticable to find a single Filipino physician willing to accept appoint- 
ment at the Culion leper colony and to continue to serve his own country- 
men there. The work for lepers at this place is performed exclusively by 
American physicians and hospital stewards, Spanish and American Jesuit 
priests and French Sisters of Charity. 

I believe that the young men now being trained in medicine and 
surgery at the Philippine Medical College and at the University of Santo 
Tomas will be not only far better equipped as regards technical train- 
ing than are most of our present district health officers but imbued 
witli a proper sense of the responsibility to the sick and to the public 
at large which necessarily rests upon those to whom is given the right 
to practice medicine and surgery. These young men should be given 
practical experience at Manila in sanitary work as a part of their regular 
course of study. Upon their graduation they should be appointed as 
sanitary inspectors or municipal health officers and after having gained 
the necessary practical experience should be given an opportunity to 
display executive ability. Those who demonstrate that they possess it 
should be promoted to more responsible positions as rapidly as vacancies 
occur. In this way we may hope ultimately to build up a thoroughly 
efficient force. 

Let it not be imagined that this belief is idle optimism. I base it, in 
a large measure, on the admirable spirit shown by the students from the 
Philippine Medical College and from Santo Tomas University and on 
that displayed by the four young Filipina nurses from the Normal School, 
who volunteered for duty at the San Lazaro cholera hospital and who, 
with the dead and dying all about them, rendered cooly and efficiently 
disgusting services for which money could not adequately pay them, 
in the full knowledge that the least carelessness or neglect in the matter 
of disinfecting their own persons would be likely promptly to change 
their status from that of cholera attendants to that of cholera patients! 

I do not need to be told how these young men and women performed 
their work because I watched them not only by day, when they knew that 
they were under observation, but in the small hours of the night when tliey 
could have had no knowledge of my presence. 

Among the many pitiful and tragic scenes impressed upon my mind 
is that presented by a poor old wreck of a beggar woman delirous and 
constantly starting up and trying to leave her bed but calmed, restrained 
and made to lie down again by a Filipino boy of excellent family who 
treated her as gently and considerately as if she had been his own motlier. 

The young men and women who did this work showed that spirit of 
self-sacrifice and devotion to duty which Americans are accustomed to 
associate with the practice of the professions of physician and nurse. 
When to the spirit already displayed by these young men and women 
there have been added the necessary years of instruction and experience, 



126 



then and not until then will it be possible to discontinue the bringing oi 
physicians and nurses from the United States to perform the worjj 
imposed by law and by duty upon the Bureau of Health. 

WHAT THE BUREAU OF HEALTH HAS ACCOMPLISHED AND WHAT IT ILig 
FAILED TO ACCOMPLISH. 

The force of health officers heretofore available has proved sufficient 
rapidly to push through three great sanitary reforms, namely the complete 
elimination of bubonic plague from the Philippine Islands, the rapid' 
segregation of lepers and the vaccination of almost the entire population 
of the Islands against smallpox. The practical results of the latter work 
are exemplified if we compare the deaths from smallpox at Manila for tlie 
past six years with those which occurred from 1891 to 1896, inclusive: 



1891 
1892 
1893 
1894 
1895 
1896 



Deaths. 

. 359 

51 

. 863 

. 926 

13 

488 



Total 2,700 



1903 
1904 
1905 
1906 
1907 
1908 



Deaths. 
23 



Total 



-> 

1 

116 

176 



The figures for the period from 1891 to 1896 are taken from t le 
church statistics for a part of the city of Manila only and are therefore 
not complete. 

The force available has furthermore been able to prevent any geneial 
epidemic of cholera in Manila but it has proved grossly inadequate 
materially to improve other sanitary conditions in the provinces or effect- 
ively to prevent the spread of cholera there. In the effort to strengthen 
the provincial force and to meet disastrous conditions in the provinces 
Manila has again and again been stripped of its available men witli 
the result that cholera has for brief periods become epidemic and has 
then been brought under control only by the most strenuous efforts on the 
part of a force wearied almost to the point of collapse by the uphill 
struggle in the provinces, aided by every other man who could be obtained 
from any source whatsoever. 

THE SCANTY FORCE OF THE BUREAU OF HEALTH MAKES IT NECESSARY TO 
CALL ON OTHER BUREAUS FOR PHYSICIANS. 

During the present epidemic it has been necessary to call on the Bureau 
of Science and the Philippine Medical School for reenforcements. 

ASSIGNMENT OF BUREAU OF SCIENCE MEN. 

Dr. Richard P. Strong, Director of the Biological Laboratory, was 
assigned as attending physician at the Mary J. Johnston Hospital, used 
for cholera cases. 



127 

Doctors Oscar TeaguQ and Fred B. Bowman were assigned to duty at 
the same institution. 

Dr. Vernon L. Andrews was assigned to duty at San Lazaro Hospital 
las was Mr. N. T. Clegg. 

ASSIGNMENT OF PHILIPPINE MEDICAL SCHOOL MEN. 

Dr. Philip K. Oilman, in charge of the San Lazaro cholera hospital. 
Dr. Potencio Guazon, on duty at the San Lazaro cholera hospital. 
Dr. Ariston Bautista-Lin, on duty in the afternoons at the San Lazaro 
cholera hospital. 

RESULTING INTERRUPTIONS TO WORK. 

Wliile under the circumstances it was fortunate that the Bureau of 
I Health could draw on the Bureau of Science and the Philippine Medical 
[School for experts at this time it is greatly to be regretted that it was 
necessary to do so. 

The interruption to the work of the Medical School was perhaps, on 
the whole, not serious as the young men sent to the hospital had an 
opportunity while there to gain valuable practical experience, but the 
calling away from the regular work of the laboratory of practically the 
entire force was greatly to be regretted as there have arisen in connection 
with this epidemic biological problems of great importance which de- 
manded immediate investigation. 

THE DISCOVERY OF BACILLI CARRIERS AT MANILA DURING THE 
EPIDEMIC OF 1908. 

The not infrequent occurrence of cases of cholera in Bilibid Prison 
when every possible precaution had been taken to safeguard the food and 
drink of the prisoners, led to the suspicion that there might be persons 
who were infected with cholera vibrios without being ill and that they 
were disseminating infection which was proving fatal to others. By 
direction of the Acting Director of Health, two hundred and sixty-four 
convicts were accordingly examined with the result that cholera vibrios 
were found in the stools of seventeen of them. These organisms were 
typical and were conclusively demonstrated to be virulent. 

Similar examination of three hundred and seventy-six residents of 
Meisic, one of the worst infected districts of the city, showed cholera 
vibrios present in twenty-seven, or 7.18 per cent, of the cases. Here then 
was a hidden source of active infection beyond the reach of disinfectants. 
It should have been possible to put a large part of the force of the Bio- 
logical Laboratory on the work of discovering these bacilli carriers so that 
they might be treated until they were freed from cholera vibrios, and to 
the end that the question of whether the lack of symptoms of cholera in 
such cases is due to natural immunity to the disease or to the swallow- 
bag of attenuated cholera organisms which have become virulent in 



128 



I 



passing through the intestines. It is feared that by the time the labora- 
tory force can be spared from other and more immediately pressing work 
for this investigation, the opportunity for it will have passed through the 
disappearance of the material, as happened in Germany. 

IS CHOLERA ENDEMIC IN THE PHILIPPINES ? 

In view of the established facts we must admit not only that it is but 
that it has long been so. I have already had occasion to refer to the 
Memoir of Dr. Francisco Masip y Vails which was written in 1889 but 
was not published until 1896 and even then appeared with a preface 
entitled "Informe Sobre Esta Obra Emitido por la Universidad de Ma- 
nila/^ in which the medical faculty of that institution severely criticise 
the able author and rather fiercely attack some of his conclusions which 
in point of fact were unassailable. Among other statements Dr. Masip 
y Vails makes the following: 

Previous to our being so fortunate — or unfortunate — as to be eyewitnesses of 
the ravages of cholera morbus in the Philippine Islands, we eluded with well- 
founded prudence the admission of a certain belief regarding its pathogenesis; 
but now we should proceed in quite a different manner in judging the data and 
facts regarding which we can give full evidence, inasmuch as the culminating 
events which developed in our sight, all authorize us to declare that the epidemic 
which occurred in the pueblo of Taytay, in the District of Morong, in the year 
1883, and which did not spread beyond the confines of that locality, was due to 
the revivication of the germs of the epidemic that had been general throughout 
the Archipelago during the preceding year, just as cholera morbus of 1888 was 
generated at Taytay under identical conditions and spread forthwith from this^ 
center of infection to other places in these Islands which suffered from the disc 
in an endemo-epidemic form. 

With regard to this country, we can state that the sanitary conditions of 
town of Taytay are of the worst possible and therefore are of the most favorable 
in order that, as Dr. Marchal said in 1866, "the specific cause of cholera, which 
dwells in the malarial maisma exclusively, raised to its highest potency, may live 
in it like ferments, and, like them, multiply and develope." (Marchal, Lettres 
et prepositions sur le cholera, 1866.) Taytay is situate in a depression, bounded 
on one side by the Antipolo Mountains and on the other by the immense lake 
called the "Laguna de Bay," near the place where it drains into the Pasig River, 
a stream as muddy as the Nile, the Ganges, or the Mississippi. The soil of the 
town and its surroundings is made up of alluvial deposits which are exceedin; ' 
favorable to all sorts of organic fermentations of a putrid character when 
periodical inundations increase the foul growths. It has been at all times a 
permanent dumping-place for filth and animal and vegetable offals, the refuse 
of human life, which has the privilege of converting the soil into a focus of 
deleterious emanations that maintain proteiform intoxication in an endemo- 
epidemic form in that region. On the other hand, the inhabitants are exceedingly 
poverty stricken and dirty, are very poorly nourished, and use brackish water which 
they get from ill-conditioned and worse kept wells. In some parts of the town 
proper the people live too close together and their traditional indolence and 
apathy does not permit of tlieir having any other occupation than that of doing 
nothing. 

f 



tins 

% 

'■ thel 




129 



To conclude: I maintain my belief that the cholera has been and can hr 
generated in the Philippine Islands by importation, but it can also orij^inato - 
and actually has originated — in this very soil, which we may call a secondary focus 
of the Asiatic cholera morbus. I base this opinion on the fact that it has already 
been demonstrated that soil like that of Taytay is capable of sustaining and prop- 
agating morbid causes analogous to those proper and peculiar to the places bathed 
by the Cambodia and, we might even say, to the rectangle formed in the Sunder- 
bunds by the great rivers Brahmaputra and Ganges. 

Interesting confirmation of the belief of Dr. Ma,<3ip y Vails that cholera 
originated at Taytay in 1883 and 1888 is furnished, so far at least as 
concerns the latter epidemic, by certain newspaper criticisms. The press 
of that period contended, as did the press in 1902, that the "prevail- 
ing ailment" could not be cholera, a reason assigned being that its 
spread was less rapid and the mortality lower than had been the case 
during previous epidemics of cholera in the Philippines and in Europe; 
another was that some of the sick had fever while others were cold when 
they died; and finally it was said "a disease which had its origin in the 
midst of an interior province, the District of Morong, without direct 
communication with any marine port can not be cholera because no one 
could have transported germs thither from without, without first leaving 
them in the coast towns." 

Let us remember that the epidemic which is variously stated to have 
begun in 1817, 1819, and 1820 at all events continued during the years 
of 1821-22-23 and 1824; that there were epidemics in 1830, 1842, 
1854, 1863-1864 and 1865, 1882, 1885 and 1888-1889 ; that on one day 
during the epidemic which began in 1882 the number of deaths in Manila 
was 34 times the largest number that has occurred on any one day since 
the American occupation. Eemembering, too, that the reporting of Asiatic 
cholera as such was prohibited during the greater part of the period from 
1883 to 1897, inclusive, let us give due attention to the following table 
showing in summary form the deaths recorded in the churches of a part 
of the territory now constituting the city of Manila, due to cholera or 
to some disease closely resembling it: 



Year. 


Entero- 
colitis 
and 
gastro- 
enteritis. 


Cholera, 


Deaths. 


1883 

1884 


878 

70 

104 

240 


500 
4 
8 
8 


1,378 
74 


1885. __ 


112 


isn; 


248 




394 1 4 
479 ! 133 


39S 




612 




487 
616 
488 
71.5 
708 
665 
954 


595 
6 
2 



1 


1,082 


I^'s' 


622 


IS.'i 


490 


is<i2 _ 


715 


1893 - 


703 


1894 _ „. __ 


665 


1895 


955 


189G 


1,106 : 

791 , 4 


l,10f3 


1897.. . 


795 






Grand total 


8,690 1 1.265 


9,955 






• 





78079- 



Passing over the years from 1898 to 1901, inclusive, during which 
the existence of war, the withdrawal of the Spanish forces and the 
somewhat tardy reoccupation of the territory which they abandoned by 
the American forces, have rendered it impossible to get any record, let us 
remember that cholera in severe epidemic form appeared at Manila on 
March 20, 1902, and that it is known to have continued to occur either in 
Manila or in the provinces ever since except for the period, from March 
23, 1904, to August 20, 1905, and that from April 27 to July 23, 1907. 

Eemembering that it is not certain that the infection of 1902 was 
imported from without; that the 1905 epidemic apparently originated 
in the vicinity of Taytay as did previous epidemics in 1882, 1888 and 
1889, and that the cholera which appeared in the Visayan Islands in 1906 
and that which appeared at Iloilo in September, 1906, and that which 
appeared at Capiz in April, 1908, were never traced to any outside 
source, let us clearly face the inevitable conclusion that cholera has been 
endemic in the Philippines during much, if not all, of the time from 
1882 to the present day, and probably for a much longer period. 

Table showing the total number of cholera cases and deaths since the American 

occupation. 



Epidemic. 



Manila: 

March 20. 1902. to March 23. 1904. 
August 23, 1905, to Marqh 21, 1906 
May 8, 190(;. to November 27, 1906 . 
July 13, 1907, to March 18, 1908 _.. 
June 8, 1908. to October 24, 1908 ._ 



C&ses. 



Deaths. 



Total for Manila 



Provinces: 

March 23. 1902. to March 8, 1904 . 
August 20, 1905, to April 29, 1907. 
July 22, 1907, to October 19, 1908. 



Total for the provinces. 
Total for Manila 



Grand total. 



5,581 






278 






820 






426 




;^(;i 


853 




572 


7,958 


' 


279 


160,638 


lOr. 




13,026 


'. 




21,212 


i; 




194,876 


12.^ 




7,958 


t 




202,834 


13-1 


299 



LITTLE DANGER FEOM CHOLERA TO THOSE WILLING TO TAKE ORDINAR"!^ 

PRECAUTIONS. 

Of the 202,172 cases and 134,102 deaths which have occurred in thsj 
Philippines from cholera since the American occupation only 248 c;i- - 
and 124 deaths have been among Americans and this in spite of the 1; 
that during much of this time there have been a large number of American 
soldiers in the Islands. It would be impossible to give a more conclusive 
demonstration of the fact that both in Manila and the provinces the 
danger of infection with cholera is very slight for persons who are 
willing to take the trouble to observe ordinary precautions. 




131 

SUMMARY AND CONCLUSION. 

i have endeavored to show tliat Asiatic cliolera lias long been endemic 
the Philippine Islands. While this condition of affairs continues it 
1 doubtless from time to time become epidemic. What then are we to 

( limatic and topographical conditions are unquestionably favorable to 
indefinite continuance of endemic cholera, and over climatic conditions 
cast we can exercise no control. 

i'lie ignorance and superstition of the common people and certain of 
r customs, especially that of eating with their fingers, favor the rapid 
ad of cholera when it becomes epidemic. These conditions can be 

Modied only by a patient and persistent educational campaign. 

Fortunately a portion of the public press is disposed actively to aid 
the efforts of the authorities to eradicate cholera. jJVith that portion 
hich through ignorance is earnestly but mistakenly opposing the em- 
ployment of modern sanitary methods an educational campaign will 
tdtimately prove successful, while to that portion which is deliberately 
dcious, which attacks the health officers because it believes such a course 
ikely to be popular, and which plays politics at the expense of the lives 
^f the people whose interests it professes to advocate, the law must be 
applied. 

In order that we may ascertain more definitely what can be done 
toward removing the more or less permanent local sources of infection, 
a careful, patient and exhaustive scientific investigation must be made 
through the joint efforts of the Bureau of Health and the Bureau of 
Science so that we may learn, if possible, to identify cholera organisms 
QO matter what the form which they may assume under varying con- 
ditions oi environment, and being able thus to identify them may find 
the places in which they are lurking even when the disease is not present 
in active form, and may cleanse such places. 

However, there is no reason why we should delay beginning to put our 
house in order pending the result of such investigation. There are to-day 
w^ithin the city limits numerously thickly populated areas of considerable 
extent without streets, drains or any receptacles for human excreta or 
other filth. As a necessary result there exist in these regions thousands 
of seething sinks of fermentation and putrefaction in which we know 
without examination, that cholera germs swarm. Streets must be opened 
into these regions. Public p^il sheds must also be built and those who 
fail to use them must be punished. 

Unsanitary conditions which can be remedied by cleaning out the 
eeteros and constructing drains and ditches to connect with them must 
be dealt with immediately and those which can be remedied only by filling 
must receive attention as rapidly as the condition of the city finances 
will permit. 



132 

[That money may he made available for this work there must he an 
abandonment for the present of expensive projects for beautifying the 
city and there should follow in the immediate future the imposition of 
a reasonable tax upon the private property in the city in order that tltc 
necessary funds may be secured for putting unsanitary districts into 
decent condition. 

Last but by no means least there mu^t he an immediate and radical 
change in the present attitude of the municipal authorities in the matter 
of the enactment and enforcement of the necessary building ordinances 
to compel private individuals to do their share toward improving health 
conditions, or the power to inspect buildings under construction and to 
enforce such ordinances must be talcen from the city and given to the 
Bureau of Health. 

In connection with other scientific investigations, careful bacterio- 
logical examination of the feces of numerous persons not suffering from 
cholera must be made and these examinations must continue during a 
considerable period of time in order that we may ascertain whether 
"bacilli carriers" are to be met with after the cessation of an epidemic 
and to what they owe their immunity to the evil effects of the infection 
which they carry and so readily communicate to others. 

Whether or not we can entirely rid the Philippines of the chole a 
infection which has so long remained endemic in the Islands no one 
can at present say, but certainly no effort to this end should be spared. 
If we do not succeed in accomplishing this we shall inevitably be calhjd 
upon to meet frequently recurring epidemics. Even if we are fortunate 
enough to achieve a result so greatly to be desired there will still remain 
the ever-present possibility that infection will be reintroduced from 
without along one of the now numerous lines of trade which keep us 
in touch with Japan, China, India, Java, Borneo, Australia, New Guinea, 
and Celebes. 

In this connection the experience of Japan is both interesting and 
instructive. I am indebted to Dr. Ohno for the following table showing 
the occurrence of cholera in Japan since 1893 : 

Cases. CaS'2S. 



1893 633 

1894 546 

1895 ! 55,144 

1890 1,481 

1897 894 

1898 055 

1899 829 

1900 378 

1001 101 



1902 13,302 

1903 177 

1904 1 

1905 

1906 

1907 (Aug. to Jan., 1908) 3,208 

Total 77,049 



H 



133 

If, as has been so often stated recently in the public press of Manila, 
the occurrence of a cholera epidemic, witli our present scientific knowl- 
edge of methods for combating the disease, is a crime, crime would seem 
to have been rather prevalent in Japan of late ! When it is remembered 
that climatic conditions in Japan, with its cold winters^ are not such as 
to favor the continued presence of cholera; that it is claimed that the 
infection of each of these outbreaks was brought in from some foreign 
country; that the Japanese are an extraordinarily cleanly people and 
amenable to sanitary regulations and that there exists in Japan a large 
corps of admirably trained and highly efficient medical officers, it is only 
too painfully evident that in the Philippines with their tropical climate 
lying within easy reach of the great disease-breeding centers of popula- 
tion in China we can not hope to escape. 

It has been said that a properly organized and administered Bureau 
of Health would prevent the occurrence of cholera ejndemics. Such a 
contention is absurd. It would be just as logical to maintain that a large, 
brave, well-organized and well-equipped army will certainly protect a 
country from war. It will decrease the probability of war and increase 
the chances of ultimate victory. A well-organized and thoroughly efficient 
health force will decrease the probability of the occurrence of epidemics, 
will shorten their duration when they do occur, and will decrease the 
mortality which they cause, but that is all. We must, therefore, hold 
ourselves always in readiness to deal promptly and effectively with 
cholera epidemics. 

The fundamental principle involved in dealing successfully with them 
is to attack the infection actively the instant it appears. Over and over 
again within the last few years we have dealt wdth first cases, both in 
Manila and in provincial towns, so effectively that there have been no 
subsequent cases; but this can be done only when energetic, capable and 
thoroughly trained men are immediately available. It is self-evident that 
we must organize and maintain an adequate force of such men, and that 
ihis force must, from the nature of its work, be both highly mobile and 
thoroughly disciplined. To this end it should serve under the immediate 
control of the Director of Health and any of its members who, for trivial 
reasons, fail promptly to go where they are sent, or who prove themselves 
to be lacking in initiative and in executive ability to such an extent that 
they can not check cholera under reasonably favorable circumstances, 
should be promptly removed. 

Fortunately, provision has now been made for a force reasonably ade- 
quate to protect Manila, but this force -will be kept constantly on the 
defensive unless the provinces are freed from infection. In my opinion 
there should be in every province at least one really competent district 



134 

health officer selected under civil-service rules and paid from the Insular 
Treasury. 

There should be always on hand, at some convenient central point in 
each province, an adequate supply of disinfectants and spraying pumps 
so that time may not be lost in sending to Manila for such things. Th(} 
additional expense involved in carrying out this program would be insig- 
nificant in comparison with the resulting benefits. 

The less said of the work of our present presidents of municipal boards 
of health the better. They exist in 257 of the 655 municipalities of the 
Philippines, and that is about all. 

Here and there an active and capable president of a municipal board 
of health, supported by a really capable municipal council, has done 
excellent work, but in only too many cases presidents of municipal boards 
of health are neither active nor capable, or when they are possessed of 
these qualities find themselves hopelessly handicapped through lack of 
financial support by the municipal council, or of moral support by the 
municipal president. Furthermore the salaries paid them are often so 
excessively small that it would be unjust to expect them to devote much 
time to their duties. 

A thoroughly capable district health officer can, as a rule, galvanize 
slothful municipal officials into action especially if he has the vigorous 
support of the provincial authorities. Nevertheless the necessity for co; 
petent municipal health officers is too evident to admit of discussion, 
fortunately the problem of providing them involves not only a larg( 
expenditure but another serious difficulty arising from the lack of an; 
thing like a sufficient number of competent and available physicians. 
I It was to help meet this lack that the Philippine Medical School was 
established. Within a few years graduates from this school will begin to 
become available. The medical course at the University of Santo Tomas 
is now being rapidly improved, and to this institution we may also 
look in the future for capable, energetic and thoroughly trained yo 
physicians. 

Thus we shall ultimately develop an adequate force of competent men, 
but while this development is in progress we must, so far as practicable, 
utilize the services of men who may prove to be reasonably competent in 
spite of their lack of technical training. In my opinion it is useless 
expect the municipalities, especially those of the third and fourth classec-, 
to pay salaries adequate to secure the services of such men, and it would 
seem entirely obvious that if the Insular Government is to pay theii 
salaries it should control their appointment, their assignment to dui 
and their removal. 

In some instances provincial municipalities are so near each other, or 
have such good facilities for intercommunication, that one capable munic 
ipal health officer might well have charge of two or even three of them. 



rO(5 * 



11 



I 



d 



135 

Provision should be made for an adequate number of iminicipal health 
officers at reasonable salanes. They should be selected under civil-service 
rules and paid by the Insular Government. Until a sufficient force of 
duly qualified physicians is available the employment as municipal health 
officers of competent men who lack medical training should be authorized. 

The expense involved in this latter reform would be beyond the 
present means of the Insular Government unless there were made a 
material reduction in the expense annually incurred for educational work 
and this would seem highly undesirable. I am of the opinion that the 
present internal-revenue taxes should be increased one-third of one per 
cent, and the ^^l^SOO^OOO of revenue resulting should be made a special 
fund expendable along the lines above indicated for the improvement 
of sanitary conditions in the provinces of the Philippines. Such an 
addition to the taxes at present collected might perfectly well be made 
and would still leave the inhabitants of the Philippine Islands the 
low^est taxed civilized people of the world. Our present per capita 
tax is but ^3.82 per year as compared with ^7.17 for Turkey, f*=9.97 
for Bulgaria, ^10.11 for Servia, ^11.56 for Greece, ^12.56 for Swit- 
zerland, ^12.61 for Japan, TU.dl for the United States, ^16.33 for 
Roumania, ^16.62 for Denmark, ^17.14 for the Russian Empire, ^19.29 
for Sweden, ^19.94 for Germany, ^21.33 for Norway, ^21.37 for Spain, 
^21.40 for Portugal, ^22.29 for Italy, ?=22.86 for Hungry, P24.40 
for Netherlands, ^35.14 for Great Britain, ^35.22 for Austria, and 
^36.64 for Belgium. 

In closing I wish to express my very sincere thanks to Archbishop 
Harty and Father Chouza for making it possible for me to secure 
statistics from the church records of Manila without which this report 
would have been very incomplete. 



Respectfully submitted. 



To the Philippine Commission, 

Manila P. I. 



Dean C. Worcester, 

Secretary of the Interior. 



APPENDIX TO A HISTORY 01- ASIATIC CHOLERA IN 
PHILIPPINE ISLANDS. 



GE>fTLEMEN : The original edition of my special report to you, entitled, 
"A History of Asiatic Cholera in the Philippine Islands," was exhausted 
without supplying the demand for it, so that its republication lias become 
necessary. 

In republishing it I have improved the opportunity to correct some 
errors which crept" into statistical tables. It has, furthermore, seemed 
advisable to me to add an appendix bringing the report up to date. 
Indeed I deem this essential, for the reason that an opinion of the At- 
torney-General, rendered at the request of the Acting Insular Auditor, 
has been used in such a way as to obfuscate one of the most important 
questions which has been at issue between the Municipal Board and the 
Bureau of Health, and to mislead the public. 

THE OPINION OF THE ATTORNEY-GENERAL RELATIVE TO THE POWER OF 
THE CITY OF MANILA TO COMPEL PRIVATE 0V7NERS TO FILL AND DRAIN 
THEIR LOTS AND AS TO THE COURSE WHICH SHOULD BE PURSUED BY THE 
DIRECTOR OF HEALTH IN ABATING NUISANCES. 

The following correspondence shows how this opinion came to be ren- 
dered. It will be noted that the problem which resulted in eliciting it was 
a drainage problem pure and simple, and that the general question of 
nuisances and the manner in which they might be abated did not enter 
into it, except that the Acting Insular Auditor in his seventh indorse- 
ment, under date of December 17, 1908, asked — 

"whether the property owners can be compelled by process of law to make this 
necessary improvement which appears to be in the nature of an abatement of a 
nuisance so far as the improvements are on the lands of such property holders. 
Where the improvements lie in the street it is admitted that it should be done 
by and at the expense of the city." 

Manila, October SO, 1908. 
The Acting Director of Health, Manila. 

Sir: In compliance with your instructions calling for a preliminary report 
upon the project for the correction of insanitary conditions in the barrio of Santa 
Monica, Tondo, I have the honor to submit the following. 

The barrio of Santa Monica extends from Calle Azcarraga, near the present 
Manila railroad station, a distance of some 1,200 meters. As the larger part of 
the barrio is in a district where light-material construction is permitted, most 
of the houses are of this nature. The elevation of the road or street from 

137 



138 



I 



era 

1^ 



Azcarraga into the barrio varies from 1.72 meters to 1.91 meters. The general 
elevation of the land on either side, on which houses have been constructed, varies 
from 1.2 meters to 1.4 meters, showing that the land is from 1.4 meters to 2 meters 
above mean low tide and from 0.7 meter to 1.3 meters above high tide. 

A sketch is submitted, from which it will be seen that Estero de la Rei 
suitable for diainage purposes is adjacent to this barrio. There is a long slue 
at the upper end of the barrio which is particularly objectionable, and which it 
is believed is the principal feature which it is desired to modify in the contemplated 
improvements. The natural drainage is on the side toward the Estero de la 
Reina, the outlet being shown on the map by a dotted blue line. The elevation of 
the slue is 1.1 meters above datum. 

The simplest solution for the correction of this insanitary feature is that the 
slue be drained by means of a large ditch, having a width on top of about 2 meters, 
with depth of about 1 meter, or more if necessary, depending upon the slight 
variations of the level of this surface. The side of the ditch should have a pro- 
nounced slope. A simple tide gate should be constructed at the point shown on 
the map. 

An examination of the sketch shows that about 1,200 meters of ditch at the 
upper end should be built. In addition to this 2,000 more meters of ditch with 
another 800 meters to connect with the estero should be built to drain both sides 
of the main street of Santa Monica. 

The cost is estimated as follows : 

1,200 meters of ditch ( Santa Monica-Palumpong system ) , 

1,200 cubic meters, at ^l ?1,200.00 

2,800 lineal meters of ditch ( Santa Monica-street system ) , 

2,000, cubic meters, at P=l 2,000.00 

1 tide gate at point shown on sketch 100.00 

Ten lo-inch tile culverts, at ?50 500.00 

20 per cent for contingencies 760.00 

Total 4,560.00 

The above is based upon the following assumptions: 

All tools or other equipment or material temporarily used on the work to be 
furnished by the municipality without being charged to the work. 

All engineering service and general supervision, with the exception of the 
immediate foremen regularly detailed on the word, to be furnished by the munic- 
ipality without being charged to the work. 

Coincident with the above there should be a definite street system decided upon 
for this locality and laid out and permanently monumented by the municipality, 
all new construction being made to conform thereto. This, however, will not 
necessarily mean an additional appropriation, as the work can probably be done 
by the regular field and office force out of regular appropriations. In no other 
way can the minor interior drainage of a nipa barrio be readily handled. 

The work should be undertaken by the municipality as an emergency measure 
under the general supervision of the Bureau of Health in accordance with the 
provisions of section 793 of the Revised Ordinances. 

As there are some forty landowners involved in this drainage problem it will 
be impracticable to expect the work to be done by private owners. 
Very respectfully, 

G. II. GUEBDRUM, 

Chief, Division of Sanitary Engineering. 



139 

[First indorsement.] 

Department op the Interiob, Bureau of Health, 

Manila, P. I., November 19, 1908. 
Respectfully forwarded to the lionorable the Secretary of the Interior. 
It is urgently recommended that provisions be made for the execution of the 
drainage as recommended in the within report, at a cost of f*=4,G50. 

For a system of streets and alleys, it is urged that the Municipal Board have 
plans prepared for a complete system covering the entire territory from Calle 
Morriones to Calle Solis, and from the Estero de la Reina to Estero de San Lftzaro. 

A. J. McLaughlin, 
Acting Director of Health, 
G. H. G. 
[Second indorsement.] 

The Government of the Philippine Islands, 

Department of the Interior, 

Manila, November 2It, 1908. 
Respectfully referred, through the honorable the Grovernor-General, to the 
Municipal Board, recommending tliat serious consideration be given to this project, 
which the undersigned understands has been investigated and approved by Major 
Case as a feasible and comparatively inexpensive method of improving the sanitary 
condition of this district which is at present exceptionally bad. 

Dean C. Worcester, 
Secretary of the Interior. 
[Third indorsement.] 

The Government of the Philippine Islands, 

Executive Bureau, 

December 1, 1908. 
Respectfully referred to Municipal Board, Manila, inviting attention to second 
indorsement. Prompt return of these papers is requested with report of action 
taken. 

James F. Smith, Oovemor-Oeneral. 

[Fourth indorsement.] 

City of Manila, ;Municipal Board, 

December 3, 1908. 
Respectfully referred to the city engineer for recommendation. 
By direction of the Board : 

H. L. Fischer, Secretary. 
[Fifth indorsement.] 

Department of Engineering and Public Works, 

Manila, December IJf, 190S. 
Respectfully returned to the secretary. Municipal Board, recommending that the 
work herein laid down by the Director of Health be immediately undertaken, 
and the unexpended balance of special appropriation for public works, "Dredg- 
ing of esteros — Ordinance 105," be drawn upon for cost of labor and material. 
This balance at present amounts to approximately ?"9,000, and it is believed will 
be sufficient for the work herein specified, and also that desired for the district 
of Ermita, as expressed in your file No. 9476-A2. It is possible that there may 
be some claims for compensation due to occupation of private property, but as 



140 

the land actually required for that purpose is very small in extent, it is believed 
that the charges to this account, if any, will be slight. 

It is respectfully recommended that the sanitary engineer be requested to show, 
in detail, the proposed construction of tide gate, and its location. 

W. P. Wylie, City Engineer. 

[Sixth indorsement.] _J 

City of Manila, Municipal Board, 1| 

December 15, 1908. 

Respectfully returned to the Insular Auditor, inviting his attention to the 

fact that a large part of this work will probably be done on property not owned 

by the city, and requesting his approval to the use of unexpended moneys in the 

cholera emergency fund for this purpose. 

By direction of the Board: 



H. L. Fischer, Secretar 



[Seventh indorsement.] 



I 

8Mt 



Bureau of Audits, 
Manila, December 17, 1908' 
Respectfully forwarded to the Attorney-General for advisory opinion whether 
the property owners can not be compelled by process of law to make this neces- 
sary improvement which appears to be in the nature of an abatement of a 
nuisance so far as the improvements are on the land of such property holders. 
Where the improvements lie in the street it is admitted they should be done 
by and at the expense of the city. 

Prompt return of this paper is requested, 

W. H. Clarke, Acting Atiditor. 

[Eighth indorsement] ^fl 

Manila, P. I., December 24, 1908. ^ 
Sir: It appears from the correspondence accompanying your indorsement of 
December 17, 1908, that certain real estate of private o^vnership in the city of 
Manila is in a highly insanitary condition and that the municipal authorities 
desire to have the same remedied. The Muncipal Board requests your approval 
of the use of unexpended moneys in the cholera emergency fund for this purpose, 
and you request an advisory opinion as to whether the property owners can not 
be compelled to make the necessary improvement at their owm expense. 

There is no question that lot owners may be constitutionally required to 
drain and fill up their lots at their own expense and that the power may be 
delegated to the municipal authorities. Legislation of this character is sustained 
as a legitimate exercise of the police power for preservation of the public health. 
In order, however, for a municipality to exercise this power it must be clearly 
and unquestionably conferred. (City of Rochester vs. Simpson, 31 S. E., 
821; City of Lawrence vs. Webster, 46 N. E., 123; Bliss vs. Kraus, 16 Ohio 
Stat., 55; City Council of City of Charleston vs. Werner, 17 S. E., 33.) Said 
power is clearly conferred upon municipalities organized under Act 82 in section 
39 (n) as follows: The municipal council shall — 

"require any land or building which is in an insanitary condition to be cleansed 

at the expense of the owner or tenant, and, upon failure to comply with such 

an order, have the work done and assess the expense upon the land or building." 

/ find, hoxcevcr, upon examining the Charter of Manila as amended that no 



I 141 

k power is given to said city, and I therefore advise you that the city of 

nila has not the power to do this work at the expense of the owners of the 

perty. I think, however, that the desired result may be obtained by another 

I hod. Act 1150 as amended makes the Bureau of Health the local Board of 

alth for the city of Manila and gives it power to draft, for enactmeht by the 

nicipal Board, health ordinances for said city. Section 3 (r) of said Act 

powers the Board to provide in the ordinances so drafted by them "declaration, 

luition, and prohibition of nuisances dangerous to the public health." This, 

said Bureau of Health has done in the Sanitary Code of Manila, which was 

!y enacted by the Municipal Board and is found in the Revised Ordinances 

ui .said city. Section 809 {h) of the Revised Ordinances of said city declares as 

a nuisance — 

"any accumulation or deposit of stagnant water, sullage water, manure, house 
refuse, or other matter, wherever situated, which is unhealthful or obnoxious." 
Section 810 of said ordinances provides, among other things: 
'"No owner or occupant or other person in charge of any lot, tenement house, 
premises or building, or other place whatsoever, shall allow or permit any 
nuisance to exist in such lot, tenement house, premises, building or other 
place * * *." 

Section 813 of said ordinances provides: 

"Any person in the city of Manila who shall violate any section or part 
thereof of this title or of title fourteen of chapter seventeen hereof or any regula- 
tion made in accordance therewith may be proceeded against as prescribed by the 
provisions of section five of Act Numbered Eleven hundred and fifty of the Phil- 
ippine Commission." 

Section 814 of said ordinances provides for a fine of not more than P^200 or 
by imprisonment for not more than six months, or by both such fine and im- 
prisonment, in the discretion of the court, for each offense, upon conviction of 
the violation of any of the aforesaid sanitary provisions. 

Section 5 of Act No. 1150 referred to in section 813 of the aforesaid municipal 
ordinances provides as follow^s: 

"The Director of Health, or any health officer duly appointed by him, is 
empowered, and it shall be his duty, to make complaint under oath in w^riting 
against any person violating any health ordinance before the municipal court 
of Manila, and it shall be the duty of that court to issue a warrant for the 
arrest of such person so complained of, and when arrested to try him as in other 
cases of violations of city ordinances: Provided, That nothing herein contained 
shall be construed as preventing any municipal oflGicer or any person from also 
making such complaint." 

It is within the power and clearly the duty of the Director of Health to 
notify the owners of the property in question of the maintenance by them of the 
said nuisance thereon and requiring that they shall, within the time and 
manner specified in the notice, abate the same, and should such property owners 
neglect or fail to so do, they are then subject to prosecution for the maintenance 
of said nuisance in the manner provided in the provisions of law hereinbefore 
quoted, and, as the nuisance is a continuing one, the owners may be repeatedly 
prosecuted and fined or imprisoned, or both, urjtil they shall have complied 
with the requirements of the orders of the Bureau of Health in the premises. 
Very respectfully, 

Ignacio Villamob, Attorney-General. 
Acting Insular Auditor, Manila. 



142 

[Ninth indorsement.] 

Executive Bureau, 
Manila, January I4, 1909. 
Respectfully returned to the Municipal Board, inviting attention to indorsement 
of this date from this office on Executive Bureau file No. 76352-A44, Municipal 
Board file No. 9476-A2. 

Please advise the approximate cost of securing the street areas and rights 
of way for the drainage described in the within report. 

James F. Smith, Governor-General 

This opinion, which was rendered during my absence from Manila on 
a long inspection trip, appeared in the public press under such headlines 
as the following : 

"The Municipal Board is entirely sustained. — Attoi;ney-General renders decision 
against the Secretary of the Interior and Director of Health. — City can not im- 
prove low areas and unsanitary gi'ound of private owners at public expense." 

It was furthermore promptly made use of by the Municipal Board in 
throwing responsibility for the continuance of the existence of low-lying 
and unsanitary premises upon the Director of Health, for in a letter 
dated January 4, 1909, the secretary of the Municipal Board advanced the 
following extraordinary contention : 

"That by sections 809 {h) and 813 above cited, which were drafted and 
proposed by the Bureau of Health, approved by the honorable the Secretary of the 
Interior and passed by the Board in accordance with Act 1150, the power and 
duty of enforcing the filling in of low lying insanitary premises is placed upon 
the Bureau of Health." 

In point of fact the sections referred to are not designed to have any- 
thing to do with the filling in of lowlands, which subject is fully covered 
by sections 790, 791, 792, and 793, and the Municipal Board, in author- 
izing the making of such a statement, acted as if it were in ignorance 
of its own ordinances, which expressly impose this obligation upon the 
city engineer. 



THE FAILURE OF THE ATTORNEY-GENERAL TO CONSIDER CERTAIN PRO- 
VISIONS OP LAW IN RENDERING HIS OPINION. 

Upon reading the opinion of the Attorne3'-General I was amazed to 
find that it omitted all mention of tlie existing provisions of law which 
bear directly upon the subject under consideration, namely, the filling and 
draining of lowlands ; that it expressly made the extraordinary statement 
that the power to require lot owners to drain and fill up their lots at their 
own expense had not been conferred upon the city of Manila, and that in 
outlining a procedure which might be followed in dealing with insanitary 
conditions in low and undraincd lands, it cited only certain provisions of 
law which hy indirection might be made applicable. 

An occurrence of this sort admits of but two explanations. Either the 
person who prepared the opinion was ignorant of the law or he chose to 



143 



iniore it. Adopting the fonner of these explanations as the true one, 
• Idressed to the Attorney-General the following letter: 

"February a, 1909. 

lO Honorable, 

the Attorney-General, Manila. 
Sir: I note that at the request of the Auditor you have rendered an opinion 

[vr date of December 24, 1908, in response to a request from the Acting Auditor 
for information as to whether the private owners of certain real estate in the 
city of Manila, which is in a highly unsanitary condition, can be compelled to 
make the necessary improvement at their own expense. 

"This opinion appears to have been requested by the Auditor for the reason 
that the Municipal Board had requested his approval of the use of unexpended 
moneys in the cholera emergency fund for improving the sanitary conditions of 
this real estate. 

"You find that the power to require any land or building, which is in an 
unsanitary condition, to be cleansed at the expense of the owner or tenant, and 
upon failure to comply with such an order have the work done and assess the 
expense upon the land or building, is explicitly conferred upon municipalities 
organized under Act 82, by paragraph (n) of section 39 of said Act, but that upon 
examining the Charter of the city of Manila as amended it appears that no such 
power is therein given to said city and have therefore advised the Auditor that 
the city of Manila has not the power to do this work at the expense of the owners 
of the property. 

"You have expressed the further opinion that the desired result may be 
obtained in another way, namely, by having the Director of Health declare the 
property in question to be a nuisance and require that it be abated. In the event 
that property owners neglect or fail to comply with such orders of the Director 
of Health, you invite attention to the fact that they may be prosecuted and that 
as the nuisance is a continuing one they may be repeatedly prosecuted and fined 
or imprisoned, or both, imtil they have complied with the orders of the Bureau 
of Health in the premises. 

"As a matter of fact the method of reaching these cases suggested by you is 
one that has long been followed by the Director of Health in dealing with them 
and it certainly affords one way out of the difficulty. 

"Your opinion has, however, been understood to apply, and has been quoted 
in the public press as if it did apply, to the specific unsanitary conditions arising 
in low and poorly drained lands. In point of fact this particular question is 
one of the two important questions relative to the avoiding and remedying of 
unsanitary conditions which are now pending between the Bureau of Health and 
the Municipal Board and I understand that the ruling requested of the Auditor 
was in connection with contemplated improvements on such lands. 

"Inviting your attention particularly to the provisions of paragrap (s) of 
section 3 of Act 1150, and to section 793 of the Revised Ordinances of the City 
of Manila passed by the Municipal Board in accordance with the provisions of 
said paragraph, I inquire what olficer should, in accordance with said provisions 
of law, call upon and require the owner of any such premises to make the same 
sanitary by filling, draining, etc.? 

"Your opinion is also requested as to whether under authority of the proviso 
of said section the city engineer is authorized himself, or through his agents, to 
remedy such unsanitary conditions and, in the event that he is, who should pay 
for the work ? 



144 

"In this connection attention is invited to the closing provisions of paragraph 
(a) of section 12 of Act 1150, and your opinion is requested as to the bearing of this 
provision upon the general question of who should do the work of the sort 
referred to in said paragraph and who should pay for it, in view of the fact that 
the law requires the plans and estimates of the cost of such sanitary work to be 
submitted to the Municipal Board. 

"Very respectfully, Dean C. Wobcestee, 

"Secretary of the Interior." 

This letter was sent forward with a rush card. Some time having 
elapsed without any response, I took the matter up with the Honorable, 
the Secretary of Finance and Justice, asking him to expedite the render- 
ing of the opinion as much as possible. This he very kindly promised 
to do, but a considerable further period elapsed without any result and I 
took the liberty of bringing the matter to his attention a second time. 

He once more promised to take it up. After further delay I finally 
requested my secretary to see if he could secure action. He called at 
the Attorney-General's office once and telephoned that office three times 
at considerable intervals and was repeatedly assured that the opinion 
would be rendered shortly, but it did not come. 

Finally, on April 1, having waited in vain for -fifty days for an opinion 
on a subject on which the Acting Auditor had been able to secure an 
opinion in seven days and with which the Attorney-General was pre- 
sumably familiar, as he had already given attention it, I addressed a 
letter to the Governor-General calling his attention to my efforts to secure 
an opinion in this matter and to their complete failure; and stating that 
I would, under the circumstances, venture to express my own opinion in 
the premises. 



K 



OPINION OF THE SECRETARY OF THE INTERIOR AS TO THE LAW RELATIVI] 
TO THE CLEANSING, DRAINING OR FILLING OF LOWLANDS. 

This appendix has been completed, except for the opinion of the 
Attorney-General, for many weeks, and I do not feel justified in longer 
delaying its publication. Pursuant to my promise to the Governor- 
General I venture to include, at this point, an expression of my own 
opinion relative to the law as to the cleansing, draining or filling of 
lowlands. I do this with the less hesitation because the law on this 
subject is so explicit that it would really suffice to quote it. There 
little room for difference of opinion as to its provisions.^ 
Paragraph (s) of section 3 of Act 1150 reads as follows : 
"Sec. 3. The ordinances drafted by the Board of Health may provide for : 



I 



"(s) Cleansing, draining or filling of lowlands where such lands are in an 
unsanitary condition and in the opinion of the Board of Health constitute a serious 

* For the Attorney-Generars opinion, finally rendered on April 3 in response 
to my letter of February 9; for his explanation of his extraordinary delay, and 
for further comments by me, see the Addendum at the close of this report. 



145 

menace to piihlic health: Provided, That no order for the cleansing, draining or 
filling in of such lands involving a cost of more than three hundred pesos, Phil- 
ippine currency, shall be effective without the approval of the Secreta.ry of the 
Interior, who may request from the sanitary engineer of the Philippine Islands 
a report as to the cost of cleansing, draining, or filling in any such piece of lowland, 
and the sanitary engineer shall make such report when so requested." 

It should be noted that by subsequent legislation the powers conferred 
by Act No. 1150 upon the Board of Health were transferred to the 
Director of Health. Pursuant thereto the Director of Health prepared 
and submitted certain ordinances on this subject which were duly passed 
by the Municipal Board. They constitute sections 790, 791, 792 and 793 
of the Revised Ordinances of the City of Manila and taken collectively 
make up chapter 80, entitled "The Filling of Lowlands." 

Section 793 reads as follows: 

"Sec. 793. City engineer may abate nuisances. — Where any premises within the 
limits of the city are composed of lowlands, or are so excavated or walled, diked, 
or dammed as to admit or cause the fonnation on the surface thereof of stagnant 
or foul waters which are a nuisance and a menace to the public health, the city 
engineer may call upon and require, subject to the limitations of subsection (s) 
of section three of Act Numbered Eleven hundred and fifty of the Philippine 
Commission, the o^vner of any premises whereon such pools may exist to fill up 
the same with good clean earth or other approved material to the level of the 
surrounding ground, or to drain such pools by means of surface drains into any 
channel with which such surface drains may lawfully communicate, or to cut or 
breach any retaining walls, dike, or dam so that such retained water may have 
free escape: Provided, That whenever the Director of Health shall declare that 
any lowland, marsh, or stagnant pool or pond in the city of Manila is in an 
unsanitary condition and constitutes a serious menace to the public health, the 
city engineer shall take steps to cause the said loiolands, marshes, stagnant pools, 
or ponds to he cleaned, drained, or filled in and the unsanitary conditions removed." 

In other words, the Municipal Board, acting under due authority of 
law conferred by the same legislative body which passed the act to in- 
corporate the city of Manila commonly known as the Manila Charter, 
passed an ordinance providing that, subject to the limitations of sub- 
section (s) of section 3 of Act No. 1150, which are — 

"that no order for the cleansing, draining, or filling in of such lands involving 
a cost of more than three hundred pesos, Philippine currency, shall be effective 
without the approval of the Secretary of the Interior" 

the city engineer may call upon and require the owner of any premises 
whereon pools may exist to fill up the same with good clean earth or other 
approved material, to the level of the surrounding ground, or to drain 
such pools by means of surface drains into any channel with which such 
surface drains may lawfully connect, or to cut or breach any retaining 
walls, dike or dam so that such retained water may have free escape ; and 
providing further, that whenever the Director of Health shall declare 
that any lowland, marsh, stagnant pool or pond in the city of Manila is 
in an unsanitary condition and constitutes a serious menace to the public 
78079 10 



146 

health, the city engineer shall take steps to cause said lowlands, marshes, 
stagnant pools or ponds to be drained or filled in and the unsaniti 
conditions removed. 

'These provisions of law clearly contemplate that action to cause i 
remedying of the unsanitary conditions above enumerated will he taken 
the city engineer and by him alone. The Director of Health is givt 
no status in the matter except that he may declare thai any lowland, 
marsh, stagnant pool or pond in the city of Manila is in an unsanitary 
condition and constitutes a serious menace to the public health, thereby 

IMPOSING UPON THE CITY ENGINEER LEGAL OBLIGATION TO CAUSE THE 

REMOVAL OF THE UNSANITARY CONDITIONS. In other words, wc liavc here 
a consistent carrying out of the policy long since decided upon relative 
to sanitary work in the city of Manila, namely, that the Director of 
Health should decide what was to be done and that the city should do it. 

CRITICISM OF THE ATTORNEY-GENERAL'S OPINION OF DECEMBER 24, 1908. 

Referring now to the opinion of the Attorney-General dated Decem- 
ber 24, 1908, that official found that lot owners may be constitutionally 
required to drain and fill up their lots at their own expense and that the 
power may be delegated to municipal authorities, but that in order that 
they may exercise this authority it must be clearly and unquestionably 
conferred. He states that said power is clearly conferred upon munici- 
palities organized under Act No. 82, by section 39 (n) of said Act, but 
upon examining the Charter of Manila as amended finds that no such 
power is given to said city and therefore concludes that the city of 
Manila has no power to do this work at the expense of the owners of the 
property. 

In rendering this opinion he overlooked or ignored the fact that 
paragraph (s) of Act No. 1150, which, among other things, provides 
for the draiting of sanitary ordinances by the Board of Health and for 
their subsequent enactment by the Municipal Board of the city of Manila, 
explicitly provided for the drafting of ordinances for the cleansing, 
draining or filling in of lowlands; as well as the further fact that such 
ordinances had been drafted by the Director of Health, to whom the 
powers and duties of the former Board of Health had meanwhile been 
transferred, had been duly passed by the Municipal Board and that 
such ordinances explicitly provide that the city engineer may, 
subject to certain limitations, call upon and require the owners 
of lowlands to fill them or drain them; and that v7henever the 
Director of Health shall declare tpiat such lowlands con- 
stitute A serious menace to the public health the city engineer 
shall take steps to cause them to be cleaned, drained or filled in. 

It therefore seems to me that further consideration need not be given 
to the opinion of the Attorney-General that the power of compelling lot 
owners to drain and fill in their lots has not been delegated to the 



147 

municipal authorities and that the city of Manila has not the power to 
do this work at the expense of the owners of the property. 

The Attorney-General recognized as lawful the provisions of Act No. 
1 1150 making the Bureau of Health the local Board of Health for the city 
of Manila and giving it power to draft, for enactment by the Municipal 
! Board, health ordinances for said city. And although he failed to see the 
provisions of paragraph (s) of section 3 of said Act he did not fail to 
note the provisions of paragraph (r) of the same section of the same Act 
which empowers the Board to provide, in the odinances so drafted by 
them, for the "definition, declaration and prohibition of nuisances dan- 
gerous to the public health." 

The Attorney-General further found that the Bureau of Health had 
actually done this and that any accumulation or deposit of stagnant 
water, sullage water, manure, house refuse, or other matter, wherever 
situated, which is unhealtful or obnoxius had, by odinance, been 
declared to be a nuisance, and that it is further provided by ordinance 
that — 

"No owner or occupant or other person in charge of any lot, tenement house, 
premises or building, or other place whatsoever, shall allow or permit any 
nuisance to exist in such lot, tenement house, premises, building or other place" — 

and that under pro\dsions of law mentioned by him, the Director of 
Health or any health officer, duly appointed by him, may make complaint 
against persons violating health ordinances and may bring about their 
conviction and punishment. The Attorney-General further expresses 
the opinion that it is within the power, and is clearly the duty, of the 
Director of Health to notify the owners of the property in question of 
the maintenance by them of the said nuisances thereon, requiring that 
they shall, within a time and in a manner specified within the notice, 
abate the same, and he calls attention to the fact that should property 
owners neglect or fail so to do they are then subject to prosecution and, 
that if the nuisance is a continuing one they may be continually pros- 
ecuted and imprisoned or fined, or both, until they shall have complied 
with the orders of the Bureau of Health in the premises. 

In other words the Attornej^-General finds that the Director of Health, 
having power to act under these conditions, ought to do so. Certainly 
no one can dissent from this conclusion and the last person who would 
desire to do so would be the Director of Health. 

THE DIRECTOR OF HEALTH IN ABATING NUISANCES HAS LONG FOLLOWED 
THE PROCEDURE SUGGESTED BY THE ATTORNEY-GENERAL. 

There is absolutely nothing new in this conclusion of the Attorney- 
General and the method therein suggested by him has been pursued, not 
only in dealing with nuisances dangerous to the public health in general 
but in remedying nuisances due to imperfect drainage or lack of filling. 
This course has been followed not for the reason that it was the one 



148 

contemplated by law, for, as I have shown, it is not, but for the reason 
that experience had demonstrated the inertia of the City Engineer's 
oflSce to be such that it was practically hopeless to look there for remedial 
action, and the Director of Health had been forced to follow the pro- 
cedure outlined by the Attorney-General for the reason that in this way 
only could he get results. 

THE DUTY OF THE CITY ENGINEER. 

Considering the provisions of law overlooked or ignored by the At- 
torney-General in rendering his opinion we are forced to the further 
conclusion that the city engineer who may, under certain conditions 
require the owners of lowland to fill or drain it, also ought to do so; 
this apart from the fact that when such lowlands are declared by the 
Director of Health to constitute a serious menace to the public health 
the duty of taking steps to cause them to be cleaned, drained or filled is 
imposed by law upon the city engineer. 

THE GOVERNOR-GENERAL CALLS CERTAIN FACTS TO THE ATTENTION OP 
THE MUNICIPAL BOARD. 

In this connection attention is invited to the following indorsement 
placed by the Governor-General upon a letter from Mr. P. G. McDonald 
of the Municipal Board, which, with its inclosures, was apparently 
designed to show that the unsanitary condition of the district known 
as Bilibid Viejo had repeatedly been reported to the Bureau of Health 
and that that Bureau was to blame for its not having been put into 
sanitary condition: 

"[Sixth indorsement.] 
• "Executive BureaU; 

"Manila, January 25, 1909. 
"Respectfully returned to the Municipal Board, Manila, calling attention to 
^the fourth indorsement, to a letter of the Acting Director of Health dated 
November 18, 1908, and memorandum of the sanitary engineer. It is impossible 
to drain some of these districts unless streets are put through. Hoio can a prop- 
erty owner he compelled to drain his property if his drains are to pass over the 
private property of his neighbors? The putting through of streets, it seems to me, 
is an absolute prerequisite to the forcing of the majority of property owners to 
drain their property. We can not force the property oicner to an outlay which 
virtu<illy means a confiscation of his property interests. 

"James F. Smith, Oovernor-General." 

A LIMITATION ON THE POWER OF THE SECRETARY OF THE INTERIOR TO 
APPROVE ORDERS FOR THE FILLING OR DRAINAGE OF LOWLANDS. 

In this indorsement the Governor-General calls attention to two points 
of vital importance. The first is that the exercise of the power con- 
ferred upon the city engineer to compel owners to abate this class of 
nuisance must prove abortive unless the city constructs the necessary 
streets with their accompanying drains or at least provides some general 
drainage system. 



i 



\ 



149 

The second is that there is a sharp limitation imposed on the power 
jonferred on the Secretary of the Interior to approve orders for the 
jleansing, drainage or filling in of lowlands by section 3 (s) of Act 
<io. 1150. 

While to an uninformed person such power might seem to be absolute 
;he courts of tha United States have held over and over again that it 
s not, and can not be, absolute, but tliat in exercising it the approving 
iuthority must take into consideration the value of the land and the 
jost of the filling or drainage needed to put it into a sanitary condition, 
and that where such cost would bear an improper proportion to the 
yalue of the land so that it would be unreasonable to expect the owner 
to do the necessary filling or draining to put it into sanitary condition, 
and that compelling him to do so would in effect result in confiscating 
lis property, an order compelling him to fill or drain it can not be 
nforced. This point has been so fully established that it admits of no 
discussion, and the Secretary of the Interior in passing upon orders 
to property owners to fill lowlands has always borne it clearly in mind. 

GENERAL DRAINAGE SYSTEMS MUST BE PROVIDED BY THE CITY. 

It must be clearly remembered that the provisions of law on which 
the Attorney-General based his opinion deal with the sanitation of 
lots, and not with the much larger question of establishing general 
drainage systems, which must of' necessity be installed and maintained 
by the city authorities, and without which many low-lying lots can not be 
made sanitary. 

If the property of a private owner abuts upon a river, estero or other 
natural outlet he may, under the provisions of chapter 80 of the Revised 
Ordinances, be required to drain his premises into such river, estero or 
outlet, but if his premises are not so situated and if, on the contrary, 
his land is surrounded on three sides by the land of other private persons 
and upon the fourth side abuts upon a public street which has no drainage 
facilities he is then absolutely helpless so far as concerns his own efforts, 
for in order to get rid of the drainage from his property he may not 
enter upon the property of his neighbors nor may he construct a drain in 
the street. 

Under such circumstances the digging of ditches on his property would 
simply make additional places of retention for foul water for which there 
would be no outlet, while the filling of his property suflSciently to raise 
it above that of his neighbors might involve a cost which would be 
absolutely prohibitive, and if not, the net result might well be that the 
property of his neighbors would then become low-lying as compared with 
his and would receive and retain the water that ran off his lot, so that 
the general sanitary conditions would remain unimproved. Still worse 
is the predicament of the man whose property is surrounded on four 



150 

sides by the property of other individuals. There is absolutely nothing 
which he can do to get rid of his drainage. It is idle to expect that 
these difficulties will, or can, be overcome through the cooperation of 
private owners. Not only do such owners lack the necessary initiative 
and experience to make it possible for them to establish general drainage 
systems but they usually lack inclination to do it as well. 

A man who owns a dry and sanitary piece of land will, as a rule, 
vigorously resent the running through it of a ditch for the discharge of 
offensive waste from his neighbor's property. Even when the Bureau of 
Health, in dealing with great emergencies such as those presented by 
cholera epidemics, has attempted to cross private property with drainage 
ditches, the owners of such property have frequently entered strong 
protests and such protests have necessarily been sustained not only by 
the Secretary of the Interior but by the Governor-General. Where then 
do we find authority for the construction of general drainage systems for 
the disposition of sewage and surface water? Such authority is vested 
in the city government which also has the power to condemn land through 
the exercise of the right of eminent domain, without which the estab- 
lishing of such systems would he impossible. 

It is the usual practice to combine the -general drainage system of a 
city with its general street system to the end that economy may be secur^ 
through the utilization, for both street and drainage purposes, of s 
land as it may be necessary to condemn. But there is nothing to preven 
a city from condemning land for drainage purposes in regions where it 
is not as yet prepared to construct streets. The streets should, of coure^e, 
follow as soon as possible. 



iredi 

lem^ 



i 



THE STREETS NECESSARY FOR THE SANITATION OF THICKLY SETTLl! 
DISTRICTS MUST BE BUILT BY THE CITY. 

The only system for the disposition of excreta which will be available 
for years to come in many of the unsanitary outlying districts of Manila 
is the pail system. Garbage, too, must be carted away, and this can not 
be done unless there are streets along which carts may be driven. 

DUTIES OF THE CITY RELATIVE TO THE COLLECTION AND DISPOSAL OF 



The city of Manila has further obligations in the matter of improvin in- 
sanitary conditions. Section 7 of Act No. 1150 reads: 

"Sec. 7. Should the Board of Health find that excreta, garbage, refuse, the 
contents of closets, vaults, cesspools, or any other unhealthful or dangerous 
substance is being collected, disposed of, or allowed to accumulate by the city 
authorities in such manner as to endanger the public health, it shall make 
complaint through the Secretary of the Interior to the Municipal Board, and 
should the Municipal Board fail to take seasonable and suitable measures to 
remedy the evil, the Board of Health shall make complaint through the 



151 

retary of the Interior to the Civil Governor, who shall issue to the Munic- 
1 Board such instructions as he may deem necessary in the interest of public 
a 1th." 

While private owners may be expected, and compelled, to place the 
excreta, garbage, refuse, etc., from their premises in the proper receptacles 
and at proper places for collection, it is entirely clear from this section 
that the work of collecting and disposing of such matter is to be performed 
by the city authorities, and that such authorities are not to allow it to 
accumulate in such a manner as to endanger the public health. 

COMPLAINTS AGAINST THE MUNICIPAL BOARD AND THE CITY ENGINEER. 

I will now briefly summarize the complaints made by the Secretary of 
the Interior and by the Director of Health against the Municipal Board 
of Manila and the city engineer, as well as the replies of the latter to sucli 
complaints so far as I am familiar with them. 

First. In certain unsanitary districts of Manila the municipal author- 
ities have persistently neglected or refused to make adequate provision for 
the collection and disposal of excreta, garbage, refuse, etc., by the instal- 
lation of necessary public closets and the construction of necessary streets. 
In reply the city makes the plea that it may not lawfully improve the 
property of private owners. 

While it is doubtless true that the city may not enter upon the property 
of private owners and improve it for the sole benefit of such owners, it 
most certainly may take private property for its own necessary use in the 
performance of the duties imposed upon it by law, and that is precisely 
what we ask it to do. 

In regions where general street and drainage systems have not been 
installed the best effort of private owners to make their premises sanitary 
must be in a large degree fruitless. The reasons why neither the Bureau 
of Health nor private owners can install general street and drainage sys- 
tems are so obvious that I should insult the intelligence of the public 
were I again to enumerate them. If these improvements, so absolutely 
essential to the proper sanitation of the city of Manila, are not made by 
the city authorities they can not and will not be made at all. 

Second. The office of the city engineer, which alone is empowered to 
see to it that building ordinances are complied with has, in a most 
lamentable manner, failed properly to discharge its duties. It has not 
prevented the repair of numerous old nipa buildings, or the erection of 
many new ones within prohibited districts. In many cases it has failed 
to enforce those provisions of the building ordinances which are especially 
designed to insure against the unsanitary conditions directly due to lack 
of light and ventilation. In one instance it has even repealed such a 
provision without consulting the health authorities. In very numerous 
cases it has, in effect, encouraged the evasion of such provisions by writing 



152 






upon the faces of building permits such statements as "jSTot to be used 
for human habitation" with the certain knowledge that the structures 
in question would be used for human habitation immediately upon their 
completion if not before, and when called to task has endeavored to shift 
responsibility to the Director of Health by claiming that if he considers 
the premises unsanitary he had power to require them to be vacated ! 
While this is true, it is also true that it is very bad policy for one branch 
of the government to authorize the erection of a new structure of a certain 
kind and for another branch of the same government promptly to prohibit 
its use for the purposes for which it was obviously intended. 

Third. The worst result of the maladministration of the city engineei-'s 
office is that- we get no general improvement in the sanitary condition 
of the city. The Director of Health may order persons out of unsanitary 
buildings, and he very frequently does so. What happens then? The}- 
flock into other unsanitary buildings and add the evils of overcrowding 
to those which previously existed. This condition will necessarily con- 
tinue until the provisions of the building ordinances are enforced so that 
all new buildings constructed are necessarily sanitary. We shall then 
get suitable structures into which persons driven out of unhealthful ones 
may go. 

The practical working of the present arrangement is as follows : 
The Director of Health discovers a lot of unsanitary nipa shae 
perhaps on the very ground that he ordered cleared a year or two befoi 
He asks the city engineer why the erection of these buildings has betm 
allowed and the latter replies (as he has done over his own signature) 
that he is very sorry but that the force of his office is too small to attend 
to such matters. He adds that if the Director of Health does not con- 
sider these building sanitary he should order their occupants out. This 
the Director of Health does. There ensue the usual delays, petitions to 
the Governor- General and perhaps extensions of time by the municipal 
court. Ultimately the unfortunate occupants are ejected. They then 
take refuge in the houses of "parientes" or friends, and watching their 
opportunity, put up new nipa shacks elsewhere, only too frequent Iv 
within the hard material zone. They are again discovered by the Direc- 
tor of Health and reported to the city engineer who once more is vc: \ 
sorry and politely inquires why the Director of Health does not compel 
them to move out if he deems the buildings unsanitary! So the merry 
round goes on, with the net result that the Director of Health and the 
Municipal court waste their time; that the poorer classes are constantly 
molested, and that no material improvement in the sanitary condition of 
Munila is brought about. What is the remedy for this condition ? In my 
opinion there is but one and it is very simple. The power at present vested 
in the office of the city engineer relative to the enforcement of those provi- 
sions of the building ordinances ivhich have to do with sanitation should 
be taken from that office and vested in the Director of Health who would 



^re\ 



153 

then not only have authority to cause unsanitary buildings to he vacated 

BUT WOULD BE EMPOWERED TO INSIST ON" SANITARY CONSTRUCTION IN 
NEW BUILDINGS. 

It is idle for the city engineer to disclaim responsibility for the erection 
of nipa shacks within the hard-material zone and for the evasions of the 
sanitary provisions of the building ordinances on the ground of the in- 
sufficiency of his force unless he can show that he has earnestly sought to 
secure authorization for the appointment of an adequate force. 

I most earnestly urge upon the Commission the necessity of doing 
away, once for all, with the present delay and inaction in connection with 
the matters just discussed, by vesting all power relative thereto in the 
office of the Director of Health. 

Fourth. In the case of the San Lazaro Estate, where certain streets 
had existed and have been used by the public for years, and where the 
necessary land for others has been cleared and offered to the city, the 
city has persistently refused to construct the necessary streets and drains 
to render possible the establishment of decent sanitary conditions on the 
absurd ground that the streets of this estate, which is in fact a trust 
administered by the Insular Government for the benefit of the public, 
should not be improved by the city since the city may not improve private 
property, and this estate, being the property of the Insular Government, 
is in effect private property ; and is indeed ev^ less entitled to improve- 
ment than ordinary private property for the reason that the government 
does not pay taxes on it ! 

Leaving out of consideration the fact that it is not customary for 
governments to pay taxes on their own property to the municipalities 
in which it happens to be situated, and the further fact that the income 
derived from this particular property is largely expended in caring for 
the insane, the lepers and the victims of other dangerous communicable 
diseases among the inhabitants of the city of Manila, attention is invited 
to the opinion of the former Attorney-General, Sr. Gregorio Araneta, 
which is set forth in full on pages 88 and 89 of the report to which this 
appendix is now added. The Attorney- General makes, among others, the 
following statements : 

"The streets now existing through the San Lazaro Estate are public streets 
belonging, as such, to the city of Manila. 

*»♦*»»• 

"It is, undoubtedly, the duty of the city of Manila to maintain and keep in 
repair any and all public streets within the limits of the city. The fact that a 
street is bordered by lands exempt from taxation does not change the status of 
the street or modify the ■liability of the city in regard to the repair of the same. 

"The fact that the San Lazaro Estate is exempt from taxation and is adminis- 
tered by the Insular Government in no way affects the character of the public 
streets that pass through such estate. These streets belong to the city. They 
were opened and dedicated to the use of the general public of the city of Manila, 
and their use is not confined to the residents and tenants of the San Lazaro Estate. 



154 

The general public uses the streets and have the right, as citizens of the city 
of Manila, to demand that the streets be kept in a reasonable state of repair. 
A public street, even though laid out in a particular locality within the city limits, 
appertains to and is subject to the use of the general public of the city of Manila; 
and it can not be said that the status or condition of a particular public street is 
fixed by the condition of the adjacent property. 

"/ am, therefore, of the opinion that it is the duty of the city of Manila to 
maintain and keep in repair the public streets within the limits of the city of 
Manila, including those public streets which pass through the San Lazaro Estate, 
and that no distinction can or should be made because of the condition of adjacent 
property." 

It might be anticipated that this opinion would have settled the 
matter; but did it? Not at all. It was rendered in response to an 
indorsement dated August 24, 1907. On October 12, 1907, noth' 
having meanwhile been done by the city, the matter was taken up ij ^ 
the Director of Lands in a communication which was forwarded to the 
Municipal Board on October 17, 1907, with the following indorsement : 

"Respectfully referred to the Municipal Board with the request that a con- 
ference be had with the Director of Lands and arrangements made to carry out 
the proposed improvement of the San Lazaro Estate with the least practicable 
delay." 

"James F. Smith, Governor-General." 

On February 6, 1908, the city engineer, W. P. Wylie, in returning ilie 
papers to the Municipal Board, stated : 

*'The chief of the department of sanitation and transportation informs ■" 
that at the present time he can not undertake to carry out the wishes of 
Director of Lands. Estimate will shortly be presented by this department, to 
the Board, for certain work in the street areas in connection with the proposed 
expenditure of funds raised by the extra peso cedula tax." 

Under date of February 8, 1908, the papers were returned to the Gov- 
ernor-General with this statement : 

"The street areas within this zone will receive attention in the near future." 

This was cheering, hut unfortunately the street areas did not receive 
the promised attention and when cholera reappeared in 1908 much of 
this estate was in an indescribable condition of filth as a result of the 
absence of public closets, the impossibility of moving garbage carts over, 
or rather through, the series of bogs and sinkholes which took the place 
of streets, and the complete absence of any general drainage system 
with which the drains of private occupants might connect. The efforts 
at providing drainage which they had made necessarily resulted in the 
formation of unspeakably filthy deposits upon the borders of their several 
holdings. 

When members of the Municipal Board were taken by me to v 
these conditions they renewed their old plea that the estate was G 
ernment property and that for the purposes of the city it must he con- 
sidered private pi'operty which they were not at liberty to improve. Upon 



I 

thi 






I 155 

Imy inquiry if they disputed the correctness of the Attorney-General's 
opinion and defied the Governor-Generars order, they replied to my utter 
aiiiazement that they had never seen the opinion of the Attorney-General 
which, in point of fact, had been promptly forwarded to them when it was 
rendered! 

I thereupon furnished them a copy of it, and the Governor-General 
having approved the expenditure of five thousand pesos for the purpose, 
there was constructed an experimental system of open drains connecting 
with, a neighboring estero. The Director of Lands immediately made 
available ^5,000 for draining the lots in the area covered by this system, 
witli the result that it was promptly brought into decent sanitary condi- 
tion. I believed the matter at last settled. But upon my return from 
a long inspection trip through the provinces what was my surprise to find 
upon my desk the following letter which had been transmitted for my 
information. 

In writing this letter the Governor-General makes no mention of the 
fact that he himself, under date of October 17, 1907, had requested that 
arrangement be made to carry out the proposed improvements on the 
San Lazaro Estate with the least practicable delay and that his request 
had been absolutely ignored for more than one year ! 

Manila, December 23, 190S. 

Gentlemen : I have the honor to acknowledge the receipt of your indorsement 
of December 17 on Executive Bureau file 74400-A31, Municipal Board file 9322-Al, 
in which it is stated, with reference to the improvement of the San Lazaro Estate: 

"III this regard it respectfully adheres to its opinioji frequently expressed that 
lands of the San Lazaro Estate are in the same relation to the city government 
with regard to improvement as those of a private owner." 

It has long since been decided that the position taken by the Municipal Board 
is untenable. The San Lazaro Estate is a trust administered by the Government 
for the benefit of the lepers, who would otherwise be a public charge. Moreover, 
there is not a private property owner in the city of Manila for whom the city 
has not done work in improving streets, by curbing, putting in water service, 
sewer connections, etc., irrespective of whether the property paid taxes or not. 
The city is buying land for streets and then improving them at its own expense. 
Why not accept the gift of streets and improve them in the same manner? This 
matter has been settled by an opinion of the Attorney-General and must bo 
considered a closed incident. The stubbornness of the Municipal Board in refusing 
to follow the opinion of the Attorney-General long since delivered to them, has 
brought upon them criticism which they might very well have escaped, had they 
followed that opinion. 

The Executive recognizes that the Municipal Board has accomplished great 
work in the improvement of the city of Manila and that its sanitary condition 
is immeasurably better now than it was at the time the Municipal Board took 
control. The Board has built new streets, greatly improved the old ones, filled 
in large areas of city lands, made attractive the breathing places of the city, 
installed a new water system, and is about to finish a new sewer system. All 
these things are to the credit of the Board. 

It is not, I think, to the credit of the Board, hoicever, to stand out stubbornly 
against opening up the district of San Lazaro. The streets have been dedicated 



15G 



I 



% 



to the city so far as it is possible for the Insular Government to dedicate them. 
The land for these streets has not cost the municipality one dollar, and the 
failure of the city to improve them or to install proper drainage has brought 
upon the Insular Government and the Municipal Government a burden of expense 
which it is not pleasant to contemplate. To save P 10, 000 or 9^20,000 in drainage 
the Municipal and Insular Governments have been put to an expense of nearly 
^-500,000. 

The adding of a new suburb to the city of Manila is of advantage to the city 
and the failure of the Municipal Board to recognize that fact indicates either 
that it has not considered the advantage of extending residential areas, or that 
it has no sense of proportion. The Executive is compelled to speak plainly on 
this subject and it is hoped that the dissensions between the city of Manila and 
the Bureau of Health will cease and that both of these branches of the Govern- 
ment will set aside their private differences and work together harmoniously for 
the public good. 

Very respectfully, James F. Smith, 

Governor-General. 

To the Municipal Board, Manila, P. I. 

The Governor-General's rebuke to the Municipal Board was admin- 
istered on December 23, 1908, but even this was not enough. Beginning 
with February 10, 1909, there ensued the following correspondence : 

Depaetment of the Interior, Bureau of Lands, 

Manila, February 10, 190i 

The Municipal Board of the City of Manila. 

(Through The Director of Health, Manila.) 

Gentlemen: Complaints are continually being received by me regarding the 
condition of Calle Timbugan, which passes through the San Lazaro Estate. 
These complaints arise from the fact that this street is, during the season of 
high tide, under water at least once and sometimes twice daily. The raising of 
the grade of this street at least to the level of the surrounding territory would 
appear to be a reasonable request of these residents, and it would seem that a 
slight fill along this street could be made without a very large expense. 

I am referring this request through the Director of Health in order that he 
may be advised thereof, as undoubtedly a street which is under water once a day 
through different seasons of the year can hardly be called sanitary, and I therefore 
request that, if possible, the Board take such action as will improve this streei 
at as early a date as possible. 
Very respectfully, 

C. H. Sleeper, Director of Lands. 

[First indorsement.] 

Bureau of Health, 
Manila, P. I., February 17, 1909. 

Respectfully forwarded to the Municipal Board through the honorable th€ 
Secretary of the Interior. 

As the condition of the streets of San Lazaro has repeatedly been brought to 
the attention of the Board both by this Bureau as well as the Bureau of Lands, 
the undersigned can merely forward this communication reiterating previous 
requests and recommendations. 

Special attention may be invited to Calle Timbugan where a drainage ditch 
laid on the correct street line has obstructed a provisional existing roadway and 
thrown the present roadway out on to the soft ground on the side. Calle O'Donnel 



157 

is low and in need of metalling. Calle Felix Huertas between Lope de Vega and 
Ziirbaran has also been moved, by the extension of fences to correct street lines, 
out on to soft ground. Calles San Lazaro and Malabon are in wretched condition. 
However, all streets it may be mentioned should be improved. 

ViCTOE G. Heiseb, Director of Health. 

[Second indorsement] 

Department of the Interior, 
Manila, P. L, February 27, J909. 
Respectfully forwarded to the Hon. James F. Smith, Governor-Qeneral, inviting 
attention to the fact that the assurance given by the Municipal Board on February 
8, 1908, has never been realized and that it is urgently necessary that something 
should be done for the improvement of these streets. 

Dean C. Worcester, 

Secretary of the Interior. 
[Third indorsement.] 

Executive Bureau, 

Manila, March 8, 1909. 
Respectfully referred to the Municipal Board, Manila, requesting an explana- 
tion of the delay and failure to take action on this matter. Prompt return of 
these papers is desired. 

James F. Smith, Governor-General. 

[Fourth indorsement.] 

City of Manila, Municipal Board, Secretary's Office, 

March 9, 1909. 
Respectfully referred to city engineer, inviting attention to preceding indorse- 
ment. 

By direction of the Board : 

H. L. Fischer, Secretary. 
[Fifth indorsement.] 

Department of Engineering and Public Works, 

Office of City Engineer, 

Manila, March 12, 1909. 

Respectfully returned to the secretary of the Municipal Board, inviting 
attention to the following facts relative to the streets in San Lazaro district. 

The Board has never yet authorized the expenditure of funds allotted to this 
department for construction of streets in the San ]L/azaro district, though 
^■65,013. 37 has been spent in maintenance and repairs, and the work recently 
authorized for the laying of a water main will amount to the construction of a 
roadway in a portion of Calle Timbugan. 

In August, 1907 (see Mun. Bd. file 7982), the Board stated its position in a 
letter to the honorable the Secretary of Finance and Justice, in the following 
terms : 

"* * * in view of the fact that no land tax is collected in the estate, it 
does not feel justified in expending taxes collected in other parts of the city to 
repair and drain the streets in the estate." 

Lengthy correspondence ensued, including the opinion of the then Attorney- 
General to the effect that it is the duty of the city of Manila to maintain and 
keep in repair the public streets which pass through the San Lazaro Estate, 
and that no distinction can or should be made because of the condition of adjacent 
property. The city engineer was called upon to furnish an estimate of the cost 



158 

of constructing all the streets in the estate, and two estimates were prepared, one 
to cover the full width of every street in the district; the other to construct 
6-meter roadways throughout the district, with gutters on two streets only. The 
correspondence ended on February 8, 1908, when the papers were returned to the 
Governor-General by the Municipal Board "inviting attention to the preceding 
indorsement, which shows the expense of the requested improvements to be so 
great that the city can not possibly undertake them. The street areas within 
this zone will receive attention in the near future." 

At the time of the discussion hy the Board of the estimates for the current 
fiscal year, in May and June, 1908, the question luas taken up in connection with 
public works, hut no appropriation toas made for the purpose, and the appropria- 
tions as approved hy the honorahle, the Governor-General, made no provision 
for this work. 

Under these circumstances I can not see that the city engineer has any authority 
to expend public funds in the construction of the streets in the San Lazaro 
district, but only for maintenance of the streets already constructed. 

I respectfully invite attention to Municipal Board files 6694, 7982, 8246, 9560, 
and 8756. 

On March 18, 1908, the undersigned was directed to confer with the residents 
of Calle Timbugan with a view to ascertaining to what extent they would assist 
the city in improving the condition of that street. I held more than one interview 
with Mr. Guevara, who represented the petitioners for improvements; but Mr. 
Guevara finally admitted that they could not assist to the extent of more than a 
few pesos, if at all. As the cost of the improvements requested by them ran 
into the thousands of pesos, the matter was dropped. 

' W. P. Wylie, City Engineer. 



[Sixth indorsement.] 






City of Manila, Municipal Board, Secretary's Office, 

March 15, 1909. 
Respectfully returned to His Excellency the Governor-General, inviting attenti 
to the fifth indorsement. 

The city's assurance of February 8, 1908, has been fulfilled to the best of i 
ability in the allotment of street expenses, by giving attention to San Laza; 
street areas to the extent of approximately ^"6,500 during the present fiscal yea; 
in ditching. If the city is to undertake the improvement of the San Laza 
Estate, almost all of the funds available in any one year for street work through 
out the entire city would have to be expended in this district. 
By direction of the Board: 

H. L. Fischer, Secretary. 
[Seventh indorsement.] 

Executive Bureau, 

Manila, March 18, 1909. 
Respectfully returned to the Municipal Board, Manila. I have talked so much 
ahout this sanitary proposition and ahout the necessity of expending money to 
secure sanitation, and have pointed out so frequently that the opening of streets 
is of the very first necessity iji securing sanitation, that I have hecoine tired of 
harping on the subject. I shall mako an inspection of San Lazaro Monday morning 
next at 9.30, in company with the Director of Health. The Municipal Board, if 
it chooses, may send a representative to he present during the inspection. I 
desire to say that if I find San Lazaro in an unsanitary condition or that no attt 
tion has been paid to counsels heretofore given as to street improvemets whl 
should he made, I shall feel myself justified in coming to the conclusion that the 



159 

rpose of the Municipal Board is to obstruct sanitary xoorlc and to bring to 
light all efforts on the part of the Bureau of Health to better health conditions 
one of the three unhealthy districts in the city of Manila. 

James F. Smith, QovernorOeneral. 

[Eighth indorsement.] 

City of Manila, Municipal Board, 

March 2Jf, 1909. 
Respectfully returned to His Excellency the Governor-General. 
The Board believes that after tlie inspection made on March 22, the Governor- 
General is satisfied that the city is proceeding with the improvement of the streets 
of the San Lazaro Estate; and assurance is hereby given that such work will be 
continued as the resources of the city permit. 
By direction of the Board: 

H. L. Fischer, Secretary. 

[Ninth indorsement.] 

Office of the Governor-General of the Philippine Islands, 

Manila, April 8, 1909. 

Respectfully returned to the Municipal Board, Manila. 

It is not expected to run drains into or fill in lots belonging to the San Lazaro 
Estate. That is the duty of the Bureau of Lands. The Bureau must fill in the 
lots which are unsanitary and must bring the drains to the line of the street, 
wliere the city should have drains provided in the streets to carry the water from 
such lots. Where large districts require drainage and there is no outlet for the 
water or drainage, it is the duty of the city to provide streets or ouHcts or to 
condemn a right of way for drainage ditches in such district. It is useless to 
require property otoners to drain their lands lohen no outlet has been provided 
by the city for such drainage: The attention of the Municipal Board is respect- 
fully called to the fact that when streets are established and brought to grade, 
it is the important duty of the city to provide ample and suitable outlets for the 
water, which would otherwise be confined by reason of the raising of the street 
levels. 

In this behalf the attention of the Municipal Board is called to the case of 
Conniff vs. The City and Country of San Francisco (67 Cal., p. 45). 

James F. Smith, Governor-Oeneral. 

In point of fact, at the time of the Governor-GeneraFs visit practically 
nothing had been recently done to improve these streets of this estate 
except to construct certain temporary drains, this latter work having been 
really ordered by the Governor- General after he had been taken by me 
to inspect the shocking conditions on this estate in company with the 
Municipal Board; and having been carried out, not by the city engineer's 
office/but under the direction of the sanitary engineer of the Bureau of 
Health. 

For more than four years earnest efforts have been made by the 
Director of Health, the Director of Lands, and the Secretary of the In- 
terior to persuade the Municipal Board to perform its lawful duty by 
improving the street areas in this thickly settled portion of the city of 
Manila, a duty which should have been performed in any event out of 
due consideration for the inliabitants of this region; a duty the per- 
formance of which was, furthermore, imperatively necessary in order that 



160 

it might be possible to remedy shockingly unsanitary conditions which 
were disastrously affecting the public health of the city. 

Not only has the Board signally failed to discharge its duty relative 
to the improvement of sanitary conditions on the San Lazaro Estate, 
by placing the streets as a whole in such condition that it would be 
possible for vehicles to pass over them during the wet season or by 
discharging its own duty in the matter of the removal of night-soil 
and refuse, but in doing this it has ignored the opinion of the Attorney- 
General as to its duty in the premises and has repeatedly failed to 
comply with the orders of the Governor- General, if requests from the 
Chief Executive are equivalent to orders, and I hold that they are. 

In view of these facts, what is to be expected of this Board in those 
cases where the initiative in the matter of opening streets and building 
drains is left to it, under its general obligation to look after the interests 
of the city? 

EPIDEMICS ARE EXPENSIVE. 

The Municipal Board complains that the proposed improvements 
would cost a lot of money. May I suggest that epidemics also cost 
money? The recent epidemic in Manila cost the Insular Government 
approximately ^203,000 in cash. It cost the city government a large 
additional sum. At what price shall we assess the lives that were lost ; 
the suffering of cholera victims who recovered; the loss to the business 
interests of the city which resulted from marine quarantine and othcjr 
sanitary restrictions, and from the long-continued delay in the landin, 
of the officers and men from the United States battle ship fleet ; and 1 
but not least, the injury to the fair name of Manila through the resultin 
publication to the world of false and misleading statements relative to 
the sanitary conditions prevailing in the city as a whole? 

Gentlemen, the net cost of the last cholera epidemic in Manila, if 
reduced to dollars and cents, would pay for the establishing of all needed 
public closets, the construction of enough streets and drains to make 
possible the sanitation of the thickly settled regions which now lack these 
improvements, and the betterment of many other unsanitary conditions ! 



in^ 

ing' 



A WORD OF WARNING. 



esH 



Remember that cholera has not ceased to prevail in the provinc 
Remember that just as surely as day follows night it will reappear at 
Manila, and that just so surely as we allow existing unsanitary condi- 
tions in the outlying districts of that city to continue so surely will it 
linger, injuring us in the future as it has injured us iii the past ! 

We are now well toward the close of the dry season. What have we 
done to improve conditions and what are we going to do in the few weeks 
that remain until the rains, which may be expected to begin at the latest 
by the middle of June, render further sanitary work difficult ? 



I 



101 
SOME ACTUAL PROGRESS MADE. 

Die first effort toward securing progress, made by the Director of 

;)lth, consisted in forwarding the plans prepared by tlie sanitary 

:ineer for the improvement of some of the worst unsanitary districts 

Manila. Among the more important projects the following may be 

i.jiitioned : 

I One for the correction of unsanitary conditions in the Barrio of Santa 
Monica, Tondo; 

One for the immediate correction of unsanitary conditions in that part of 

iihx bounded b}^ Calles Herran, Georgia, Vermont, Wright, San Andres and 

ota; 

>ne for the drainage of the territory included between Calles Morriones, E. 

la Reina and Manila Bay. 

>o far as appears these projects, prepared and forwarded in accordance 
h the provisions of existing law, have been carefully pigeon-holed by 
I he Municipal Board or have been disposed of by referring them to the 
committee hereinafter mentioned, and may be expected to repose undis- 
turbed for the present unless the Governor-General positively orders 
action upon them. However, some progress has been made. 

APPOINTMENT OF THE SPECIAL COMMITTEE OF CITIZENS AND OFFICIALS. 

On January 6, 1909, the Governor-General issued Executive Order 
No. 3, series of 1909, which reads as follow^s: 

The Government of the Philippine Islands, 

Executive Bureau, 
Manila, January 6, 1900. 
Executive Order No. 3.] 

Felix M. Roxas, president, Municipal Board, city of Manila; James F. Case, 
Director of Public Works; Dr. A. L. McLaughlin, Acting Director of Health; 
W. P. Wylie, city engineer, city of Manila; Enrique Mendiola, member, Munic- 
ipal Board, city of Manila; Dr. Fernando G. Calderon, professor of obstetrics, 
Philippine Medical School; Daniel Earnshaw, jr.; H. L. Heath, and Simon 
Erlanger, are hereby appointed a committee of citizens and officials for the 
pose of making a careful investigation of the following matters, and to 
;...>ke a report thereon to the Governor-General, with recommendations, to wit: 

1. The location and extension of residence districts of the city of Manila 
which are swampy in character or overflowed during the rainy season; 

2. The cost of draining such districts, or if that be impracticable, the cost 
of raising them to a level which will make them sanitary and fit for residence 
purposes ; 

3. The location and extent of areas which are so unsanitary as to make it 
inadvisable that they should continue to be occupied for residence purposes 
until they are drained or filled in; and 

4. Whether the expense of the draining or the filling in of swampy, over- 
flowed or low-lying districts or areas should be paid for by the property owners 
or by the municipal government. In case the expense is to be paid by the 
municipal government, can this expense be met out of current revenues, or will 
it be necessary to impose a special tax for that purpose. 

JAiiKS F. Smith, Oovemor-General. 
78079 11 



162 

On March 8, 1909^ this order was reissued in the following amende( 
form: 

The Government of the Philippine Islands, 

Executive Bureau, 
Manila, March 2, 1009. 
Executive Order No. 14.] 

Executive Order Numbered Three, current series, is hereby amended to reac 
as follows: 

"Felix M. Roxas, president, Municipal Board, city of Manila; James F. Caae 
Director of Public Works; Dr. A. J. McLaughlin, assistant Director of Health 
W. P. Wylie, city engineer, city of Manila; Enrique Mendiola, member, Munic 
ipal Board, city of Manila; Dr. Fernando G. Calderon, professor of obstetrics 
Philippine Medical School; Daniel Earnshaw, jr.; H. L. Health, and Siraor 
Erianger are liereby appointed a committee of citizens and officials for th( 
purpose of making a careful investigation of the following matters, and to make 
a report thereon and on such other matters pertaining to the sanitation of the 
city of Manila as the committee may deem wise to include in its report, to the 
Governor-General, with recommendations, to wit: 

"1. The location and extent of residence districts of the city of Manila which 
are swampy in character or overflowed during the rainy season; 

"2. The cost of draining such districts, or if that be impracticable, the cost of 
raising them to a level which will make them sanitary and fit for residence 
purposes ; 

"3. The location and extent of areas which are so unsanitary as to make itj 
inadvisable that they should continue to be occupied for residence purposes until! 
they are drained or filled in; 

"4. The cutting of streets and alleys through congested unsanitary areas, iind\ 
providing sanitary sites for nipa shack dicellers forced out of the strong material 
districts; and 

"5. Whether the expense of the draining or the filling in of swampy, o 
flowed, or low-lying districts or areas should be paid for by the property owners 
or by the municipal government. In case the expense is to be paid by the 
municipal government, can this expense be met out of current revenues, or \\U\ 
it be necessary to impose a special tax for that purpose." 

Jaj^ies F. Smith, Governor-General. 

The' step thus taken was fraught with great possibilities for good and 
for evil. 

There can be no doubt as to the wisdom of formulating, at the earli 
practicable moment, a comprehensive plan for the sanitary improvem 
of the city of Manila along the lines suggested in this order. In inu 
past I have repeatedly found myself placed in a most embarrassing posi- 
tion in exercising the power of approval or of disapproval of orders 
filling, vested in the Secretary of the Interior by paragraph (s) of section 
3 of Act No. 1150, in such cases as the following: 

A property owner possessed a triangular piece of land surrounded on 
all sides by streets. This land had been reasonably dry and sanitary 
until the city raised the level of three streets which completely enclosed 
it, thereby converting it into a bog hole. There were gutters in th 
streets hut they were of no use to the property owner as the water oh-^' - 



163 

ruitely refused to run uphill into them! The city engineer held that the 
o^\ne^ ought to be compelled to fill his land, while the sanitary engineer 
of the Bureau of Health argued that it was unjust to compel him to 
do so for the reason that the street level had been improperly fixed and 
that if a proper level had been adopted both this and numerous adjacent 
pieces of property could have been rendered dry and sanitary by the 
inexpensive expedient of connecting them with street gutters at a proper 
level, which would in turn have emptied into a neighboring estero. 

Failure of others finally to fix street and drain levels has been made the 
basis of many excuses for doing nothing by the city engineer. In one 
instance during the recent cholera epidemic, when it was imperatively 
necessary immediately to drain an unsanitary area, I asked the city 
engineer whether we could not accomplish the desired result by running a 
ditch some 200 meters long to a neighboring estero. He replied that he 
did not knoAv, as he had been waiting four years for some one to give 
him a line. To run that particular line about sixty minutes! 

THE WORK OF THE SPECIAL COMMITTEE OF CITIZENS AND OFFICIALS. 

The most important act of this committee thus far would seem to 
be set forth in the following communication : 

City of Manila, 
Department of Engineebing and Public Works, 

Office of City Engineer, 

January 15, 1909. 
Sr. Felix Roxas, 
Maj. J. E. Case, ^ 
Mr. H. L. Heath, 

Subcommittee to Special Sanitary Committee, Manila, P. I. 

Gentlemen: At the meeting of the special sanitary committee appointed by 
the Governor-General, held on January 9, 1909, the following resolution was 
passed: 

"Resolved, That the Governor-General be requested to instruct the department 
of engineering and public works to prepare a map of the city of Manila on a large 
scale, showing: 

''All streets and alleys; 

"All esteros with their bottom levels; 

"All land occupied by houses divided into strong material and nipa sections ; 

"All land unoccupied; 

"All sewer lines as will be upon completion of the new^ system; 

"All storm-water lines as will be upon completion of the new system; 

"All water lines as will be upon completion of new system ; 

"All street levels; 

"Six-inch contour lines in red ink, covering all lands within the city not up to 
established city grade lines; 

"Six-inch contour lines in black ink, for all lands up to or above established 
city grade lines; 

"The purpose of this map being for the accurate information of the committee 
in its duties. Upon this map it is the intention of the city to locate. 



164 

"Sanitary areas having bad drainage; 

"Unsanitary areas having bad drainage; 

"Sanitary areas having good drainage; 

"Unsanitary areas having good drainage ; 

"Present ownership of unsanitary areas; 

"Present ownership of sanitary areas; 

"This map to accompany and be a part of the report of this committee wii 
the recommendations to the Governor-General." 

It being the sense of the committee that the foregoing resolution should 
presented in person to the Governor-General, committee consisting of Mr. F. ] 
Roxas, Maj. J. E. Case, and Mr. H. L. Heath, was appointed to present the sai 
in person. 

During the discussion upon the resolution, it appeared that the work specific 
therein would require from six to twelve months for its completion, and that an 
appropriation for this specific purpose will be required to carry out its provisions. 
Respectfully, 

W. P. Wylie, 
Secretary Special Sanitary Committee. 

Copy respectfully furnished Mr. Felix M. Roxas. * 

[First indorsement.] 

Executive Bureau, 

January 20, 1900. i 
Respectfully referred to the Municipal Board of the city of Manila. 
A subcommittee to special sanitary committee has waited upon me with a 
request that certain data, facts, plans, maps and other things be furnished to this 
committee. It sems to me that that which is required by the committee 
necessary for its work. I have some doubt as to whether the six-inch contouiB 
absolutely necessary, but the committee is the better judge of that matter sm 
I am convinced that the committee should be furnished with all that it require 
I am informed by Major Case that ^5,000 will be necessary in order to mak 
surveys, establish grades and determine the levels of esteros, and finish the majH 
required. It is suggested to the Municipal Board that they appropriate at om 
from the cholera fund the sum of ^5,000 for this purpose. 

James F. Smith, Oovernor-Oeneral. 

If this means that the preparation of plans for the sanitary improv( 
ment of the worst districts of the city of Manila are to be delayed froi 
six to twelve months for the completion of a map, then in my opinio* 
this committee will have demonstrated its tremendous potentialities fo 
evil. There are numerous unsanitary areas known to be badly draine< 
and to be susceptible of being well drained. The improvement of sue 
areas by the construction of proper temporary drainage systems coul( 
and should begin at once. Definite plans for such improvement havi 
been prepared by the Sanitary Engineer and submitted to the Muuicipa 
Board. Why should this committee not pass upon them, once for all 
and make such recommendations that the work will begin in the im 
mediate future? 

The whole city of Manila has already been surveyed and resurveyed 
These particular areas have been surveyed again by the sanitary engineer 



165 

Are we now to do additional surveying and map making, which will 
take a period of six to twelve months, and will at the very best carry 
,ns fairly into, the next rainy season, before we make any move toward 
remedying such conditions when they can so readily be remedied at 
comparatively small expense? 

To put the whole matter in a nutshell, if this committee acts promptly 
upon the matters requiring most urgent attention so that work may 
begin, and then devotes itself successfully to the preparation of a general, 
definite and final plan for the sanitary improvement of the city of Manila ' 
it will be an unmixed blessing. If it delays all action for the improve- 
ment of the outlying districts of the city of Manila until six-inch contour 
lines covering all lands in the city of Manila not up to established grade 
have been made it will, in my opinion, be a very great evil. Of what 
immediate importance will it be, in our effort to remedy unsanitary 
conditions in a group of swampy, filthy lots in the city of Manila, if we 
have six-inch contour lines showing the exact location and depth of each 
mud puddle on the property in question when we already know without 
the running of another line that the existing difficulty may be remedied 
if the city will run a main gutter or ditch so that the Director of Health 
may compel private owners to drain their lots into it ? 

COMPLETION OF THE NEW WATERWORKS. 

On November 12, 1908, the new waterworks system for the city of 
Manila was opened. The source from which the city water is now drawn 
is such as to do away, once for all, with the danger of a general infection 
of the water supply ; a menace which of necessity continued to hang over 
us so long as our drinking water was drawn from the Mariquina River 
below the towns of Mariquina, San Mateo, and Montalban. This in itself 
is a long step forward. 

NUMBER OF PUBLIC CLOSETS INCREASED. 

Numerous new public closets have been installed in thickly settled 
districts, for the most part at the cost of the city, although those located 
on the San Lazaro Estate were paid for by the Bureau of Lands. This 
also is a substantial and important improvement. 

UNSANITARY BUILDINGS VACATED OR REMOVED. 

During the period from February, 1908, to February, 1909, the 
Director of Health has issued one hundred and twenty-three orders that 
buildings be vacated or removed, and as a result many of the most 
unsanitary buildings in the city have been done aw^ay with. 



166 

THE EFFORT TO PROVIDE SANITARY BUILDING SITES. 

In the effort to supply land for persons evicted a large tract has beeS 
provided by the Bureau of Lands on the San Lazaro Estate, while another 
was secured on the Hacienda Baclaran by the Acting Director of Health. 

An offer of much-needed land on the Hacienda Santa Mesa was volun- 
tarily made on behalf of the owners of the property and its acceptance w£is 
urged by the Acting Director of Health. The matter was complicated by 
the action of the city engineer, who estimated for the complete construc- 
tion of a city street where only the acceptance of a gratuitiously offered 
right of way was requested, and by the Municipal Board in raising a 
question as to the authority of the agent, to offer the land. 

The importance of the efforts made to assist evicted persons in securing 
proper sites for their future homes can hardly be overestimated. I have 
always contended that it was well-nigh useless to drive people out of 
unsanitary structures as long as some effort was not made at the same time 
to aid them to secure sanitary sites, and unless they were compelled in 
rebuilding to erect sanitary structures. 

As long ago as 1902 the then existing Board of Health urged the city 
authorities to interest themselves in the construction, on city or Insular 
Government land, of sanitary tenements for the poor. It demonstrated 
that if such tenements were constructed not only would the more or less 
continuous expense involved in attempting to maintain naturally un- 
sanitary districts in a comparatively innocuous state be avoided, but th(j 
tenements would prove a source of actual revenue to the city. 

Unfortunately no interest was taken in this project by the city author- 
ities and it died of inanition. The recent effort to interest the Municipal 
Board in securing suitable building sites for persons compelled to leave 
unsanitary buildings has, as above stated, been productive of little result, 
and the only land secured has been obtained through the active interest 
of the Director of Lands and the Acting Director of Health. 

So far as I am aware, the rendering of this kind of aid to poor people 
who are compelled to leave their homes and to build new houses, is not the 
legal duty of anyone, but it is a matter in which the city is most vitally 
interested and in my opinion it is to be deeply regretted that the Munic- 
ipal Board has displayed such apathy that practically the whole onus of it 
has necessarily fallen upon two of the Bureaus of the Department of the 
Interior. 

DRAINAGE WORK. 

On October 24, 1908, with the approval of the Governor-General, the 
sum of ^5,000 was made available by the Municipal Board for experi- 
mental drainage work. Of this amount ^3,778.59 were spent on the San 
Lazaro Estate and ^1,221.42 on the San Sebastian area. On November 
13 the Director of Lands made 1P5,000 available for use in supplying 
interior drainage on the San Lazaro Estate. On December 10 the Mu- 



167 

nicipal Board appropriated an additional ^1,500 for the completion of 
temporary drains on all streets south of Calle Tayuman on the San 
Lazaro Estate. 

As a result of these several appropriations all parts of the San Lazaro 
Estate are now supplied with properly graded open drainage canals in 
the streets and interior alleyways, while 530 meters of alleyways have 
been provided with stone gutters. 

EXTENSION OF WATER SYSTEM. 

Additional water hydrants have been installed as follows : 

Two in barrio of Palumpung between Santa Monica and Gagalangin. 

One in the barrio of Palomar. 

One in the barrio of Santa Clara. 

Three in the barrio of San Roque, near Balic-balic. 

One at corner of Cervantes and Tayuman. 

One at corner of Cervantes and Tayabas. 

One on Cervantes near railroad crossing. 

One at end of Cervantes near San Leyes. 

Two are being installed on Can San Leyes. 

RECOMMENDATIONS. 

Before radical and permanent sanitary improvement in the city of 
Manila can be hoped for the following things must be done : 

1. An adequate number of public pail sheds must be installed so 
that the poorer inhabitants may justly be compelled to use them and 
that the necessity for disinfecting square miles of territory, which ex- 
isted during the last cholera epidemic, may be avoided. 

2. The water supply system must be extended to all thickly settled 
unsanitar}' districts so that their inhabitants may be freed from the 
temptation to drink filthy water from esteros and shallow surface wells. 

3. The street system of the city must be extended so as to make 
possible the removal of night-soil, garbage and other harmful waste sub- 
stances from all thickly settled unsanitary districts, and the city must 
attend to such removal. 

4. The general drainage system of the city must be extended, to the 
end that private owners may be able to drain their lots and that the 
sanitary engineer or the Director of Health may, without injustice, 
compel them to do so if necessary. 

5. The city engineer must be compelled to enforce the building ordi- 
nances or the power to enforce them must be removed from him and con- 
ferred upon the Director of Health. 

The proper enforcement of the building ordinances could be arranged 
for in a very simple manner, without additional legislation, were the 
Director of Health to forward to the Municipal Board for approval an 



^6S 



I 

irv 

1 



amendment to the existing health ordinances making the neoessai} 
transfer of powers relative to the sanitary inspection of buildings, a: 
were the Board to approve it. 

It is not seen why the Board should object to doing this. The woi 
has always been distasteful to the city engineer who constantly plead 
as an excuse for his failure to perform it, the utter inadequacy of 
force. He could, therefore, have no just cause for complaint were 
transferred to some other office which could and would employ a fo 
sufficient to perform it. 

The unsanitary conditions due to tlie existence in Manila of la: 
tracts of low, undrained land can not, under the most favorable circum- 
stances, be remedied immediately and it is idle to demand impossibilities, 
but the Secretary of the Interior and the Director of Health do insist 
that in the immediate future there should be smaller expenditure in 
connection with expensive projects for beautifying the city and materially 
increased expenditure for the sanitary improvement of its worst districts. 

They further insist that the construction of all needed public pail 
sheds and the extension of the city water S3^steni should be provided for 
and carried out at once and that, at the very least, temporary drains 
should be constructed in the worst districts without -awaiting the final 
fixing of street lines and the construction of streets. 



ANOTHER WORD OF WARNING. 



4 



i 



Yo2ir attention is earnestly invited to the following facts: Cholera 
lias not disappeared from the provinces; with the existing force at the 
disposal of the Director of Health it is materially impossible to remedy 
this condition of affairs. 

The rainy season will soon he upon us again. Shall we have a repe 
tion of last year's costly experience while we are making elaborate maps 
and bickering over the obligations of the city and the Director of Health 
in the matter of bringing about the sanitary improvement of private 
property^ 

Shall we continue to drive the unfortunate poor of the city out of 
unsanitary shads only to allow them to erect others? Shall we make 
no systematic effort to aid them in finding, and securing the u^e of, 
healthful sites for their new dwellings? Or without waiting for the 
report of any committee shall the policy and the responsibility in each 
of these several matters be now definitely and finally fixed to the end 
that we may get early action? 

ADDITIONAL HISTORIC DATA AND REPORTS CONCERNING CHOLERA. 

If now only remains for me to bring the historical part of this repc 
up to date. 

One of the ends subsen-ed by the publication of reports is that publ 



169 

attention is attracted to the subjects discussed, and Uiai additional iu- 
formation of importance is likely to be forthcoinin«T. This has occurred 
in the present instance. 

Senor Epifanio de los Santos, fiscal of the Province of Bulacan, 
who for many years has been engaged in collecting and studying his- 

lical works in which mention is made of Philippine affairs, has written 
nic a letter containing interesting and important data derived from 
sources which have not been accessible to me. He shows conclusively 
that the occurrence of cholera in the Philippines in 1812 is a matter of 
record, and gives much valuable information relative to the earlier epi- 
demics. He further says that an epidemic occurred in 1843. His letter 
is appended hereto as Exhibit A. 

The results of practical experience in dealing with epidemic diseases are 
always of value. The Acting Director of Health presented to the Manila 
Medical Society a paper entitled "The suppression of a cholera epidemic in 
Manila," and under date of November 13, 1908, he forwarded to the 
Secretary of the Interior a supplementary report. These documents are 
appended and are marked Exhibits "B" and "C," respectively. The re- 
commendations embodied therein were prepared by the Acting Director 
of Health without consultation with me. 

At the meeting of the Medical Society above referred to there were 
presented the following additional important papers relative to cholera : 

"A Suramp.ry of the Results Obtained in the Bacteriological Diagnosis of 
Cholera." by Moses T. Clegg; 

"Indications for Treatment in Asiatic Cholera," by Dr. Richard P. Strong, 
Chief of the Biological Laboratory; 

"The treatment of Cholera, a Summary of the Experiences of the Physicians 
at the Mary Johnston Chohna Hospital," by Henry T. Nichols, lieutenant, ^led- 
ical Corps, U. S, Army. 

These papers are also appended and are marked respectively, Exhibits 
"D," "E" and "F." 

On December 22, 1908, the special committee of the Manila Merchants' 
Association made its report, forwarding a copy of it to the Governor- 
General. This valuable and interesting document is marked Exhibit G. 

The undersigned received from the chairman of the committee of 
the Manila Merchants' Association a copy of the reply of Member 
McDonnell of the Municipal Board to strictures of the committee relative 
to certain unsanitary conditions in the city of Manila. Transmitted 
with this communication was w^hat purported to be a compilation 
of the Acts of the Philippine Commission embodying various ordinances 
under which the sanitary work in the city of Manila is performed. 
I sent a reply to this communication which incidentally contains a 
discussion of the attitude of certain members of the Municipal Board 
in attacking the Bureau of Health for failing to do its duty by com- 
pelling the abandonment of unsanitary dwellings and sites on the one 



170 



hand, while on the other they pose as the would-be friends of the unfor- 
tunate persons made victims of the arbitrary action of the Bureau of 
Health by being compelled to leave their happy homes! 

A copy of this communication was sent by me, through the Governor- 
General, to the Municipal Board. It is appended hereto as Exhibit H. 

Finally I have included an English translation of an article entitled 
"Always Persecuted" which appeared in a Filipino paper. It affords 
a demonstration of the attitude of a portion of the native press toward 
sanitary work which will be of especial interest to readers in the United 
States. 

Respectfully submitted. 

Dean C. Worcester, 
Secretary of the Interior. 

Baguio, April, 2, 1909. 



ADDENDUM. 



The opinion of the Attorney-General, rendered in accordance witli 
my request of February 9, finally reached me on April 17, having been 
forwarded with the following indorsements: 

"[Second indorsement.] 

"The Government ob' the Philippine Islands, 

"Office of the Attorney-General, 

"April 12, 1909. 
"Respectfully forwarded to his Excellency the Governor-General. 
"The within opinion is addressed to the honorable the Secretary of tlie Interior, 
and has been held since the 3d instant owing to the fact that under date of 
April 1 in a communication to your excellency, the honorable the Secretary of 
the Interior withdrew his request for same. The opinion is now forwarded to 
you in pursuance of your telephonic request therefor. 

"Ignacio Villamor, Attorney-Oeneral. 

"[Third indorsement.] 

"The Government of the Philippine Islands, 

"Executive Bureau, 
"Manila, April IS, 1909. 
"Respectfully referred through the honorable the Secretary of Finance and 
Justice, to the honorable the Secretary of the Interior. 

"James F. Smith, Governor-General. 

"[Fourth indorsement] 

"The Government of the Philippine Islands, 

"Department of Finance and Justice, 

"Manila, April 16, 1909. 
"Respectfully forwarded to the honorable the Secretary of the Interior. 

"Gbegorio Abaneta, 
"Secretary of Finance and Justice." 

On April 26, 1909, the Attorney-General stated in a communication 
to the honorable the Secretary of Finance and Justice, that the extra- 
ordinary delay in this matter was due to lack of sufficient assistance in his 
office and to his own illness. 

The letter of the Attorney-General, communicating his opinion,' reads 

as follows : 

"Manila, April 3, 1909. 
"Sir: In reply to your communication of February 9, 1909, I have the honor 
to state that on December 17, 1908, the Acting Insular Auditor submitted to 
this oflBce for an opinion the question whether or not the owners of real e-state 

171 



in a highly unsanitarj^ condition may be judicially compelled to make the neces- 
sary improvement on said estate for the purpose of abating the nuisance. In 
an opinion, rendered on December 24, 1908 (Off. Gaz., Vol. VII, p. 279), this 
office held that 'it is within the power and clearly the duty of the Director of 
Health to notify the owners of the property in question of the maintenance by 
them of the said nuisance thereon and requiring that they shall, within the time 
and manner specified in the notice, abate the same, and should such property 
owners neglect or fail so to do, they are then subject to prosecution for the 
maintenance of said nuisance in the manner provided for in the provisions of law 
hereinbefore quoted, and, as the nuisance is a continuing one, may be repeatedly 
prosecuted and fined or imprisoned, or both, until they shall have complied with 
the requirements of the orders of the Bureau of Health in the premises.' 

"It is stated in your communication that said opinion of this office 'has. 
however, been understood to apply to the specific unsanitary conditions arising 
in low and poorly drained lands. In point of fact this particular question is one 
of the two important questions relative to the avoiding and remedying of un- 
sanitary conditions which are now pending between the Bureau of Health and 
the Municipal Board, and I understand that the ruling requested of the Auditor 
was in connection with contemplated improvements on such lands.' 

"I should like to state, however, that said opinion of December 24, 1908, was 
limited in its scope to the question presented to this office and only referred in 
general terms to 'nuisances dangerous to the public health,' without including the 
specific case of low and poorly drained lands which constitute a menace to the 
public health. 

"Now, the opinion of this office is requested on the following questions: 

"1. What officer should, in accordance with paragraph (s) of section 3 of 
Act No. 1150, and section 793 of the Revised Ordinances of the City of Manila, 
call upon and require the owner of any such premises to make the same sanitary 
by filling, draining, etc? 

"2. Whether or not under the authority of the proviso of said section the 
city engineer is authorized himself, or through his agents, to remedy such un- 
sanitary conditions and in the event that he is, who shall pay for the work? 

"3. As to the bearing of paragraph (a) of section 12 of Act No. 1150 upon 
the general question of who should do the work of the sort referred to in said 
paragraph, and who should pay for it, in view of the fact that the law requires 
the plans and estimates of the cost of such sanitary work to be submitted to the 
Municipal Board. 

"I shall now proceed to answer the questions propounded in the order they 
liave been stated. 

"1. 

"Section 3 of Act 1150 provides as follows: 

" 'The ordinances drafted by the Board of Health may provide for — 
»♦«»«*♦ 

"'(s) Cleansing, drainage, or filling in of lowlands where such lands are in 
an unsanitary condition and in the opinion of the Board of Health constitute a 
serious menace to the public health: Provided, That no order for the cleansing, 
drainage, or filling in of such lands involving a cost of more than three hundred 
pesos, Philippine currency, shall be effective without the approval of the Secretary 
of the Interior, who may request from the Sanitary Engineer of the Philippine 
Islands a report as to the cost of cleansing, drainage, or filling in of any such 
piece of lowland, and the sanitary engineer shall make such report when 
roq nested.' 



173 

"By virtue of this authority, the Board of Health drafted Ordinance No. 80, 
which was approved and adopted by the Municipal Board of the city of Manila, 
in pursuance of the mandatory provisions of section 1 of Act 1150, as an ordinance 
of the city of Manila. Section 224 of said ordinance, which corresponds to sec- 
tion 793 of the Revised Ordinances, provides as follows: 

* 'Where any premises within the limits of the city are composed of lowlands, 
or are so excavated or walled, diked, or dammed as to admit. or cause the 
formation on the surface thereof of stagnant or foul waters which are a nuisance 
and a menace to the public health, the city engineer mny call upon and require, 
subject to the limitations of subsection (s) of. section three of Act Numbered 
Eleven hundred and fifty of the Philippine Commission, the owner of any 
premises whereon such pools may exist to fill up the same with good clean earth 
or other approved material to the level of the surrounding ground, or to drain 
such pools by means of surface drains into any channel with which such surface 
drains may lawfully communicate, or to cut or breach any retaining walls, dike, 
or dam so that such retained water may have free escape : Provided, That whenever 
the Director of Health shall declare that any lowland, marsh, or stagnant pool in 
the city of Manila is in an unsanitary condition and canstitutes a serious menace 
to the public health, the city engineer shall take steps to cause the said lowlands, 
marshes, stagnant pools, or ponds to be cleansed, drained, or filled in and the 
unsanitary conditions removed.' 

"T?ie wording of section 793 of the Revised Ordinances of the City of Manila 
clearly shows that the city engineer is authorized to require the owner of low- 
lands to drain the same {subject to the limitations of subsection (s) of section 
3 of Act 1150). 

"As stated in the aforesaid opinion of December 24, 1908, the Municipal 
Board of the city of Manila was not empowered by its Charter prior to the 
enactment of Act 1150 to require the owner or tenant of any land or building to 
cleanse the same at their own expense, or, upon failure to comply with such a 
requirement, have the work done and assess the expense upon the land or building, 
as are municipalities organized under Act 82, in pursuance of subsection (n), 
section 39 of said Act. Undoubtedly the intention of the Philippine Commission 
in passing Act 1150, which makes the Bureau of Health the municipal board 
of health for the city of Manila with authority to draft, for approval by the 
Municipal Board of Manila, health ordinances for that city, was to remedy 
this deficiency in the city charter. 

"The language used by section 3 of Act 1150, 'The ordinances drafted by the 
Board of Health may provided for the cleansing, drainage, or filling in of lowlands, 
etc.,' " though differing from the terms used in section 39 (n) of Act No. 82, has, 
however, the same meaning — i. e., that the work of filling or cleansing be made 
at the owner's expense. I understand that the power conferred upon the Board 
of Health by Act 1150 to draft ordinances providing for the cleansing, drainage 
or filling in of lowlands carries with it authority for establishing the procedure, 
the manner and conditions under which such cleansing, drainage, or filling must 
be accomplislied. The act of asking or requiring the owner of low land (sec. 793 
of the Rev. Ord.) to fill the same with good, clean earth or other approved 
material, subject to the limitations of subsection (s) of section 3 of Act 1150 
means nothing but that when the cost involved does not exceed ?=300 the owner 
should do it at his own expense; but when the cost involved exceeds P300 it 
shall be necessary to obtain first the approval of the Secretary of the Interior in 
order to require such filling to be done. 

"The law might result too strictly in those cases where the value of the prop- 
ertv is far inferior to the cost of the improvement; but, in view of the terms 



174 

used in section 793 of the Revised Ordinances, it is difficult to say how it could 
be otherwise construed. The limitations set forth in subsection (s), section 3 
of Act 1150 are intended to mitigate the rigor of the law and to protect owners 
of lowlands of small value from being put to the expenditure of large sums of 
money, for the Secretary of the Interior, upon the information received from tlie _ 
sanitary engineer, may approve or disapprove the order of filling, or take such 
other action as may be advisable according to the facts in the case. 

"Therefore, I am of the opinion that the city engineer is authorized to require 
owners of lowlands to cleanse, drain, or fill the same in accordance with section 3, 
subsection (s) of Act No. 1150 and section 793 of the Revised Ordinances of the 
City of Manila. 

"2. 

"The other question on which the opinion of this office is requested is wliether 
or not the city engineer is authorized, by himself or through his agents, to 
remedy the unsanitary conditions existing in the lowlands, marshes, stagnant 
pools, or ponds in the city of Manila; and in such event who should pay for the 
work? 

"The proviso of section 793 of the Revised Ordinances, referred to in the 
preceding question, reads as follows: 

" 'Provided, That whenever the Director of Health shall declare that any low- 
land, marsh, or stagnant pool or pond in the city of Manila is in an unsanitary 
condition and constitutes a serious menace to the public health, the city engineer 
shall take steps to cause the said lowlands, marshes, stagnant pools, or ponds 
to be cleansed, drained, or filled in and the unsanitary conditions removed.' 

"The second question propounded mu^t te answered in the affirmative. Since 
the Municipal Board is vested with authority to enact an ordinance of the nature 
contemplated in subsection (s), section 3 of Act 1150, and has enacted such an 
ordinance authorizing the city engineer to carry out the provisions of subsection 
(s), said officer or his agents are undoubtedly authorized to take all the necessary 
steps to have all the lands declared by the Director of Health as lowlands and a 
menace to the public health filled up. 

"With reference to the question as to who shall pay for the filling above 
referred to, I observe a deficiency in the law in that it fails to provide that such 
improvements, being ordered, can be accomplished by the city engineer and the 
cost made a lien against the property, or some such similar arrangement. But 
I believe the compliance with this ordinance and the order to cleanse, drain, or 
fill may be imposed in the same manner as every other ordinance of the city of 
Manila, and section 813 of the Revised Ordinances says: 

" 'Any person in the city of Manila who shall violate any section or part 
thereof of this title * * * or any regulation made in accordance therewith 
may be proceeded against as prescribed by the provisions of section five of Act 
Numbered Eleven hundred and fifty of the Philippine Commission.' 
"And section 814 says that: 

" 'Any person ♦ * * who shall violate any provision of any section or 
part thereof of this title [that is, title 11, Public Health, p. 2401 * * * or 
any sanitary regulation of the Bureau of Health made in pursuance of law, shall, 
upon conviction, be punished by a fine of not more than two hundred pesos or 
by imprisonment for not more than six months, or by both such fine and imprison- 
ment, in the discretion of the court, for each offense.' 

"Section 793 of the Revised Ordinances is a health ordinance, passed in 
pursuance of section 3 (s) of Act No. 1150, which Act is entitled 'An Act further 
defining the powers and duties of the Board of Health for the Philippine Islands 
and of the Municipal Board of the city of Manila in connection with the pres- 



175 

ervation of the public health of that city, * * ♦,' and section 5 thereof 
contemplates that any health officer is empowered, and it is made his duty, to 
make complaint under oath in writing before the municipal court of Manihi 
against any person violating any health ordinance, and it shall be the duty oi 
that court to issue a warrant for the arrest of such person so complained of, and, 
when arrested, to try him as in other cases of violations of city ordinances. 

"There is not one scintilla of evidence that the Commission in enacting section 
3 (s) of Act No. 1150 intended that the city of Manila should fill any lowlands 
belonging to private parties, nor does such intention appear in section 793 <> 
the Revised Ordinances. If that was the intention, the Commission and the 
Municipal Board have absolutely failed to express same. At the time Act 1160 
was passed appropriations for the city of Manila were made by the Commission. 
Tlie appropriate method of expressing such an intention would have been for th' 
Commission to make an appropriation of so many thousand pesos to be expended 
for the purpose of filling in any or all such lowlands as are contemplated by 
the section, upon the approval of the city engineer and the Secretary of the 
Interior; that would have been all that was necessary. But the filling in of 
lowlands is an expensive proceeding and after same have been filled or drained the 
property is rendered far more valuable to the owner, and to hold that the legislation 
under consideration has created authority in the city engineer, or health officials, 
and the Secretary of the Interior to fill in lowlands of private ownership at the 
city's expense is virtually taking public property for private uses without due 
process of law, and it places the city of Manila in the anomalous position when 
health officers, the city engineer, and the Secretary of the Interior have issued an 
order requiring the filling in or draining, of violating its o^vn ordinance if it is 
unable to furnish the necessary money or if it fails to make provisions for 
securing the same for said purpose. The intention of the Commission is perfectly 
clear, that where lowlands exist which are a menace to public health they shall 
be filled in. There is no more reason for holding that it was the intention to have 
the city of Manila fill in or drain lowlands than there is for saying that it was 
the intention to have the city of Manila pay for all necessary expenses incurred 
by reason of enforcing compliance with the other subsections of Act 1150, section 
3, from (a) to (r). For instance, take subsection (d), which refers to drainage 
and plumbing; it is public knowledge that many thousand pesos have been spent 
in the city of Manila in pursuance of orders of health officials to renovate plumb- 
ing systems or drainage systems in private homes at the owner's expense. 

"3. 

" 'As regards the third question proposed, paragraph (o) of section 12 of Act 
1150 provides as follows: 

" The sanitary engineer shall inspect buildings, plumbing, waterworks, drain- 
age and sewer systems, streams, and esteros within the limits of the city of 
Manila, reporting the result of such inspection to the Board of Health, and a: 
the request of the Board of Health shall submit plans for and estimates of the 
cost of remedying unsanitary conditions discovered by him. He shall further, 
at the request of the Board of Health, prepare and submit to the Board plan« 
and estimates of the cost of improving the general sanitary condition of unhealthful 
districts in Manila, and shall perform such other sanitary engineering work in 
the city of Manila for the Board of Health as the Board may direct.' 

"The question as to who shall execute the work mentioned in the preceding 
paragraph, can not be possibly answered in a positive manner. In the first plac«, 
'the sanitary engineer shall, at the request of the Board of Health, prepare plans 
for and estimates of the cost of remedying the unsanitary conditions discorored 



17G 

by him;' in tlie second place, 'he shall prepare and submit plans and estimates 
of the cost of improving the general sanitary condition of unhealthful districts 
in Manila;' and in the third place, 'he shall perform such other sanitary engineering 
work in the city of Manila for the Board of Health as the Board may direct.' 

"The provisions of paragraph (a) of section 12 of Act 1150 should be applied 
to specific cases according to their respective circumstances; since there maj 
be cases in which not only private individuals are concerned but also the Insular 
Government itself, and in which the expense incurred under this section may not 
perhaps have to be borne exclusively by the city of Manila. 

"In view of the general terms used in said provisions, I am constrained to say 
that it will be more convenient to leave the decisions of specific cases with the 
Insular Auditor. This office has decided more than once not to render any opinion 
on hypothetical questions. 

"Very respectfully, "Ignacio Villamob, 

"Attorney-Oeneral. 

"To the Honorable the Secretary of the Interior, 

"Manila, P. /." 

Eeferring to the paragraph which reads — 

"I should like to state, however, that said opinion of December 24, 1908, was 
limited in its scope to the question presented to this office and only referred in 
general terms to "nuisances dangerous to the public health," without including 
the specific case of low and poorly drained lands which constitute a menace to the 
public health" — 

I can only express my surprise, in view of the fact that the case which 
called forth this opinion was a case of action desired to be taken by the 
city in remedying unsanitary conditions on low and poorly drained lands, 
that the Attorney-General, in rendering it, should not have deemed it 
necessary to refer to the law dealing with the subject in question, but 
should have contented himself with referring in general terms to 
nuisances dangerous to the public health. 

With the conclusions of tlie Attorney-General as to the meaning and 
effect of the existing provisions of law, once they were called to his 
attention, I have no quarrel. So far as they cover the same subjects, they 
are in substantial accord with those before reached by me and set forth 
in this appendix. 

Dean C. Worcester, 
Secretary of the Interior. 



Exhibit A. 



[Translation.] 



The Provincial Government of Bulacan, 

Malolos, Bidacan, November 2Jt, 1908. 
Hon. Dean C. Worcester, 

Secretary of the Interior, Manila, P. I. 
My Dear Mr. Worcester: I take pleasure in acknowledging receipt 
of your favor of the 17th instant, and of the English copy of your notable 
work, "History of Asiatic Cholera in the Philippine Islands." 

:): * * * * * « 

With regard to your report, I must frankly inform you that I have 
been delighted to read it. Up to the present moment it is the most 
scientific report written on the subject in the Philippine Islands. Your 
dissertation with regard to the subject during the past regime is brilliant, 
notwithstanding the scarcity of material available, which you were almost 
compelled to improvise. However, the date that you record as the first 
year when cholera appeared in the Islands, 1817, seems recent. 

M. P. F. Keraudren, in his "Memoria de la Colera morbo de la India, 
y su Metodo Curativo, etc." (Spanish version, Madrid, 1831), says on 
page 52 : 

"It was on January 22, 1812, when the royal frigate Cleopatra anchored in the 
roads of Manila, Philippine Islands, and on the 30th the cholera morbus appeared 
on board. * * * In a very short time the number of the sick had increased to 
thirty-two, and seven had died." 

The author supposes that there was cholera at Manila at that date 
because the fourth of his conclusions contains the following : 

"It is dangerous for vessels to go to and remain in a port wliere the cholera 
has appeared recently in an epidemic form, which is proved by the arrival of the 
frigate Cleopatra at Manila." 

It would have been very instructive if you could have inserted in your 
report the curative methods employed during the past regime, especially 
beginning with 1820. 

Don Manuel Lecaroz reprinted in 1820 the Novena: "Dia diez y seis 
de cada mes, dedicado al culto y obsequio de Senor San Eoque Especial 
Abogado contra todo genero de peste y enfermedad contagiosa, etc.," of 
which a large number of copies was printed, which were sent to the parish 
priests for distribution to their parishioners, and to the ^^military officers, 
78079 12 177 



178 

in order that through the chaplains it be practiced likewise in the 
barracks, and in the hospitals and asylums by their chaplains, in the 
prisons by the wardens, and in the houses by the respective heads of 
families." As will be concluded, the method employed is prayer, the 
reading of the Novena for nine days or longer, beginning with the 16th 
of each month; and if the Lord's Prayer and Hail, Mary is said once at 
the end, the cholera patients will have eighty days indulgence. This 
Novena seems to be a reprint of that of 1795. Did the cholera exist in 
that year? During the same year a Tagalog version of this Novena was 
prepared by the "Ex-Definidor, Vicario Provincial y Foraneo del Partido 
de Bulacan," Friar Esteban Diez, parish priest of Baliuag. The motive 
for the publication of the Novena was, with regard to the Spanish edition : 
The spiHtual and temporal welfare of all the inhabitants of the Philippine 
Islands, and with regard to the Tagalog version: compassion for the 
Tagalogs (aua rin naman niya sa sang Catagalugan) on the part of Friar 
Esteban Diez. 

The botanist, Don Gines Fernandez, surgeon of the infantry batallion 
Principe Fernando, published in 1821 the following work dedicated to 
Governor-General Mariano Fernandez Folgueras: "Colera morbo. Ob- 
servaciones generales sobre el conocimiento y tratamiento de las Enferme- 
dades. Dispuesto para la Gente del Campo, y aquellos que carecen de 
medicos en las provincias y aldeas'^ (Cholera Morbus. General Ob- 
servations regarding the Knowledge and treatment of the diseases, 
prepared for the Inhabitants of the Country, and for those lacking Phy- 
sicians, in the provinces and villages), in which he recommends the 
following prescription, which, according to the author, is miraculous 

"Take an ounce of brandy, and if there is none, of spirits of wine; dissolve 
it three grains of camphor; add one scruple of vitriolic ether, and one scruple 
liquid laudanum; mix these, and if this prescription is given in time, you will 
believe that you have performed a miracle: But it is not so, it being the work of 
nature." 

Carlos Luis Benoit, who was surgeon of the French vessel Alejandfl^ 
and who escaped from the massacre of the foreigners in 1820, had an 
opportunity to study cases of cholera in Manila during the years 1820, 
1821, 1822, 1823 and 1824, and inserts very curious things in his work, 
the title of the Spanish version of which, published in Madrid, 1832, is 
as follows : "Observaciones sobre el Colera morbo espasmodico, 6 Mordechi 
de las Indias Orientales, recogidas en las Islas Filipinas, y publicadas 
con su metodo curativo por el Dr. D. Carlos Luis Benoit, etc." mi 

The following is a sample of the things said by this author : 

(Page 100) "I can not but insert here the exact translation of the result of 
a consultation given by a Chinese physician on the occasion of His Excellency 
the Captain-General of the Philippine Islands, Don Juan Antonio Martinez, being 
attacked by cholera in the year 1824, which caused the greatest consternation to 
his entire interesting family. 



# 



J 



179 

"The General liad me introduced to the Cliinoae surgeon Kanhi, who, after 
having spent an hour observing him and hearing him breathe, and two hours in 
feeling his pulse, told me, through the interpreter, the following: 

"This disease is caused by a lack of vital air, of blood, and of semen. TIk? 
kidneys are not relieved; their water does not suffice for the fire, and therefore 
the passages are closed; the patient does not urinate, and sometimes the uriiu' 
dries, similar to the sky; when it does not rain, the earth dries. The patient 
must endeavor to preserve a tranquil mind, shun woman, and not tire his mind.' " 

In the preceding pages I have not seen the data proving the existence 
of cholera in 1819 according to the summary of page 15 of your report. 
However, Sinibaldo de Mas affirms (pp. G4 and 65 of the second part of 
his Informe) that: 

m- "In 1819 the cholera appeared, and this was the signal for the barbarous 
! massacre committed with impunity on the persons of the foreigners and of a few 
' Chinese who, because of the war of the year 1762, were looked upon with disfavor 
by the priests and by a large part of the population. * * * When martial law 
was proclaimed, the matter had already run its course because almost none of the 
foreigners who were the objects of public hatred remained alive. During the 
disorder several corporations and private citizens took treasure of great value to 
the fortress, in which nearly all the Spaniards who were living outside took refuge. 
This money was not attacked anywhere, because the simple statement that it 
belonged to a Spaniard enabled it to pass without difliculty. The same respect 
was shown to the Spanish houses. 

"It seems that Folgueras, as his excuse for the assaults made by the Filipinos 
upon the foreigners, wrote to the court that he had not taken energetic measures 
previously because he had no confidence in the officers under his orders. * ♦ ♦" 

This statement of the fact, which is rather sibylline and mysterious, 
is clearly established by the proclamation of Governor-General Folgueras 
on October 21, 1820, addressed "To the Natives of the Philippine Islands, 
and especially to those of the district of Tondo." 

In the body of this proclamation Governor Folgueras inserts the author- 
ized report of the Juez de Letras, Licenciado Don Jose Maria Jugo, dated 
at Santa Cruz on October 15, 1820 ; here are the conclusions of this report : 

"According to what has been shown, Your Excellency will see that the imputa- 
tion that the French had done the poisoning either themselves or through third 
persons, has been merely a fable with which the uneducated masses have been 
deceived. 

"However, this has not been the worst, but there have been many persons of 
whom it seems impossible to believe that they would concur in such a gross error ; 
but the fact is that such is the case, many of these persons being members of the 
clergy, and that for this reason the illusion took such proportions that it caused 
scandalous deeds that are now being deplored by all good men, it being a fact that 
there is no better means of propagating an error than its being adopted by persons 
of authority. 

"The belief of a poisoning doubtless originated from the ignorance of the 
Indians, but there is also no room for doubt that ill-minded persons, making use 
of this indiscretion and lack of enlightenment of the Indians, stirred them up 
to commit the murders and robberies of the disastrous 9th and 10th. 

The best evidence for this opinion is that after the disturbance of the first 



180 

daj-, when the persons who deemed themselves offended by the French should have 
been satisfied, there came the second day, the 10th, when the movement was 
against the Chinese, who had not been accused of poisoning until that day; but 
on that day the motive for the disturbance was the rumor that spread that at 
a place on the Escolta a Chinaman or Chinamen had been caught poisoning, and 
this was sufficient cause for tlie rioters, who were already agreed, to begin to 
loot the shops and dwellings of the Chinamen with tlie utmost shamelessness and 
daring. * * *" 

For this reason Governor Folgueras absolves the Indians of their sin^. 
addressing to them these kind words: 

"Deceived and rendered furious by a few depraved persons, you have covered 
yourselves with horror and ignominy; you have for the first time contradicted 
the opinion that the world had of your virtues and hospitality; and while you 
have brought consternation to every reasonable mind, you have made yourselves 
an object of abomination and wrath for the nations that do not know your 
simplicity and credulousness which have been abused by the wicked instigators of 
the unfortunate events on those gloomy days, the 9th and the 10th of the current 
month." 

Mr. Benoit, a French surgeon, miraculously escaped from the massacre, 
also absolves, in his way, these Indians, who, "though humble, religious 
and peaceable, were converted into furious murderers. * * *" 

These quotations are rather lengthy but are very necessary to enable 
one to understand the lugubrious legend of the poisonings, and explain. 
mutatis mutandis^, the origin and duration of that legend, and of othe]- 
things of the same or of a similar character. 

You also failed to make mention of the cholera in IS-iS, though it was- 
precisely during that year when the measures prescribed by the Boar* 
of Health as it then existed were issued for the prevention and treatmen; 
of said disease. It will, however, be difficult to obtain these sanitarv 
ordinances, and for this reason, and on account of its importance, I shall 
copy them in full : 

"instructions prepared by the board of health of these islands with 
regard to the measures that must be taken in order to prevent cholera 
morbus and attend to the patients at the first stage of the disease. 

"To avoid it, the following measures should be taken : 

"Persons who are out of breath and perspiring must not expose themselves to u 
current of fresh air. 

"Water must not be taken on an empty stomach or at midnight, or when in a 
state of perspiration. 

"River water used for drinking purposes should first be strained through a 
clean cloth, and aftewards there should be added to it a decoction of zamhon, of 
flor de Santa Maria, of manzanilla, sage, ginger, or toasted bread. 

"To sleep exposed to the dew is very injurious and must be avoided with 
particular care; likewise, the windows of the sleeping rooms must not be left 
open, because the neglect of this precaution will result in catching cold and a 
cooling of the body. 

"Clothing made of flannel, cotton or silk is useful for preserving a person from 
the disease, being much better than clothing made of linen or of native cloth. 



181 

The eating of shelllish, or fish having a bad Jinicll, whether dried or fresh, 

iijiirious and may cause the disease, especially if the stomach is weak. 

"Green fruit, and especially cold fruit such as melons, watermelons, camlas 
and banquilincs are also harmful, and it is advisable not to eat them. 

"It is also injurious to take a bath while heated or after taking food, to cat 
iwhile in the water or to remain a long time in the water. 

"Lastly, it is essential and good for the health to keep the body clean, and 
likewise to keep clean the dwelling rooms, which must be sprinkled with vinegav 
from time to time. 

"Whenever a person has stomachache, fits of vomiting, and stools with cramps, 
the following rules shall be observed: 

"To protect the body Avith hot cotton or woolen blankets. 

"Rub the body with rough cloth, fine brushes, hot flannel, spirituous liquors, or 
spirits of camphor. 

"To apply fomentation to arms, legs and feet, and also to the spinal cord, 
using ground mustard seed and cold water. 

"Hot cloths should be placed on the abdomen and changed frequently. 

"It is advisable to drink in great quantities, or every half hour, taju, or tea, 
or a decoction of fio7' de Santa MaHa, or samhon, or ginger, mixing with the said 
beverages during the first two hours of the disease a teaspoonful of cologne, bitters, 
or brandy. 

"The patients should be kept in a well closed room in order to obtain as soon 
as possible a ready and abundant perspiration. 

"Lastly, apprehension or fear should generally be avoided because, as has 
been observed in Paris and in other European capitals, this state of mind has an 
influence on the body and predisposes it to the disease. 

"The Presiding Gk>vernor, 

"ObaA. 
"Dr. Ponce, Secretary. 

"Manila, April 2^ 1848." 

It is a pity that I have no other special works on the subject available 
as, for instance, the "Folleto sobre el Colera morbo asiatico (Manila, 
1879)/' by the Licenciado Pedro Kobledo y Gonzales; "Ensayo de un 
libro 6 Manila, la Higiene y el Colera * * * " of Don Francisco 
Capelo y Juan, who was Professor of the Faculty of Medicine (in Manila, 
1883) ; another of the same year by Pedro Kobledo y Gonzales, entitled 
"El Colera en Filipinas. Memoria sobre la epidemia que se padecio en 
Yigan, capital de la provincia de Ilocos Sur, desde el 8 de Noviembre 
de 1882 hasta el 19 de Febrero de 1883,'' (written by superior order 
and published by the "Correspondencia Medica, Madrid") ; "Memoria 
sobre el Colera Morbo Asiatico, con Ligeras Nociones sobre la Etiologia 
de esta Enfermedad (Madrid, 1884)," by Eamon Alba y Martin, which 
is confined to the cholera in 1882 in Zamboanga; and the "Cartilla 
Higienica y de desinfeccion. Con las Precauciones que deben tomarse 
en el caso de una Invasion Col erica," (anonymous publication, Manila, 
1888). 

However, in view of what you have stated in your report and what I 
have just said, the fact may be established that cholera began in the Arch- 
ipelago in 1812, then again in 1819, and existed in a continuous manner 



182 

until 1824; then in 1842, 1843 (date of the sanitary ordinance), and 
in the years that you mention in your report. 

The sanitary measures or curative methods mentioned, which are still' 
practiced by a majority of the people, and which certainly do not owe 
their origin to the natives, and likewise the notorious poisonings, and 
the prayers and processions dedicated to San Eoque, are of ancient origin,, 
and these practices were doubtless condemned by our physicians, including 
Dr. Eizal. 

Fortunately, thanks to the amiability of Sr. Eetana, I have before me 
the notes of Don Juan Sitges, who was politico-military commander in 
Dapitan in 1893, and who tells the following anecdote of Eizal : 

(Notes 12 and 13.) "In Dapitan, the same as in all the missions of the 
Archipelago, there was a saint with a patronage and congregations for nearly all 
the contingencies of life, it happening that each street of a pueblo which had the 
name of a saint, added another patron saint to those of the population, which, 
together with the rest of the advocates of youth, good voyage, happy confinement, 
etc., brought great revenues to the mission because it meant for every fiesta the 
fees for a sermon, a high mass, and other fees, in addition to subscriptions that 
were taken up by the missionaries in the houses. 

"The day of San Eoque, the patron saint for the pest arrived, at a time when 
one of the Manila mail boats had come flying the yellow flag, and Father Obach, 
having gone to Rizal in order, to ask him to contribute to a church function to 
petition the saint for protection, Rizal replied: 

" 'But, father, how do you expect me to give anything to a competitor? Don't 
you see that if he delivers us from the pest I shall not have any patients ?' " 

This anecdote is very good and of a wide Scope, and I leave its 
application to your discretion. 

What I have stated must not be taken as a charge against the state of 
affairs during the past regime, especially with regard to the first half 
of the nineteenth century, because it is an established fact that there 
was a scarcity of physicians, and modern hygiene had not extended as 
it has in recent times. On the contrary, we have to be verj^ grateful 
to the herb doctors and botanists for their good desire to furnish us with 
miraculous prescriptions curing during the pest by enchantment, and 
to the good friars who wrote books destined to give us health, such as 
the "Libro de Medicinas de esta Tierra * * *," of our countryman, 
the Augustinian friar, Ignacio Mercado; the famous "Manual de Medi- 
cinas Caseras," of the Dominican, Fernando de Santa Maria; "Los 
Eemedios Faciles * * *,'' of the Jesuit Pablo Clain; and "Ang 
maliusay na paraan * * *," of Father Blanco, being the Tagalog 
version of the "Aviso al Publico," of Tissot, who says more or less that 
the works of his colleagues Santa Maria and Clain are detrimental, and 
kill rather than cure. 

I believe that I must conclude tliis long, drawn-out letter and dis- 
continue taking up your time. 

Wishing you health and prosperity, I am, 

Very sincerely yours, 

Epifanio de LOS Santos. 



Exhibit B. 



THE SUPPRESSION OF A CHOLEBA EPIDEMIC IN MANILA. 

[By Passed Assistant Surgeon Allan J. McLaughlin, P. H. and M. H. S., Acting Director of 
Healtli for the Philippine Iblanda.l 

The cholera epidemic of September, 1908, was probably a continuation 
of the outbreak which had its greatest intensity in January, 1908. 

In January, 1908, there were 184 cases of cholera in Manila. In 
February, 14 cases of cholera were registered, and in March 3 cases 
were registered. In April, cases resembling cholera clinically began to 
present themselves, which bacteriologically were negative. In May, one 
case bacteriologically positive was reported on the 14th. In June, one 
case of true cholera was found on the 11th, and suspicious cases, re- 
lembling cholera clinically, but negative bacteriologically, were found 
on the 3d, 4th, 18th, 19th, 24th (2), 27th, 28th, and 29th. These cases 
resembled the true clinical picture of cholera more closely from day 
to day. Some were fatal in a few hours, and the intestinal contents 
yielded a motile vibrio which resembled the cholera vibrio but did not 
respond to the agglutination test. 

These suspicious cases continued in July, as follows : 

July 4, 1 case, suspicious cholera — negative bacteriologically, 
July 8, 1 case, suspicious cholera — negative bacteriologically. 
July 11, 1 case, suspicious cholera — negative bacteriologically. 
July 13, 1 case, suspicious cholera — negative bacteriologically. 
July 14, 1 case, suspicious cholera — negative bacteriologically. 

On July 16 a case of typical cholera was found, and thereafter cases 
appeared in July, as follows: 

July 21, 1 case, true cholera. 
July 22, 1 case, -true cholera. 
July 26, 2 cases, true cholera. 
July 28, 4 cases, true cholera. 
July 29, 3 cases, true cholera. 
July 30, 4 cases, true cholera. 
July 31, 2 cases, true cholera. 

In August, cases of cholera, bacteriologically confirmed, were as follows : 

August 1 2 j August 10 2 I August 25 2 

August 13 3 j August 26 3 



August 2 „ 1 

August 3 2 

August 5 1 

August 6 4 

August 7 1 

August 8 2 



August 17 1 1 August 27. 

August 19 1 1 August 28 1 



August 20 1 

August 21 ~ 1 

August 23 3 



August 9 2 I August 24 4 



August 29 2 

August 30 5 

August 31 5 

183 



184 



These suspicious cases bridged over a gap between the outbreak of 
Januaiy, 1908, and that of September, 1908. One need only see these 
cases at the bedside or at the autopsy to recognize the possibility that 
they may be cases of cholera in which the vibrio has lost some of its 
properties, including its aggiutinability with high dilutions of anti- 
cholera serum. 

Kolle,^ in a series of vibrios taken from cases in Egypt, which clinically 
were cholera, found only a few vibrios which did not agglutinate with 
anti-cholera serum. Kolle's conclusion was that these cases were cholera 
but that the cholera organism w^as not isolated because of faulty technique. 
His contention is that other vibrios are sometimes found in the human 
intestines which, in the enriching fluid, grow more vigorously that the 
cholera vibrios, and one may easily fail to isolate the cholera organisms. 
This seems unlikely to occur in any considerable number of cases, 
especially if the transfer to the hard medium is made direct from the 
stool, or after a very short time of growth in the peptone solution. 

In September, from the 1st up to the 9th, there was an average of 
about three cases daily. On the 10th, the cases reached seven, on the 
11th, nine, and on the 12th, seventeen. The course of the disease- 
well shown on the chart showing the cases from September 1 to Octu./ci 
12, 1908. 



September 1 3 

September 2 1 

September 4 C 

September 5 4 

September G 4 

September 7 4 

September 8 5 

September 9 3 

September 10 7 

September 11 9 

September 12 17 

September 13 11 

September 14 10 

September 15 16 



September 16 37 

September 17 25 

September 18 24 

September 19 43 

September 20 60 

September 21 55 

September 22 38 

September 23 45 

September 24 40 

September 25 44 

September 26 37 

September 27 14 

September 28 18 

September 29 13 



September 30. 



11 



I 



October 
October 
October 
October 
October 
October 

October 7 8 

October 8 13 j 

October 9 8; 

October 10 6 

October 11 3 

October 12 4! 



The high-water mark of the epidemic was reached on September 20,1 
when 60 cases were reported in twenty-four hours. 

When the number of cases reached 9 on September 11, the wriu. 
recognized the probability of an epidemic, and took personal charge of the 
operations. On September 12, the number reached 17, 12 being in 
Meisic district. Upon investigating this district, he found that in 18 
cholera houses, that is, houses in which cases of cholera had occurred, in 
every case the closet was in a filthy condition. They had the following 
combination : Filthy closets, rats, flies, cockroaches, and other insects, and 
a kitchen immediately adjoining the closet. With this combination, all 



^ Zeitschrift fur Hygiene, vol. 44. 



185 

is necessary is the presence of the bacilli carrier, who, by using the 
A. et, will furnish the infective material. 

Two additional disinfecting squads were put to work immediately for 
he exclusive duty of disinfecting closets, and on the 13th, the cases 
dropped to 11, and on the 14th to 10. On the 15th, 16 cases occurred, 
ind 105 additional men were employed. This force was increased as 
apidly as possible without causing confusion and disorganization, and by 
September 22, the complete organization of 500 men was working 
nioothly. This force was increased by the 25th to 600 men. 

ORGANIZATION. 

The property division of the Bureau of Health purchased all supplies 
md equipment, with a very slight increase of personnel. The statistical 
livision of the Bureau of Health took care of the records and statistics. 
The clerical division handled all financial transactions and current busi- 
less. The department of sanitation and transportation of the city of 
iianila furnished ambulances, tank wagons, carretelas, carromatas, and 
lorses. 

The boundaries of the health districts already existing were left un- 
hanged, the city being divided as follows: 

Station J, Intramuros, including Malate and Ermita. 
Station L, Paco, including Santa Ana, Pandacan, etc. 
Station A, Meisic, including Binondo, Quiapo, and Santa Cruz. 
Station C, Tondo. 
Station I, Sampaloc. 

The office force of each station was not increased, but the field force 
yas enormously increased. 
The organization of the field force in each district was as follows : 

STATION A — MEISIC DISTRICT. 

1 medical inspector, in charge of district. 

3 municipal physicians, assistants to medical officer in charge. 
1 sanitary inspector, in charge of all the men. 

1 sanitary inspector, for inspection of disinfecting gangs and quarantines. 
12 American foremen, each in charge of a lime squad. 

124 Filipino lime throwers. 

2 American foremen, each in charge of a disinfecting tank wagon and 6 men. 
12 Filipinos, G for each disinfecting wagon. 

1 chemical fire engine and crew. 

1 disinfecting carretela, with crew of 5 men, disinfectants, and hand pumps, 

for room disinfection of cholera-infected houses. 
Total personnel of station: 

4 medical officers. 

2 sanitary inspectors. 
14 foremen. 

136 Filipino laborers. 

5 Filipino disinfectors. 

Total, 161. 



186 



STATION C — TONDO DISTRICT. 

1 medical inspector, in charge of district 

2 municipal physicians, assistants to medical inspector. 
1 sanitary inspector, in charge of all the men. 

3 American foremen, in charge of lime squads. 
1 American in charge of disinfection of wells and pools. 

64 Filipino lime throwers. 

3 foremen, each in charge of large disinfecting tank wagon and 6 men. 

1 foreman, in charge of small tank wagon and 4 men. 
22 Filipinos, on disinfecting wagons. 

1 chemical fire engine and crew. 

1 disinfecting carretela with 5 men. 
Total personnel of station: 

3 medical officers. 

1 sanitary inspector. 

8 foremen. 
86 Filipino laborers. 

5 disinfectors. 

Total, 103. 

STATION J — INTBAMUROS DISTRICT. 

1 medical inspector, in charge of district. 

1 municipal physician, assistant to med'cal inspector. 

I sanitary inspector, in direct charge of all the men. 

1 sanitary inspector, in charge of disinfecting crews. 

1 disinfecting carretela, crew of 5 men. Day duty. 

1 disinfecting carretela, crew of 5 men. Night duty. 

6 American foremen, in charge of lime squads. 
100 Filipino lime throwers. 

3 American foremen, each in charge of disinfecting tank wagon. 
17 Filipinos, disinfecting tank wagons. 

1 chemical fire engine and crew. 

Total personnel of station: 

2 medieai officers. 
2 sanitary inspectors. 

9 foremen. 
117 Filipino laborers. 

10 disinfectors. 

Total, 140. 

STATION I — SAMPALOC DISTRICT. 



1 medical inspector, in charge of district. 

1 municipal physician, assistant to medical inspector. 

1 sanitary inspector, in charge of all the men. 

4 American foremen, in charge of lime squads; 25 men each. 
100 Filipino lime throwers. 

2 American foremen, each in charge of tank wagon and 6 men. 
12 Filipinos, 6 on each tank wagon. 

1 chemical fire engine and crew. 

1 disinfecting carretela with crew of 5 men. 



187 



Total personnel of station: 

2 medical officers. 

1 sanitary inspector. 
6 American foremen. 
112 Filipino laborers. 

5 disinfectors. 

Total, 126. 

STATION L — PACO DISTRICT. 

1 medical inspector, in charge of district. 

1 sanitary inspector, in charge of all the men. 

1 municipal physician, assistant to medical inspector. 

1 foreman, in charge of tank wagon and 6 men. 

6 Filipinos on tank wagons. 

3 foremen, in charge of lime squads. 
52 Filipino lime throwers. 

1 disinfecting carretela, with crew of 5 men. 

Total personnel of station : 

2 medical officers. 

1 sanitary inspector. 

4 foremen. 

58 Filipino laborers. 

5 disinfectors. • 

Total, 70. 

Total personnel — all stations. 





Medical 
oflBcers. 


Sanitary 
inspect- 
ors. 


Fore- 
men. 


Labor- 
ers. 


Disin- 
fectors. 


Total. 


SUition A — Meisic 


4 
3 
2 
2 
2 


2 

1 
1 
2 
1 


14 
8 
6 
9 
4 


136 
86 
112 
117 
58 


5 


1A1 


Station C — Tondo 


5 ! 103 


Stiition I— Sampaloc -_■ ^ 


5 126 


^'■'ionJ — Intramuros . _ 


10 1 14U 


on L — Pace _ 


r> 70 








Total 


13 1 7 1 41 . .<sn9 ! ia 1 aaa 

















Note. — This does not include police for house-to-house inspection, nor some 300 
men of the city street cleaning force, who have been assisting in draining the 
worst places in the barrios, nor the Constabulary for quarantine guards. 

Lime squads varied in size according to the district. In open districts, 
or sparsely settled districts, one foreman could properly supervise from 
15 to 25 men. In a district like Meisic, where the houses are crowded 
together, a foreman could not properly supervise more than 12 men. 

One mechanic was assigned to the duty of keeping the disinfection 
wagons, pumps, and hose in good condition. He traveled from wagon 
to wagon with tools, thus avoiding sending the wagon in for repairs, 
which were often trivial and could be made in a few minutes on the spot. 

The expenditure of disinfectants was enormous; about 150,000 pounds 
of lime per day, and about 700 gallons of carbolic acid daily, or its equiva- 
lent in creoline, tricresol, or formalin. There was some difficulty in secur- 
ing enough disinfectants to satisfy this enormous demand. The entire 



188 

stock of carbolic acid, formalin, and ticresol in the Philippine Islands ■- 
used before the end of September. Four thousand gallons of Je;, : 
fluid (a creolin preparation) was secured from Hongkong and Japiin 
in time to prevent the wagons lying idle. Four of the 11 tank wagons 
might have lost two days on account of lack of disinfectants, but the 
Director of the Bureau of Science suggested that salt water could be 
electrolyzed, forming a disinfecting fluid, which, according to laboratoiy 
tests, would kill cholera bacilli promptly. His offer to electrolyze the 
solution was accepted, and for two days, four of the> wagons used this 
fluid. In a short time all the lime in Manila and vicinity was usod 
and the entire daily output of the kilns in the Island of Luzon was 
taken. The lack of lime sometimes caused the cessation of lime disiii- 
fection at 3 or 4 o'clock in the afternoon, but lime squads were equipped 
with shovels, hoes, rakes, brooms or other cleaning up instruments, and 
their spare time was utilized in digging ditches, and cleaning up tlie 
yards of premises. 

Infected districts were subdivided into subdistricts ; maps were made 
of these subdistricts, and the foreman in charge of a disinfecting wagon 
or lime squad was furnished with a map of his subdistrict. For example. 
Meisic was subdivided into 20 subdistricts and Tondo into 14. 

The ordinary chemical fire engine makes an excellent disinfecting 
apparatus. The 80-gallon tanks are charged by CO2 produced from 
bicarbonate of soda and sulphuric acid; to make an efficient disinfecting 
solution it is only necessary to add carbolic acid, creoline or other disin- 
fectant to this solution. The ordinary street-sprinkling wagon is conveit- 
ible into an excellent disinfecting apparatus. All that is necessary is to 
install an ordinary pressure pump, and several hundred feet of hose, put 
in the disinfectant, and fUl the tank from the street hydrant. We u- 
eleven of these wagons and four chemical engines, and they were aii 
effective. The tank wagon possessed the advantage of being cheaper, as 
the cost of soda and sulphuric acid for charging the chemical engine is 
not inconsiderable. In Manila the cost was offset by receiving the ser- 
vices of the chemical engine crew free of charge. 

Several kinds of disinfectants were used in the tank wagons. Crystal 
carbolic acid does not mix readily and requires careful handling in using 
it on a large scscle. Formalin is good but causes a great deal of complaint 
from the people because of its irritating properties. Crude carbolic, in 
our experience, did not mix well, and from both kinds of carbolic acid, 
because of irregular distribution in the solution, minor accidents oc- 
curred, as burning of the hands and feet of the. laborers, and killing of 
dogs and chickens. The most satisfactory disinfectant was J eyes fluid, 
a creoline preparation which we secured from Hongkong. It is nearly 
foolproof and is very effective. It mixes perfectly with water, forming 
a niilkv solution of uniform strenorth. It does not burn the liands or 



180 

feet of the laborers or of children ahoul llio li()us(\ .mtl wn ill cfTi^'i^^ in»ou 
animals or chickens were noticed. 

The simplest and most effective way to use lime is with a bucket and 
a ladle. The lime gang of from 15 to 25 men was handled by one white 
foreman and one native "capataz." Each gang was followed by a cart 
with lime. Each native lime tlirower carried a bucket and scoop or 
ladle. After a little patient instruction, the natives learned to use the 
lime to the best abvantage, to place it where it was needed, and to avoid 
the spots where it was unnecessary. Their instructions were definite 
and included liming all closets and places wliere fecal matter existed or 
was likely to be deposited. 

Each chemical engine Avas handled by its own crew in charge of a 
lieutenant of the fire department. 

Each tank wagon was in charge of an American foreman, who directed 
the disinfection, was responsible for the thoroughness of the work, and 
for the conduct of the six natives who manned the pump and hose. 

In giving foremen their instructions, great stress was laid upon tlie 
necessity of displaying courtesy at all times. They were instructed to 
take part in no argument wdth householders or others, and to do their 
work with consideration for the feelings of the people, but none the less 
thoroughly. If actual obstructions were encountered, they were to notify 
the central office at once. The result of these instructions was that 
during the whole campaign the valid complaints were less than a dozen. 
All complaints were promptly investigated by the Acting Director of 
Health, and if found to be valid, the foreman in charge was dismissed. 
Only one case of actual obstruction was encountered; this man refused 
to permit the disinfectors to enter; he was arrested, fined 1P50, and no 
further trouble occurred. 

The organization was mobile, and concentration of disinfecting wagons 
from Paco, Intramuros, and Sampaloc, as a reenforcement of Meisic and 
Tondo, was effected w^hen necessary, with good results. 

The general plan of campaign was as follows : 

House-to-house inspection by police to discover promptly cases of cholera. 

Constabulary guard upon house and inmates to prevent ingress or egress until 
removal of the patient and disinfection of the house. 

Examination of the stools of cholera contacts to find bacilli carriers, the 
bacilli carriers being sent to San Lazaro Hospital for treatment. 

Daily disinfection of all unsanitary closets with lime, and disinfection of ground 
surfaces known to be, or suspected of being, soiled with fecal matter. 

An attempt was made to disinfect daily all closets in the strong-material 
districts, which were not flush closets or which were not kept clean. In 
the light-material districts the effort to disinfect the dejections of tlie 
entire population necessitated the disinfection of entire districts. It 
was necessary to disinfect practically the whole ground area. When one 
considers the enormous area to be covered daily in Tondo, Sampaloo, 



190 

Malate, and Paco. with their outlying barrios, and the fact that there are 
over 5,000 unsanitary closets in the Meisic district alone, the magnitude 
of this work may be imagined. 

Two general methods of disinfecting were employed ; ( 1 ) the spreading 
of lime, and (2) disinfection with water wagons, hose and pump, or by 
chemical engines, containing carbolic acid, creoline, formalin, or other 
disinfecting material. 

Lime was effective in conjunction with drainage in the low-lying 
swampy nipa districts, and also for disinfecting the bad closets in the 
strong-material districts. The tank wagons and chemical engines were 
used for general disinfection of lower floors, outhouses, patios, stables 
and closets in both strong and light material districts. 

Two factors, more than any others, make difficult the suppression of 
cholera in Manila; (1) the existence of bacilli carriers and bad closet 
facilities or none at all; (2) failure to find cases early. 

The presence of bacilli carriers makes necessar}^ the safe disposal or 
disinfection of the dejections of the entire population. 

The experience of the writer in the recent epidemic points to the fact 
that the most important role in the transmission of cholera is played 
by the bacilli carrier. 

If a bacilli carrier be a person of cleanly habits, and if he be in 
possession and makes use of proper closet facilities, he is practically 
harmless. But on the other hand, a bacilli carrier of filthy habit:-, 
who has no closet facilities, or refuses to avail himself of the public 
closets furnished him, is the greatest menace to the public health which 
can possibly exist, so far as cholera is concerned. The demonstration 
of the fact that over 7 per cent of apparently healthy individuals in 
the Meisic and Tondo districts were bacilli carriers, coupled with the 
unsanitary closets of Meisic district and the absence of or failure to use 
public closets in the nipa districts, will go far toward explaining the 
dissemination of cholera in Manila this year. 

Every effort was made to discover promptly light cases of the disease 
and bacilli carriers. When a case of cholera was found, the house was 
quarantined until the removal of the patient and until the disinfection 
had been completed. The stools of the other inmates were taken f 
the purpose of discovering bacilli carriers. These, if found, were sc 
to the San Lazaro Hospital, and there detained until the vibrios dis- 
appeared from their stools. A house-to-house inspection was made of 
a large area, having the infected house for a center. This was done 
daily for five days. 

The following tables show the number of apparently healthy persons 
examined for cholera bacilli, and how many were really carrying the 
bacilli : 



191 



BILIBID PRISON. 



Number of persons examined 204 

Number found positive ^ 17 

Percentage found positive 0.44 

CITY OF MANILA. 
(Exclusive of all hospitals and Bilibid Prison.) 

Number of persons examined 370 

Number found positive 27 

Number found negative but containing vibrios other than 

cholera 46 

Percentage found positive 7.18 

Percentage found negative but containing vibrios other than 

cholera 12.25 

Even with perfect daily disinfection of closets and places soiled with 
fecal matter, all chance of infection from bacilli carriers is not cut off, 
because a bacilli carrier with his soiled fingers may infect the food or 
drink of other persons. 

The prohibition of certain native foods, fruits, and vegetables was 
necessary, not only because these substances were often infected or 
dangerous of themselves, but they were also the substances carelessly 
handled by dirty people of dirty habits, many of whom were undoubtedly 
bacilH carriers, and they were the substances which were eaten without 
sterilization by boiling or cooking after such handling. 

It has been demonstrated this year that the perennial outbreaks of 
cholera in Bilibid Prison are probably due to bacilli carriers. Upon the 
appearance of cholera in Bilibid Prison, the writer gave orders that 
stools of those who had anything to do with the preparation or handling 
of food or drink be examined for cholera. Two hundred and sixty- 
four samples were taken and of this number of apparently healthy 
persons, 17 were carr3'ing the cholera organisms in their intestines. To 
find out and isolate all the other bacilli carriers would have involved an 
amount of work in stool examinations alone which would have been 
impossible for the already overtaxed bacteriologists. 

Results were obtained by an order from the writer to compel washing 
of the hands in disinfecting solution after stool and before eating. This 
order was enforced and cases ceased to appear, although there were 
doubtless many bacilli carriers among the 3,000 prisoners whose stools 
had not been examined. 

The practice of taking stools had to be discontinued when the cases 
increased to such an extent that it was no longer possible to continue it. 
For the same reason, the house-to-house inspection of infected areas had to 
be supplanted by a general house-to-house inspection of the whole city 
when the number of infected houses, that is houses in which cholera 
had appeared within five days, reached 200. 



192 

Failure to find cases of cliolera early makes the suppression or the 
disease difficult. Cases, even with the house-to-house inspection, are 
from two to twenty-four hours sick before discovery. Upon discovery a 
quarantine guard is placed upon the house and inmates, and from this 
point that particular focus is adequately cared for, but, in the hours 
before discovery other individuals probably have been infected. 

When a Filipino falls ill, all the neighbors will, either through in- 
terest or curiosity, crowd into the house. Upon discovery, or upon 
decision of the householder or doctor to report the case, these people 
promptl}^ scatter, go to their meals without washing their infected hands, 
eat their rice with these same infected hands, and even carry with them 
from the infected houses mats, articles of clothing, food and drink, to 
save them from the all-destroying disinfectors. Our disinfectors try to 
trace out these other houses to which clothing, etc., has been carried, but 
it is very difficult and often impossible. 

To illustrate the spread of the infection in this way, the couree of the 
disease in the Meisic District may be taken as an example. It will be 
observed that every four days there is a sudden increase in the number 
of cases. These are the persons infected from the cases of four days 
previous. It does not mean an incubation of four days, for these cases 
when found have already been sick for some time, but it would indicate 
an incubation of from two to three days. 

Counting a house where cholera had been found within five days a5 
a focus, on September 23 there were 241 infected foci in the city of 
Manila, well scattered, as is shown by the following table : 

District. Nuruberof 

infected foci 

Meisic 66 

Tondo 50 

Sampaloc 41 

Intramuros 54 

Paco 21 

Total : 341 

With the organization and the employment of the measures outlined 
above in twelve days the number of cases was reduced from 60, the 
maximum number in one day (September 20), to 5 cases on October 3. 
A few cases occurred daily throughout October, and these cases, in nearly 
every instance, came from well-known cholera areas, districts in which 
cholera persists after. its eradication from the more cleanly and sanit 
portions of the city. 

For example, of the last 75 cases in October, 33^ per cent, occurred in 
the district bounded by Calles Bilibid and Paz on tlie south, Calle Mag 



ite 1 

il 



t 



193 

riia and San Lazaro Estero on the west, tlie railroad on the north, 

and Calle Felix Huertas on the east. This district has no surface drain- 

; the interiors are lower than the street gutters of Calle Cervantes, 

I the majority of the houses, during a great part of the year, stand 

r collections of filthy water, slime and muck. This office demon- 

ited to the city authorities the feasibility of draining this area by 
! iclies and the drainage work is now in progress. 

Nine per cent, occurred in a triangle formed by Calle Azcan-aga on 
one side, Tondo beach on the second side, and Calle Ylaya and Calle 
.Quesada on the third side, one of the best examples of the illegal por])et- 
uation of the nipa shack in the strong material district. 

Eight per cent, occurred on the upper end of Calle Lemery and its 
continuation Gagalangin, where drainage problems also roiuaiu to be 
solved. 

Nine per cent, occurred in a small section of Meisic district, bounded 
by Calles Aceiteros, Santo Cristo, San Nicolas and Madrid. This district 
contains the filthiest and most u^sanitary closets in the city of Manila. 

Four per cent, occurred in the barrio of Balicbalic; other cases occurred 
in Palomar, in Calle Antonio Rivera, in Bancusay, and other nipa 
barrios. The other 20 cases were scattered and widely separated; 3 in 
Paco, 5 in Meisic, 5 in Sampaloc, 1 in Ermita, 1 off the Malecon Drive, 
1 in Malate, and 3 in Tondo. Less than 10 per cent, were found in 
the strong material district, and most of these could be traced to one of 
the above mentioned plague spots. 

Cholera is the same disease, whether encountered in Germany, Russia, 
Italy, Egypt, India, or the Philippines, but the measures taken to prevent 
its spread and to suppress the infection depend upon the geographical 
location of the epidemic. To suppress a cholera epidemic in a country 
like Germany, for example, is a comparatively simple proposition; while 
in the Philippines its suppression is complicated by existing conditions 
peculiar to these Islands. 

Four things are of prime importance for the suppression of cholera: 
(1) A good water supply for all the people; (2) safe disposal of the 
dejections of the entire population; (3) prompt discovery of cholera 
cases, suspects, or bacilli carriers, with immediate isolation and disinfec- 
tion, and (4) habits of cleanliness. 

If the water supply is free from cholera and can be kept so, then the 
spread of the epidemic depends upon the improperly cared for stools of 
the persons carrying the bacilli of cholera. . Flies, cockroaches, and other 
insects or animals having access to such stools carry the infection to food 
or drink. There is infection from persons who do not wash their hands 
and whose soiled fingers carry the infection to food or drink. There is 
also direct infection from actual cases of cholera. 
78079 13 



194 



WATER. 



Manila city water has been examined daily by the Bureau of Science 
and the cholera bacilli have not been found therein. However, with the 
appearance of cholera in San Mateo and Mariquina, it was deemed 
prudent to place a military guard to prevent possible pollution of the 
river. 

The new water supply, taken from higher up the gorge, will be 
practically safe from contamination by human excrement. 

The great trouble with the Manila water supply is that it does not 
reach all the people. Some barrios are at a great distance from the 
nearest hydrants, and they must carry, or pay for carrying, a long dis- 
tance. As a result, they use the water from shallow wells, ponds, csteros, 
or other questionable sources, for washing clothes, kitchen utensils, and 
also in many instances for drinking purposes. 

It was deemed necessary to close all wells, except a few in the more 
distant barrios, which were treated with permanganate of potash. Besides 
closing wells, wherever possible all stagnant places were drained by 
digging ditches and certain small, infected esteros were patrolled by 
the Constabulary to prevent the people using the water. 

■ DISPOSAL OF THE HUMAN EXCREMENT. 

The new sewer system is another sanitary improvement anxiou^h 
awaited. The existence in Meisic district of thousands of tight vaults 
and filthy closets is responsible in a great measure for the spread of 
cholera in that district and the difficulty experienced in eradicating t je 
disease. These filthy closets and tight vaults can be replaced by modern 
flush closets connected with the new sewer system. In the newer residence 
districts, septic vaults and absorbing basins are used as receivers of 
sewage from modern flush closets. It will be an improvement when all 
vaults, however satisfactory in construction, are no longer necessary, 
because of the installation of the new system. 

In the nipa districts, the people depend upon the sparsely scattered 
public closets or have no closet facilities whatever. In the latter instance, 
the fecal matter is deposited in the most convenient place; in the long 
grass, in the estero, in pools or gutters, or under the house. The family 
pig .takes care of a considerable quantity of human excreta and garbaL^c. 

There are large barrios within the limits of the city of Manila wh 
the only way of entrance is a path too narrow to permit a wagon to pass. 
These, of course, have no garbage-collection or closet facilities. 

Habits of cleanliness are best secured by a campaign of popular educa- 
tion. Excluding the water supply and the disposal of feces, the other 
factors in spreading infection can be nullified by the inculcation of cleanly 
habits. If the bacilli carrier washed his hands often enough and at the 



19.5 



I'll' 



3per times he would not transfer infection from his dirty fingers to 
food or drink of others. If the kindly native neighbors who assist 

ose sick with cholera, and who disappear before the arrival of the health- 

icers, can be taught the necessity of washing their hands before eating 

handling food, many more cases will be prevented. 

The Bureau of Health has printed cholera circulars in Spanish, English. 
and all the native dialects, telling how to protect one's self and others 
a-ainst the infection of cholera. This campaign is best conducted iii the 

toolroom and from the pulpit. The Bureau of Education and the 

unan Catholic Church have cooperated in an attempt to spread 

' knowledge and advice contained in the cholera circulars among the 

ople. Efforts along this line have met with success but it requires a 

ig time to completely change the habits of a people and it will prob- 
;; 'iy require another generation to complete the work. 

The writer has made, in his report to the honorable the Secretary of 
the Interior, the following recommendations, calculated to prevent the 
recurrence of cholera in epidemic form in Manila. The difficulties which 
attend the carrying out of these projects are recognized as well nigh 
insuperable, but they are not impossible ideals, and an attempt to realize 
these ideals should be the policy of the Bureau. 

The Manila city water supply must be extended to every part of tlie 
city and placed within easy reach of everyone. 

Tanks and reservoirs must be so constructed as to preclude the pos- 
sibility of contamination. 

Esteros must be controlled and confined to definite beds either by 
adequate walls or by dredging so that any overflow land will be drained 
between tides. 

The filling in of low places, which can not be drained, to the proper 
height above the curb is essential. 

Public closets must be established in all barrios, so that every inhabitant 
of the city of Manila will have closet facilities at his disposal. It is 
advisable to have more closets even if of less seating capacity ; six closets 
of six pails each will be of more value than three of twelve pails each, 
for the reason that the native has a shorter distance to travel. Also, the 
cutting of alleys through the back yards will facilitate his journey to the 
closet. 

Before permitting land to be used for building purposes within the 
city limits, the land should be subdivided by streets and alleys upon a 
definite plan. The indiscriminate building of nipa shacks upon the 
interior of a block without order or regard for necessar}- intervening 
spaces should not be permitted. Streets and alleys should be cut through 
already existing collections of nipa shacks and when necessary houses 
removed to permit proper spacing. Streets must be opened into barrios 



196 

within the city limits which are now isolated, and have no wagon reals 
entering them to permit the collection of garbage and refuse. 

A sufficient force of sanitary police must be employed to enforce the use 
and sanitary maintenance of closets. 

All wells must be filled in. 

More stringent measures to compel the prompt reporting of suspicious 
cases must be adopted, with severe penalties for infractions of this 
ordinance. 

Stricter enforcement of the building code in the erection of new 
buildings is necessary. 

Nipa shacks in the strong-material districts must go, and repairs to 
old nipa shacks, which perpetuate this problem, must be prevented. 
These nipa districts exist by sufferance within the strong-material dis- 
tricts; dilapdated shacks crowded together in the most unsanitary man- 
ner, where there are excellent public closets, patronized only by a select 
few. The majority still find it easier to deposit or throw their dejections 
upon the swampy ground. These districts are the natural homes of 
cholera, and from there the people who are trying to live decently are 
infected by means of muchachos, cooks, or cocheros, who spend their 
spare time in these plague spots. 

A proper system of surface drainage for every part of the city of 
Manila, where such drainage is lacking, but especially for (1) the San 
Lazaro Estate and that portion of the city from the San Lazaro Estate 
to the railroad crossing on both sides of Calle Cervantes, (2) Santa 
Monica, (3) Entonio Rivera, (4) Palomar and Magdalena interior, (5) 
that portion of Tondo north of Moriones and west of Estero de la 
Reina, and (6) that part of Malate district, bounded by Herran, Wright- 
San Andres, and Nueva. 



197 






HtMTMSTAnon-> I Diagram showing privalincc op Cholcra in MANiLi 

** '^'U rROM SePT. 6v to Nov. 6t." 1908. 



< 7 8 9'ioii'i?ii3i4i5^i«i7iie'mgtiK;}i»t»w*yt«'«yK I 



iiw!ii:ainii«|it'i»;if|n'tt.t»|ii'fflati4iMW>iMl»l»«bti<'il»"i »'• 




■4fl^/'ot>ett. 



CM.e/: DiK. o/ia/jfistica. 




.../Hima/itpuu... 



Exhibit C. 



SUPPLEMENTARY EEPORT UPON THE CHOLERA EPIDEMIC OF 1908 IN MANILA. 

Department of itle Interior, 
Bureau of Health, Office of the Director, 

Manila, P. I., November IS, 1908. 

The Honorable the Secretary of the Interior, 

Manila. 

Sir: I have the honor to make the following supplementary report 
upon the recent cholera outbreak. 

Cholera in epidemic form was suppressed in twenty-three days, or 
twelve days from the day upon which it reached its maximum, but a 
few cases of cholera continued to occur in certain well-defined areas, and 
constant employment of the most energetic measures was necessary 
throughout the month of October to prevent the infection from agaiii 
assuming epidemic proportions. 

The persistence of cholera after the epidemic had been suppressed was 
due to the unsanitary conditions of certain districts, and to the apath}', 
and in some instances, the passive opposition displayed in the past by 
the municipal authorities of the city of Manila toward recommendations 
for improvement of these unsanitary conditions. These shortcomings of 
the Municipal Board may be summarized under the following heads : 

1. Failure to furnish sufficient number of public closets. 

2. Failure to supply city water to the barrios. 

3. Failure to drain unsanitary areas by cleaning the esteros and providing 
adequate street drainage. 

4. Failure to enforce building ordinances. 

FAILURE TO FURNISH A SUFFICIENT NUMBER OF PUBLIC CLOSETS. 

In substantiation of the above the following table is appended, the 
installations being requested of the Municipal Board on the dates men- 
tioned : 



p. . I Number NiimlHi 

*'*'®' requested, installed 



May 15, 1906 

September 27. 1907. 

October 23. 1907 

May 4, 1908 _ _. 

May 29, 1908 



« About 20 were appropriated for but had not been installed when cholera had reached epidemic 
proportions. 
198 



199 

As a sample of the attention whicli comiiuinicatioiis from this oflBce 
have received, the following correspondence in regard to the request for 
two pail sheds made on January 24, 1908, is cited. 

Station C, Tondo, January 24, 1908. 
Sanitary Engineer, Bureau of Health. 

Sir: I have the honor to recommend that public closets be constructed at the 
following places : 

In rear of the public market on Calle Gagalangin, and at No. 295 interior Calle 
Gagalangin. 

Very respectfully, W. A. Cheistensen, 

Medical Inspector, Bureau of Health. 



Manila, P. I., February 8, 1908. 

[First indorsement.] 

Department of the Interior, Bureau of Health, 

Manila, P. /., February 8, 1908. 
Respectfully referred, through the :Municipal Board, city of Manila, to the 
city engineer with the information tliat the locations for public closets recom- 
mended by Medical Inspector W. A. Christensen, meet the approval of this office. 
Attention is invited to a previous communication signed by some 27 peti- 
tioners dealing with this matter and forwarded by the undersigned to the Munic- 
ipal Board on September 27, 1907. 

Victor G. Heiser, Director of Health. 

No reply to this letter was received. 

Under date of August 7, 1908, the undersigned received a petition 
forwarded by the Secretary of the Municipal Board, in which the residents 
petitioned for the very closet previously recommended as per above com- 
munications by this office, it appearing from the inclosed correspondence 
that the letter of January 24 had been filed and forgotten. 

Manila, I. F., 22 de Jutio de 1908. 
Hon. Felix M. Roxas, 

Alcalde de la, Ciudad de Manila, I. F. 
Honorable Senor: Los que suscriben, veeinos todos al rededor del Mercado 
publico del barrio de Gagalangin, Tondo, a su honorabilidad con el debido res- 
peto se presentan y exponen: 

1. Que en el barrio de Gagalangin, y A raiz de una peticidn hecha por algimos 
veeinos del mismo barrio, se han instalado dos escusados pfiblicos situados en 
ambos extremes de la calle Real de Gagalangin. 

2. Que estos dos escusados son distantes uno y otro del lugar donde estfi 
situado dicho mercado, y por tal motivo les hace imposible acudir fi los mismos 
los que viven en el centro 6 sea al rededor del citado mercado, especialmente en 
esta 6poca de aguas. 

3. Que todos los recurrentes son pobres y carecen de recursos para costear 
cubetas en sus propias casitas. 

4. Que los recurrentes creen que el mercado pflblico, es el mfis concurrido por 
ser de donde surte la vecindad efectos de primera necesidad y por tanto es el 
mfis llamado y conveniente tener al lado del mismo un escusado pflblico como 
en los demSs mercados de esta capital. 



200 

5. Por las razones expuestas; suplican & su honor, tenga k bien decretar n 
que en el lugar adecuado para el easo, sea al lado mismo del mercado ptiblico 
de Gagalangin, se instale un eseusado publico; pues obrando asl, quedarlan bene- 
ficiados tantos los recurrentes como sus familias en particular y el ptiblico en 
general. 

Honorable senor, 

Firmados: Ramon del Rosario, Gagalangin 214. Matias Sobrit- 
chea, Gagalangin 215. Justa Tabora, V. Muyot, Catalina 
Muyot, Ambrocio Santos, Sabina de Leon, V. Garcia, Nar- 
ciso Garcia, Deogracias Sanvutores, S. del Rosario, Silvina 
Ysidoro, Canuto Pena, Doroteo Aguilar, Dora Raquindan, 
Francisco Santos, J. Haru, Eladio Santiago, Patricio Gon- 
zalez, Pedro Gonzaga, Ladislao Lucas, Canuto Sacramento, 
Teofilo Domingues, Antito Tabora. 

[First indorsement.] 

City of Manila, Municipal Board, 

Office of the Secretaey, 

August 7, 1908. 
Respectfully referred to the Director of Health, in connection with the papers 
relating to midden sheds sent him on August 4, 1908. 
By direction of the Board: 

H. L. Fischer, Secretary. 
[Second indorsement.] 

Department of the Interior, Bureau of Health, 

Manila, P. I., August 7, 1908,M 

Respectfully returned to the Municipal Board inviting attention to a caa 

munication from this office dated February 8, 1908 (copy inclosed). This marke" 

site was not included in the more recent communication of may 29, 1908, as i1 

was hoped that the Board still had the matter under advisement. 

The site being a public market, it is doubly important that it be supplied! 
with closet facilities. 

A. J. McLaughlin, 
Acting Director of Health. 

Supplementary to the above, attention is invited to the fact that the 
letter of January 24 is a request for the installation of a public closei 
in one of the municipal markets. 

Failure to supply city water to the barrios. 

Date requested. May 15, 1906. 

Number of hydrants requested 21 

Number installed 3 

Date installed, 1906 and 1907. 

FAILURE TO DRAIN UNSANITARY ARK AS. 

The city, at present, due to lack of street drainage, and to filthy esteroSj 
is suffering from the unsanitary conditions thus naturally created. The" 
Bureau has made every effort to present conditions as tliey actually exist 
to the Board, but very little notice has, to date, been given to com- 
munications sent. 



201 

As a fair sample of the attention which communications have received, 

a copy of the following letter, with its indorsements, is respectfully 

submitted : 

June 5, 1907. 
The City Engineer, Manila, P. I. 

Sir: I have the honor to invite your attention to the present low, unsanitary 
condition of Calle Limasana off Calle San Sebastian, Quiapo. 

It is desired by this office to issue sanitary orders against certain houses in the 
rear of Calle San Sebastian but until the above-mentioned street is raised and 
guttered down as far as the estero to the rear, it will be difficult for the owners 
to have anything definite to work to. The estero already mentioned, is also in 
a very unsanitary condition, and should be dredged or filled in, in some manner, 
it being at present more of a menace to the health of the community than the 
houses surrounding it. 

Hoping that you may have this locality examined with a view to alleviating 
the conditions, I am, 

Very respectfully, Geo. H. Guerdrum, 

Acting Chief, Division of Sanitary Engineering. 



City of Manila, 
Department of Engineering and Public Works, 
Office of City Engineer, 

June 6, 1907. 
Mr. George H. Guerdrum, 

Chief, Sanitary Engineering Division, Bureau of Health, Manila. 
Sir: In reply to your letter of June 5, I have the honor to state that Calle 
Limasana does not extend to the estero of which you speak, and this office knows 
of no law which gives us the right, even should we so desire, to fill private lands 
at public expense. 

Very respectfully, W. P. Wylie, 

Acting City Engineer. 

The above curt reply clearly portrays the attitude of at least one 
municipal oflBcial. 

Calle Limasana is a public street. The estero mentioned is a public 
waterway. The incidental feature that Calle Limasana does not extend 
quite to the estero is dilated upon, while the important fact that the calle 
and the estero are in need of attention from the municipal authorities is 
ignored. 

The matter, however, was allowed to rest only temporarily, when the 
question was again taken up, as shown by the copies of the communica- 
tions given below. 

October 10, 1907. 
The Director of Health, Manila, P. I. 

Sir: In accordance with the provisions of Chapter XXII of the Sanitary Code, 
I have the honor to invite attention to the unsanitary condition of the small 
estero in the rear of Calle San Sebastian and Calle Limasana. Due to the fact 
that the stream is now practically filled with stagnant wastes from various 
sources, the water level has been raised to such an extent that it is nearly 
impossible to secure proper drainage for the adjoining houses. 

It is respectfully requested that the honorable Municipal Board or the city 



202 

engineer be notified of the condition, with the request that steps be taken toward 
the alleviation of the condition now existing by dredging and deepening the 
stream, and if possible protecting the banks from further washing into the river. 
Very respectfully, 

Geo. H. Guerdrum, 
Chief, Division of Sanitary Engineering. 

[First indorsement] 

Bureau of Health, 
Manila, P. I., Octoler 10, 1907. 
Respectfully forwarded to the Municipal Board, city of Manila, inviting 
attention to within communication. 

Victor G. Heiser, Director of Health. 

[Second indorsement.] 

City of Manila, Municipal Board, Secretary's Office, 

October 12, 1907. 
Respectfully forwarded to the city engineer, for investigation and report. 
By direction of the Board: 

Jno. M. Tuther, Secretary. 

[Third indorsement] 



Department of Engineering and Public Works, 

Office of the City Engineer, 

Manila, January 7, 1908 
Respectfully returned to the Secretary of the Municipal Board, with the 
formation that the estero has been cleaned as far as possible, and is bein^ 
gradually filled in with street refuse and sweepings by the department of sanita 
tion and transportation, and the sanitary conditions are improved. 

W. P. Wyle, City Engineer 



4 



[Fourth indorsement.] 






City of Manila, Municipal Board, Secretary's Office, 

January 8, 1908. 

Respectfully returned to the Director of Health, inviting attention to the 
preceding indorsement. 

By direction of the Board: 

G. S. Lane, Acting Secretary. 

[Fifth indorsement] 

Department of the Interior, Bureau of Health, 

Manila, P. I., January 28, 1908. 
Respectfully returned through the Municipal Board to the city engineer, with 
the information that upon reinspection it would appear that Mr. Guerdrum's 
letter and the indorsement of the city engineer did not refer to the same estero. 

There is a street gutter along the north side of Calle Limasana which receives 
the drainage from four or five houses and stops at a distance of about 50 meters 
from the estero. From the end of the gutter the drainage flows in a small 
stream to the estero in question, across the property of Dona Rosa Roxas. To 
fill in the estero in question would make it necessary to change the grade of the 
gutter referred to above, so that its contents would go off through Calle San 
Sebastian. 

Victor G. Heiseb, Director of Health. 



i 



203 

Baguio, Benguet, May 7, 1908. 
The Secretary, Mumcipal Board, Manila. 

Sir: I have the honor to invite attention to a communication from this office, 
forwarded to the Municipal Board on October 10, 1907, in wliich it is requested 
that an estero in the rear of Calle San Sebastian near the end of Calle Limasana 
be cleaned or dredged. 

Under date of January 7 in an indorsopient to the letter the city engineer stated 
that the sanitary conditions had been improved, in that the stream in question 
was gradually being filled with street refuse, sweepings, etc. 

The undersigned under date of January 28, 1908, returned the communication 
to the city engineer through the office of the Municipal Board with a statement 
to the effect that the city engineer and the sanitary engineer were probably 
referring to different esteros. 

No reply has been received in regard to this communication although more 
than three months have elapsed since the date last mentioned. 

Supplementary to previous communication it is desired to explain that this 
office is not desirous of having the stream filled up, as it is now the natural 
drainage for considerable territory between Calzada de Iris and Calle San Sebastian, 
and moreover is navigable for lumber rafts and small boats up to just below the 
territory complained of. What this office does desire is that the stream be cleaned 
of all filth and accumulated silt and if possible that it be deepened and widened, so 
that the adjacent land may be allowed to drain itself between tides. This com- 
mimication applies also to the various ramifications of the estero which are 
included between the Estero de Quiapo, Calzada de Iris, Calle Juan de Juanes, 
Bilibid Viejo, San Sebastian and Mendoza. 

Notification as to what action the Board intends to take in the matter is 
respectfully requested. 

Very respectfully, Victor G. Heiser, Director of Health. 



June 4, 1908. 
The Secretary, Municipal Board, Manila. 

Sir: I have the honor to advise that this office has to date received no reply 
to a communication dated May 7, 1908, dealing with a request for the cleaning 
and dredging of certain esteros contained within the territory bounded by the 
streets of Mendoza, San Sebastian, Bilibid Viejo, Juan de Juanes, Calzada de 
Iris, and the Estero de Quiapo. 

Information as to any proposed action on the subject by the Municipal Board 
is requested. 

Very respectfully, Victor G. Heiser, Director of Health. 

It seemed hopeless to expect even the courtesy of a reply in the face 
of the attitude assumed by the Municipal Board, and the matter was tem- 
porarily abandoned. 

A copy of another letter dealing with the drainage of another estero 
is also submitted, the various indorsements being self-explanatory. 

October 10, 1907. 
The Director of Health. Manila. 

Sir: I have the honor to invite your attention to the unsanitary condition of 
a small stream heading near Calle Vergara between Calles Balmes and Alejandro 
Farnesio in the district of Tanduay. Due to the fact that the stream is now 
practically filled with stagnant wastes from various sources, the water level has 



204: 

been raised to such an extent that it is nearly impossible to secure proper drainage 
for the adjoining houses. 

It is respectfully requested that the honorable Municipal Board or the city 
engineer be notified of the condition, with the request that steps be taken toward 
alleviation of the conditions now existing by dredging and deepening the stream 
and if possible protecting the banks from further washing into the river. 
Very respectfully, 

Geo. H. Guerdeum, 
Chief, Division of Sanitary Engineering. 

[First indorsement.] 

Bureau of Health, 
Manila, P. I., October 10, 1901. 
Respectful 1}'^ forwarded, to the Municipal Board, city of Manila. 

Victor G. Heiser, Director of Health. 



Baguio, Benguet, May 7, 1908. 
The Secretary, Municipal Board, Manila. 

Sir: I have the honor to invite attention to a communication from this office 
dated October 10, 1907, in which it was requested that an estero located between 
Calles Balmes and Alejandro Farnesio, Tanduay, be cleaned and deepened, with 
reference to which this office has to date received no reply. 

It is respectfully requested that the undersigned be notified as to what action 
has been or will be taken in the matter. 

Very respectfully, Victor G. Heiser, 

Director of Health. 
Other correspondence is submitted. 

June 6, 1908. 
The Municipal Board, City of Manila. 

Gentlemen : I have the honor to request that an examination of the unsanitary 
conditions existing at the corner of Calles Lepanto and Iris, Sampaloc, due to 
the lack of street gutters be made under the direction of the Board, with a view 
to the construction of cement gutters for the locality. 

Very respectfully, Victor G. Heiser, 

Director of Health. 



iew J 



June 12, 1908. 
The Director of Health, Manila. 

Sir: In reply to your communication of June 6, 1908, calling attention to 
unsanitary conditions at the corner of Calles Lepanto and Iris, Sampaloc, and 
requesting that cement gutters be constructed in this locality, I have the honor 
to inform you that this matter has already been taken up by the Board and a 
liberal provision for gutters for drainage purposes made in the estimates for th 
coming fiscal year. 

In this connection I desire to invite your attention to the fact that it wou' 
be a useless waste of money for the city to undertake to remedy such conditions 
in certain particular places without reference to a general scheme for the improve- 
ment on the drainage for the whole city, and the question for the drainage of the 
whole city has been thoroughly worked out and plans about completed. It is, 
however, such a gigantic undertaking that funds are not available to carry out 
the whole scheme at once and it will * * * therefore, be necessary to proceed 
slowly. 

Very respectfully, G. S. Lane, Acting Secretary. 



t 



I 



[First indorsement] 

Department of the Interior, Bureau of Health, 

Manila, P. I., June IS, 1908. 
Respectfully returned to tlie acting secretary. Municipal Board, requesting that 
this office be furnished with the general scheme for the drainage of the whole 
city, and more particularly the section of the city in question, in order that 
• iiplicate recommendations may not occur in the future. 

In this connection, information is respectfully requested as to whether the 
v.cws expressed in the within letter are those of the acting secretary or those of 
the Municipal Board. 

Victor G. Heiser, Director of Health. 

[Second indorsement.] 

City of Manila, Municipal Board, Secretary's Office, 

June 17, 1908. 
Respectfully returned to the Director of Health. 

Major Case, chief engineer, department of sewer and waterworks construction, 
informs me that the plan for the drainage of the city, spoken of in my letter, 
will be ready to submit to the Municipal Board for approval probably within 
two months. When same has been approved by the Board, a copy will be furnished 
the Bureau of Health. 

In reply to the second paragraph of the first indorsement hereon, I have the 
honor to inform you that the views expressed in the within letter are the views 
of the Municipal Board and not necessarily of the acting secretary. 
By direction of the Board: 

G. S. Lane, Acting Secretary. 

[Third indorsement.] 

Department of the Interior, Bureau of Health, 

Manila, P. I., June 19, 1908. 
Respectfully returned to the Municipal Board with the suggestion that the 
condition of this corner constitutes a local nuisance which could probably 
be remedied without waiting for the general storm water sewerage system, which 
it is believed can not be put into operation for several years yet to come. 

Victor G. Heiser, Director of Health. 

It would seem the height of folly to permit these unsanitary conditions 
to exist pending installation of the general storm water sewerage system, 
which probably will not be installed for years. In the meantime, whole 
areas without street drainage, constituting a direct menace to the public 
health and one of the undoubted causes of the persistence of cholera, are 
permitted to exist when the conditions could have been corrected at small 
cost by temporary drains, as is at present being demonstrated by this 
Bureau upon the San Lazaro Estate. 

A recent example of the class of replies received is appended : 

June 9, 1908. 
The Municipal Board, Manila. 

Gentlemen: I have the honor to advise that the attention of this office has 
been called to the unsanitary condition of Calle Lavanderos, Sampaloc. 

There are no gutters to this street, while the road surface is low, muddy and 
insufficiently metalled. 



206 

It is respectfully requested that an examination of the locality be made under 
the direction of the board and that steps be taken to correct the existing condi- 
tions. 

Very respectfully, Victor G. Heiser, Director of Health. 



June 12, 1908. 
The Director of Health, Manila. 

Sir: In reply to your communication of June 9, 1908, calling attention to tho 
condition of Calle Lavanderos, Sampaloc, I have the honor to inform you that 
this matter has already been considered by the city engineer and the condition 
will be remedied as much as possible and as soon as possible. 
Very respectfully, 

G. S. Lane, Acting Secretary. 

SAN LAZARO ESTATE. 

The notoriously unsanitary condition of the San Lazaro Estate has 
repeatedly been brought to the attention of the Municipal Board as the 
following correspondence shows : 

August 20, 1907. 
The Director of Health, Manila, P. I. 

Sir: I have the honor to submit herewith a report on the unsanitary condition, 
due to the lack of drainage, in the thickly populated portions of the San Lazaro 
Estate, the conditions being as follows: 

1. The streets have very little, if any, drainage, either longitudinally or 
transversely. 

2. There are no side drains to the streets, if there were any at one time, they 
have become completely obliterated. 

3. The entire harrio is practically without drainage facilities of any sort. 

To prevent the place from becoming a menace to the health of the city the 
following statement of improvements needed is respectfully submitted: 

1. A comprehensive system of paved or cemented street drains is essential. 
They should be below the level of the street (which may necessitate the elevation 
of the street grades) and built on systematic lines, on properly determinated 
grades. 

2. The ground surface of every house should be at a higher elevation than that 
of the adjacent canal and all water from the houses should drain therein. 

3. The ground beneath every kitchen or place where foul water may be 
thrown or allowed to collect should be cemented, with an incline to the street 
or yard canal; all subsidiary canals to be connected with the street canal with 
a grade of not less than one in fifty. 

Until the first recommendation, has been complied with it is believed that 
will be useless to attempt even temporary relief by endeavoring to comply with 
paragraphs 2 and 3. 

Very respectfully, Geo. H. Guerdrum, 

Chief y Division of Sanitary Engineering, 



I 






[First indorsement.] 

Department of the Interior, Bureau of Health, 

Manila, P. /., August 21, 1907. 
Respectfully forwarded to the Municipal Board for its information. 
The undersigned understands that there is some question at the present time 
as to who should pay for new streets and sewers on the San Lazaro Estate, and 



207 

that no large amount of money is available for this purpose, yet, at the same time 
this matter should receive consideration to the end that a systematic plan be 
followed providing for better sanitary conditions. 

Victor G. Heiseb, Director of Jlealth. 

NTo reply to the above was received. 

On April 28 the following letter was forwarded : 

April 28, 1908. 
The City Engineer, Manila. 

Sir: I have the honor to again invite attention to the lack of gutters and 
general drainage facilities on the San Lazaro Estate. 

It is now in the middle of the dry season but stagnant pools of mosquito and 
disease breeding liquid wastes are even now scattered throughout the area in 
question. In the strong material section many of the tenants have done everything 
that could be reasonably requested of them in the way of constructing vaults, 
absorbing basins, etc., the effluent of which can not be properly taken care of. due 
to lack of both surface and under ground drains. In other cases the street grades 
have been raised to such an extent that they surround the block, converting what 
was once fairly well drained land into an offensive marsh, rendering useless any 
local attempts at drainage by tenants. 

These tenants pay high rents and receive very little benefit therefrom. The fact 
that the place is in as fair a condition as it now is, is due largely to the natural 
excellence of the land for building purposes and to the rigid requirements of the 
administrator in regard to building operations, etc. The requirements are, how- 
ever, largely at the expense of the tenants and it is hoped that means can be 
found by which the Government, as owner of the estate can do its share toward 
making the necessary improvements. 

Especial attention is invited to the present condition of Calles Mayhaligue, 
Zurbar^n, and Oroquieta, these streets being adjacent to the main thoroughfare 
of Calle Cervantes. 

Very respectfully, Victor G. Heiser, Director of Health. 

FAILURE TO INFORCE BUILDING ORDINANCES. 

Eeports have already been made on this general subject. The previous 
reports cover the general condition of certain buildings, erected under 
permit at the following places: Palomar, Tondo; 87 interior Aceiteros, 
San Nicolas; 104 interior Aceiteros, San Nicolas; 104 interior Concep- 
cion, Ermita ; the Grand Opera House, Calle Cervantes. 

In addition may be mentioned a two story house at the comer of 
Calles Diaz and Luzon, Magdalena. Permit was granted for a one-story 
structure but in the completed building the lower part is made use of in 
spite of the fact that there is head room of less than 2 meters, the Building 
Code stating specifically that no room must be less than 3 meters in height. 

Building permit No. 1570 ; approved, December 28, 1907. 
• 

The struggles of this office with the nipa-shack problem, in the hard- 
material part of the city may be illustrated by submitting the following. 

During the months of December, January and February, 1907 and 
1908, this office, assisted by the Manila Eailway Co., succeeded in having 
numerous shacks removed from the property facing on Santa Monica 



208 

and situated between that street and the estero de la Reina. It was 
found, however, that a number of the people had merely removed their 
shacks across the estero and in defiance of building ordinances had 
erected their huts at the interior of 658 Lemery, Tondo. 

The following correspondence ensued, after many other vexations delav- 
had occurred. 

Station C, Tondo Board of Health, 

June 18, 1008. 
Lista de las pevsonas que han sido multadas por el Juzgado Municipal poi- 
reparar sus casas de nipa en la zona de materiales fuertes, los cuales viven en 
la Calle Lemery, No. 658 interior, Tondo, las siguientes: 

Nombres. Multas impuestas. 

Simeon Muuoz ^=2.00 

Ciriaco Molina 5.00 

Petronila Garcia 20 

Fausta de la Cruz 20 

Maxima de la Cruz 20 

Francisca Andres 20 

Dorotea Fulgencio 20 

A twenty-cent fine makes a very cheap building permit. 

June 10, 1908. 
The Municipal Boaed, City of Manila. 

Gentlemen: I have the honor to invite attention to the following data: 

As a result of the correspondence entered between this oflfice and the Manila 
Railroad Company, during the months of November, December, and January last, 
the plat of land known as lot No. 2 of block 15, situated on Calle Santa Monica, 
Tondo, was cleared of numerous unsanitary shacks and carabao stables. In 
vacating this land, however, a number of the people moved their huts to the other 
side of the Canal de la Reina where they now are ( interior of 658 Lemery ) . 

Such being the case, this Bureau again commenced action against these 
squatters, and during the early part of March orders were issued to have these 
places vacated. 

On May 17 a letter was received from Dr. Dominador Gomez requesting an 
extension of time for these people to vacate, which extension was granted, to 
expire June 1, 1908. 

Instead of vacating, however, a further verbal request was received from the 
tenants, presumably on the recommendation of Dr. Gomez, that the orders be 
held in abeyance or revoked. 

In view of the fact that these light-material structures have been erected in ^| 
strong-material district, it would appear that this is already a violation U\ 
section 79 and 80 as well as of section 54 of Ordinance 78, and if the necessary 
steps are taken by the Municipal Board no further action by this Bureau will be 
required. 

In this way, the unsanitary condition will be corrected and protection against 
fire secured at the same time. 

Very respectfully, Victor G. Heiser, Director of Health. 



209 

[First indorsement] 

City of Manila, Municipal Board, Secretary's Office, 

June 12, 1908. 
Respectfully referred to the city engineer, for recommendation. 
By direction of the Board : 

G. S. Lane, Acting Secretary. 

[Second indorsement.] 

Department of Engineering and Pubuc Works, 

Office of the City Engineer, 

Manila, June 16, 1908. 

Respectfully returned to the secretary of the Municipal Board with the 
following report: 

Of all the shacks cleared away from the Santa Monica property, only four 
(4) were removed to the site under discussion (interior of 508 Lemery). All 
the rest of the houses on the property of Mr. Perez have been there for some 
years. As to their sanitary condition, the Board ascertained their condition on 
its visit last month. The four shacks recently moved to this site are situated 
in the southeast corner of the property, and practically surrounded by a 
swamp. It is true that the owners can be prosecuted under Section 54, Ordinance 
78, but as the Board of Health has already taken action, I believe it would be 
well to leave the matter to their prosecution. The great majority of the orders 
issued by the Board of Health against these premises were directed against 
persons who have lived there in the same houses for four or five years; some of 
them for a longer period. In these cases, I think the Board has no jurisdiction 
whatever; certainly not under sections 78 and 80, as these buildings were in 
existence prior to the passing of the ordinance, and would therefore recommend 
that the matter be left to the Board of Health entirely. 

W. P. Wylie, City Engineer. 

[Third indorsement.] 

City of Manila, Municipal Board, Secretary's Office, 

Manila, June 17, 1908. 
Respectfully returned to the Director of Health, inviting attention to the 
second indorsement hereon, the recommendations in which have been adopted by 
the Board. 

By direction of the Board : 

G. S. Lane, Acting Secretary. 



Manila, June 19, 1908. 
Dr. Heiser: 

Sir: In regard to the illegal erection of houses at the interior of 658 Calle 
Lemery, Tondo, I have the honor to report that sanitary orders to vacate their 
houses were issued to the following persons: 

Simeon Munoz: On April 30, 1908, he was fined ?2 in the municipal court for 
erecting a house in violation of Ordinance 78. The material for this house he 
secured by purchasing one of the vacated houses on the Manila Railway property 
on the other side of the estero. 
78079 14 



210 

Nicolas Pijate, married to Ciriaco Molina who was fined ?5 in the municipal 
court for erecting a house in violation of Ordinance 78. 

Francisca Andres: Was removed from other side of estero. Was recently 
fined ^0.20 in the municipal court for constructing a light-material house in 
violation of building ordinance. 

Dorotea Folgencia : She and her mother were removed from the other side of 
the estero. Dorotea was recently fined 1P0.20 in the municipal court for erecting 
a light-material house in violation of building ordinance. 

Martina Santiago: Was removed from the other side of estero. Has now 
moved her house to the interior of Calle Lemery in violation of building 
ordinance. 

Petrona Garcia: Fined ?=0.20 in the municipal court for erecting a house in 
violation of Ordinance 78. 

Victoria de la Cruz: Victoria lived in a rented house on the other side of 
the estero, and when this was vacated by a sanitary order, she purchased same 
and erected the house at interior of 658 Calle Lemery. 

Modista Narciso: Was removed from the other side. Was recently stopped by 
Bureau of Health sanitary inspector from completing her house at interior 
Lemery and is now living in an adjacent old house. 

Fausta de la Cruz: Lived on other side of estero railway property. Was 
recently fined in the municipal court ^0.20 for constructing a light-material 
house in violation of building ordinance. 

Maxima de la Cruz: Lived on other side of estero; has constructed a light- 
material house at interior Calle Lemery in violation of building ordinance. 

Francisco Javier: Has erected a new ligh,t-material addition to his house in 
violation of Building Code. 

Felis Valiente: Lived on the railway property other side of estero and 
constructed a new light-material house at interior of Calle Lemery in violati 
of building ordinance. 

Filomeno de la Cruz : Engaged in making illegal addition to his house. 

Candelaria Enriquez: Recently constructed an illegal light-material addition 
to a light-material house. 

The above detailed information was secured by the undersigned, accompanied 
by two sanitary inspectors, by personal interrogation of the several . people at t 
houses. 

In addition to the above, additional illegal erections have been noted at interior 
of 108 Moriones; this property is reported to belong to Sr. Ricardo Aguado, 
member of the Advisory Board, and is within the limits of the district reserved 
for strong-material construction. These cases are as follows: 

Ruperto Funda: Was removed from the railroad property on the other side 
of the estero. On April 30, 1908, he was fined 9=2 in the municipal court for 
constructing a light-material house at 108 Moriones in violation of building 
ordinance. 

Marguerite Pajardo: Was removed from the railroad property on the other 
side of the estero. Has recently erected a light-material house. 

Julia Ronquillo: Was removed from the railroad property on the other side 
of the estero. Has recently erected a light-material house. 

Respectfully submitted. 

GtO. H. GUEBDBUM, 

Chief, Division of Sanitary Engineering, 



;iOT 1 



nied J 



211 

The importance of the work is shown l)y tlie following newspaper 
clipping : 

"hamper work of sanitation — PETTY POLITICIANS PROTECTING SQUATTERS A(iAl.N.s I 

CITY ORDINANCES. 

•'The sanitary engineer of the Bureau of Health has been having great trouble 
in removing squatters from little bairios just out of sight of the main highway, 
because they are protected by the petty politicians in the city. 

"Yesterday several of these squatters were on trial in the municipal court for 
breaking the liealth ordinances by erecting shacks in tlie interior oi G58 Calle 
Lemery, Tondo, and while the court was in session one of them was taken ill 
with cholera and carried to San Lazaro. The court room was thoroughly disin- 
fected, and inspectors were sent to disinfect the house at Calle Lemery. In 
the afternoon two more of the residents of these shacks were removed to San Lazaro 
suffering from cholera * * *." 

It became apparent that the Municipal Government was desirous of 
limiting the authority of the Bureau of Health to such an extent as to 
make it largely noneffective. This was manifested by its repeal of an 
important section of the Building Code (sec. 143) dealing with light and 
ventilation of buildings, on August 23, 1907, without previous con- 
sultation with this office. 

A more decided step was, however, taken by the Municipal Board on 
September 10, 1907, when the following resolution was adopted by it, 
all members voting "aye" with the exception of Mr. Hastings, who voted 
"no" : 

"Resolved, That it is the sense of the Board that the interpretation of all 
building ordinances is the exclusive function of the Municipal Board." 

In view of the provisions of Act No. 1150, particularly section 12(a), 
and even more particularly section 6, reading respectively as per below, 
the Bureau of Health has never recognized the validity of the resolution. 

"Sec. 12 (a). The sanitary engineer shall inspect buildings, plumbing, water- 
works, drainage, and sewer systems, streams, and esteros within the limits of 
the city of Manila, reporting the results of such inspection to the Board of Health, 
and at the request of the Board of Health shall submit plans and estimates of 
the cost of remedying unsanitary conditions discovered by him. He shall furtlier, 
at the request of the Board of Health, prepare and submit to the Board plans 
and estimates of the cost of improving the general sanitary condition of unhealth- 
ful districts in Manila, and shall perform such other sanitary engineering work 
in the city of Manila for the Board of Health as the Board may direct." 

"Sec. 6. * * * The city engineer of Manila or his duly authorized agent 
shall inspect and supervise the construction, repair, removal, and safety of build- 
ings and premises and the ventilation, drainage, and plumbing: And provided 
further, That the Board of Health shall have power to make inspections through 
its duly authorized agents in order to ascertain whether such ordinances are being 
enforced, and to initiate complaints against violators of such ordinances after 
consulation with the city engineer." 



212 



The adoption of the resolution is thus mentioned in detail in order 
to illustrate the very great difficulties under which this Bureau has 
labored in its endeavor to comply with the very clearly expressed provi- 
sions of one of the acts of the Commission, and the municipal ordinances. 

Having arrogated unto itself the exclusive interpretation of the Build- 
ing Code, the Municipal Board has, nevertheless, failed to prevent tlie 
illegal construction and repair in the strong-material district, while in 
other cases it has allowed the erection of buildings under permit at direct 
variance with the building ordinances. By its adoption of the above 
letter of the city engineer, it is endeavoring to force this Bureau to under 
take the necessary task of controlling the erection of unlicensed nipa 
shacks in the strong-material part of the city. 
Eespectfull}^ 

A. J. McLaughlin, 

Acting Director of Health. 



I 



Exhibit D. 



INDICATIONS FOR TREATMENT IN ASIATIC CHOLERA. 

[By Richard P. Strong. Chief of the Biological Laboratory.] 

I shall limit my remarks more particularly to the indications for 
treatment in cholera and shall leave the details of the treatment, with 
the various drugs to be employed, dosage, etc., for others to discuss. 

In a typical case of Asiatic cholera, it is always possible to distinguish 
certain w^ell-marked stages of the disease in which the clinical features 
vary greatly. Thus in a large number of instances a premonitory or 
incubative stage can be recognized, followed by a stage of evacuation in 
which purging, vomiting and muscular cramps are the most prominent 
symptoms. This condition is superseded by one of collapse and should 
the patient survive longer, a period of reaction takes place in which a 
rise of temperature occurs and if no complications supervene the case 
may end in recovery. 

For this reason it is convenient to discuss the treatment of cholera 
separately for each of these clinical stages; however, bearing in mind 
that throughout the course of the disease the treatment should be 
symptomatic. In the first stage, namely the incubative one, in which 
diarrhoea is the most definite and common symptom, almost all author- 
ities now agree that an attempt should be made to check this premonitory 
looseness of the bowls. It was formerly asserted that if the diarrhoea 
was arrested and the intestine set at rest, for example by some form of 
opium, that a better opportunity was offered for the cholera spirillum to 
multiply and elaborate its toxin. Actually, however, such a condition is 
not brought about by this treatment. Long experience with the use of 
castor oil, neutral salts and other purgatives, including calomel, has 
demonstrated that treatment with these drugs frequently, if not usually, 
exercises an unfavorable influence over the course of the disease. Cer- 
tainly, in the human intestine the cholera organism multiplies most 
rapidly in a fluid medium ; moreover, the action of these purgatives tends 
to increase the catarrhal condition and to impair the resisting power of 
the mucous membrane of the intestine. Therefore, the purgative treat- 
ment during this stage of the disease can not be recommended, and the 
indications are to limit peristalsis and to put the intestine at rest. 
Practically aU the intestinal disinfectants that could be tried by the 
mouth have also been made use of during the premonitory stage but so 

213 



2U 

far without satisfactor}^ result. Either these substances become too 
dilute before they reach the organism in the lumen of the intestine or 
the bacteria have already penetrated too deeply into the glands of the 
mucosa for the disinfectants to reach them. Therefore, this method of 
treatment should also be abandoned. 

By some observers enteroclysis (particularly the enteroclysis of catani 
with tannic acid) has been recommended in this stage of the disease. 
However, I believe, that the best results are to be obtained by bringing 
about as complete a rest of the intestine as possible. Confirmation of 
this idea may be seen from a study of those cases of cholera in which 
surgical procedures were adopted and where the abdomen and intestine 
were opened, a hollow sound introduced and the intestines washed out 
with a disinfecting fluid. Only unfavorable results were obtained. 

The premonitory state of cholera, as is generally known, may either 
be overlooked or be absent, or at all events when the patient reaches 
the hands of the physician this stage has frequently been passed and 
that of evacuation already begun. During this period of the disease as 
mentioned, purging and vomiting are the most frequent s3^mptoms. Plot 
fomentations and mustard plasters applied to the abdomen and small 
pieces of ice given internally may be of some value in checking the 
vomiting. All medicines by the mouth, with the exception sometimi < 
of dilute solutions of cocaine, are of little avail ; alcohol is contraindicated ; 
washing out of the stomach has given rise to no good results and even 
attempts to remove by means of gastric irrigation the cholera poisoi . 
which it has been claimed by some observers is excreted by the gastric 
mucosa, have failed. The treatment in this state, therefore, resolves 
itself into an attempt to quiet the peristaltic action of the intestine a- 
much as possible by the hypodermic use of morphia, and to secure as 
complete physical and physiological rest as possible. The cramps in the 
muscles frequently require appropriate treatment such as brief inhala- 
tions of chloroform. 

The treatment with morphine should not be pushed when definite sign- 
of collapse have appeared. During the stage of collapse the pulse fi- 
nishes the most important indication for treatment. If the pulse in 
the radial artery is present and the blood pressure not too greatly reduced , 
the patient requires little treatment beyond that made to conserve ili' 
body lieat. If on the other hand, the pulse loses volume and power and 
becomes weak and thready, stimulants, preferably strychnine, hypoder- 
mically, are indicated. If the pulse disappears at the wrist more urgent 
action is called for. By far the most valuable treatment of all in the 
stage of collapse consists in tlie intravenous injection of saline solution, 
which should be administered in all grave cases. If no response 
obtained from the hypoderaiic administration of strychnia, ether admin- 
istered in a similar manner may be necessary in the interval before or 



215 

ting the introduction of the saline solution. The question of the 

)st desirable solution to be used for transfusion and of its composition 

11 be left for discussion to the other papers to be presented. After the 

1 ravenous injection of normal salt solution, even in cases in profound 

1 lapse, provided a sufficient amount has been introduced, the pulse 

;arns at the wrist, the face loses its pinched expression, the tissues lose 

.'ir shrunken appearance, cyanosis disappears and warmtli returns to 

' skin. In some cases it may be necessary to inject as much as 3 

liters of the solution intravenously before the most favorable result is 

obtained. The pulse must be the main indicator of the amount to be 

introduced. When it reaches sufficient volume and the blood pressure 

has been restored, injections should be discontinued. Obviously, the 

transfusion should not be carried to a point where the pulse becomes 

bounding and the blood pressure is increased beyond its normal limit. 

One learns greatly by practical experience in regard to the amount of 

fluid to be injected intravenously in cholera. 

The question has been raised as to whether the saline solution should 
be given intravenously or subcutaneously. If there is no radial pulse to 
be distinguished, the injection should unquestionably be given intraven- 
ously; in such instances subcutaneous injections can not be absorbed in 
time to be of any value. I have never observed serious results when the 
solution has been injected judiciously. The intravenous injection may 
be supplemented later by subcutaneous injections. Perhaps nowhere in 
medicine do we see the beneficial effects of treatment demonstrated to a 
greater degree than in the proper employment of intravenous injections 
of saline solution in the state of collapse in cholera. Many lives are 
undoubtedly saved by this procedure, and the mortality of cholera can 
undoubtedly be considerably reduced by this method of treatment. The 
results obtained may be frequently spoken of as brilliant. 

When the subcutaneous method of injection fails entirely the intra- 
venous method gives excellent results. In order to prevent the return 
of the collapse, should the purging recur, constant attention must be paid 
to the pulse and to the reintroduction of saline solution. Sometimes it 
is necessary to continue transfusion at intervals during a period of forty- 
eight hours or longer. 

The other treatment of the stage of collapse consists chiefly in stimula- 
tion by means of full doses of strychnine, by conserving the body heat, 
and by symptomatic treatment of the distress and pain. 

Another important symptom during the stage of collapse which requires 
speedy and special treatment is that of profound cyanosis and apncea. 
This condition is brought about partly by the spasm of the pulmonary 
arteries, the lung refusing to transmit the thickened blood. Frequently 
only by immediate action can such a case be saved, for after coagula have 
developed in the right heart, death is inevitable. The administration 



11 o:" 



216 

of nitrite of amyl or nitroglycerin to overcome the spasm of the pulmonary 
arteries, together with rapid intravenous transfusion of saline solution, 
is urgently indicated in cases with such symptoms. 

After the stage of collapse, should diarrhoea persist, this may frequently 
be favorably influenced by large, high tannic acid enemeta. In the 
typhoid stage of cholera should the temperature continue high, cold 
enemeta may be of advantage. During this stage, should the tongue bt3 
coated and the secretion of bile violently interfered with, the admin- 
istration of calomel in small amounts may be indicated. 

By far the most important symptom requiring treatment in chol 
apart from the stage of collapse, is that of anuria, and the restoration 
the urinary excretion is the most important s}Tnptom in determining. th(^ 
prognosis after the patient has survived the collapse. 

It is particularly interesting to recall the statistics collected by Eumph 
and Frankcl in relation to this symptom. Of about 700 cases of cholera 
in which no anuria existed, even in the first days of the attack, although 
the urinary secretion was considerably diminished, only about 4.7 per cent 
died. In 1,000 cases in which anuria was observed, 57.3 per cent died. 

In this connection it is interesting to review the causes which give 
rise to the special symptoms of Asiatic cholera. The local effect of the 
spirilla in the intestinal mucosa, which is manifested by a severe catarrh, 
may be sufficient to explain the intestinal symptoms, such as the copious 
exudations, the violent diarrhoea and perhaps the vomiting, but the hean: 
failure, cyanosis, nephritis, and other accompanying symptoms can not b(j 
explained in this manner. We may conceive that these disturbances ma}' 
be brought about first by the enormous abstraction of water, both from 
the blood and from the tissues. Numerous analyses of the blood in chol- 
era have shown that the specific gravity of the blood is increased and the 
amount of water decreased. The percentage of water in the tissues is 
also decreased, as was particularly sho^vn by the careful observations of 
Buhl. The amount of salt in the blood and tissues is also decreased, 
while the organic matter is naturally increased. Whether the variation 
in the salt content of the blood is an important factor in producing the 
intoxication, therefore, is very doubtful, since the salts also pass into the 
intestine and are excreted with the water. Second, the symptoms may 
be brought about by the action of toxic substances, produced by the cholera 
spirillum and absorbed from the intestine, and third, by the shock which 
the central nervous system must receive through the terminal nerve fibers, 
which are exposed in the intestinal lesions. Just how much the anuria and 
subsequent nephritis occurs as a result of the abstraction of the water from 
the blood and tissues and just how much they are due to the action of the 
cholera toxin, is not altogether clear. However, it seems unquestionable ^ J 
me that the abstraction of such enormous amounts of water from the dQ 
sues, resulting as it does in the increased thickening of the blood, its loss in 



217 

volume and consequent rapid fall of blood pressure, must play a very 
important role in the production of the collapse, and consequently, in 
the interruption of the blood supply of the kidney, with resulting damage 
to its parenchymatous cells. It is interesting to recall that when guinea 
pigs are inoculated intraperitoneally with lethal amounts of cliolera 
spirilla, while before death a condition of shock is brought about witli 
rapid pulse and progressive lowering of the temperature, undoubtedly 
due to the action of the cholera toxin, after death has occurred in 
these animals, no such advanced lesions of nephritis are encountered as 
are seen in the kidneys of human cases of cholera, which have succumbed 
after symptoms of anuria. 

With the idea of throwing more light on this question, Dr. Teague and 
I have introduced into monkeys by means of the stomach tube and by 
subcutaneous injection large amounts of sodium sulphate in concentrated 
aqueous solution. We have found that by the introduction of this sub- 
stance into the stomach we have been able to produce watery stools, intes- 
tinal catarrh with the contents of the bowels containing much mucous, 
and occasionally resembling the so-called rice water material of cholera 
and by the subcutaneous injections we have produced excessive subcuta- 
neous oedema. 

In most instances death of the animals in profound collapse has 
resulted, usually within a few hours. Time has not permitted us 'as yet 
to harden the sections of the kidneys and to ascertain what microscopical- 
pathological changes have taken place in these organs nor to determine 
accurately the cause of death of the animals. This, however, will be done 
and the lesions compared with those encountered in the kidneys in true 
cases of cholera. It may be mentioned that in one monkey the kidneys 
already presented evidences of nephritis, visible to the naked eye, with 
injection of the superficial vessels of the cortex. 

If, therefore, as seems probable, the disturbance of the circulation plays 
such an important part in the production of the anuria in cholera and 
the subsequent nephritis, it seems still more important for us to watch 
and restore the circulation in the treatment of this disease and make good 
as early as possible the loss of fluid and thereby prevent at least some 
of those pathological changes which must result in the parenchyma cells 
of the kidney if the blood supply is even temporarily interrupted in 
this organ. Once the circulation in these organs has been profoundly 
disturbed, the restoration of their function becomes a much more difficult 
problem to treat, as does also the resulting uraemia which so frequently 
follows. The discussion of the further treatment of this very important 
complication, I shall leave to Dr. Nichols. I wish only to add that 
stimulating diuretics should not be employed in cholera uraemia. Their 
use is of no benefit and they frequently do harm. 

In regard to the serum treatment of cholera no recent advances of 



218 



importance have been made. E. Kraus has claimed the production of a 
soluble toxin in' certain cultures of the cholera spirillum and the produc- 
tion of a cholera antitoxic serum of value. I was able, last year, in 
Vienna, to go over this work with Professor Kraus. However, the 
animal experiments which he performed for me did not demonstrate that 
this seram possessed any greater value than the cholera sera we have 
prepared in Manila in former years. The most recent important results 
which have been obtained in the treatment of Asiatic cholera by antitoxic 
serum were those carried on in this city in 1906 b}^ Dr. Denier of the 
Pasteur Institute. In all 52 cases of cholera were treated with serum. 
The injections were given intravenously and in large quantities, as much 
as 250 cubic centimeters in a liter of Hay em's solution being inoculated at 
a single dose. The average amount of serum given each patient was from 
300 to 500 cubic centimeters, but in one case 1,000 cubic centimeters 
were inoculated in 24 hours. The cases in the hospital were treated 
alternately with serum; that is, every other case admitted received this 
treatment. The percentage of mortality in the cases treated with this 
serum equalled that in the cases which received no serum. We are 
convinced that the antitoxic serum treatment of cholera is of little value. 



Exhibit E. 



THE TREATMENT OF CHOLERA: A SUMMARY OF THE EXPERIENCES OF THE 
PHYSICIANS AT THE MARY JOHNSTON CHOLERA HOSPITAL. 

[By Henry T. Nichols, lieutenant. Medical Corps, United States Army.] 

The conclusions reached ^ agree with those of the physicians at San 
Lazaro. The two serious conditions to be met are collapse and ura3mia. 

Collapse was overcome in 90 per cent of the cases by the intravenous 
injection of normal salt solution, repeated as often as necessary. The 
average number of injections given was two and the average amount of 
solution injected 2,800 cubic centimeters. The only cases that died 
early in the disease from collapse were very old patients and those w]io 
were moribund on admission. The giving of intravenous injections was 
greatly facilitated by receiving from the Bureau of Science sterile normal 
salt solution in 1 and 2 liter bottles which were heated and used directly 
as reservoirs by inverting them in a rack, after inserting a two-way cork 
with glass and rubber tubes. The injection was followed in several cases 
by chills, but no other bad effects were noted. 

Uraemia followed recovery from collapse in nearly one-half of the 
severe cases and was fatal in about 33 per cent of all cases. The amount 
and character of the urine was closely watched in connection with 
clinical signs of uraemia and hot packs, rectal injections and fluid by the 
mouth seemed to be effectual in some cases. In others all measures, 
including diuretic counterirritations and blood letting, were without 
avail. 

Bacteriological diagnoses were made in all cases within twenty-four 
hours after admission and two consecutive negative reports were required 
before discharge. 

CONCLUSIONS. 

I. Intravenous injection of noiTual salt solution greatly reduces the 
mortality of cholera from collapse. 

II. The more the patients that survive collapse the more important 
uraemia becomes as a complication. 

III. It is impossible to tell which patients will develop severe uraemia 
and after the onset of this complication all measures may fail. 



» By Dr. Strong. 

219 



Exhibit F. 



A SUMMARY OF THE RESULTS OBTAINED IN THE BACTERIOLOGICAL DIAGNOSIS 

OF CHOLERA. 

[By Moses T. Clegg, of the Biological Laboratory, Bureau of Science,] 

The bacteriological examinations of the stools of cholera patients during 
this epidemic were carried out according to the enriching method as 
follows : 

Cultures were made in peptone solution (1 per cent Witte peptone 
and 0.5 per cent sodium chloride in distilled water) and kept at ordinary 
tropical room temperature (about 30° C). After three hours transfers 
were made from the surface of the cultures to fresh peptone tubes made 
on alkaline agar slant tubes. These remained at ordinary temperature 
for from twelve to fourteen hours. 

In a series of 500 cases examined, including both acute and convales- 
cent patients, there was a constant morphology of the organism and no 
great variability in the degree of agglutination. Clumping occurred 
generally within a period of fifteen minutes in dilutions of 1 to 400 and 
1 to 500. 

Specimens for bacteriological examination collected by inserting steril- 
ized rectal tubes were found to be more satisfactory than those collected 
by enemas. In an average of 1,000 patients harboring the cholera vibrio 
it was found that the shortest length of time the organisms remained 
present in the intestine and could be recovered from the faeces was five^ 
days and the longest eighteen days. 

220 



Exhibit G. 



REPORT OF THE SPECIAL COMMITTEE OF THE MANILA MERCHANTS' 
ASSOCIATION. 

Manila, December 22, 1908. 
To the President, Manila Merchants' Association, 

Manila, P. I. 

Sir: Pursuant to your instructions given in your resolutions of Oc- 
tober 12 last, your committee on cholera investigation begs to report: 

That organization was effected on October 14. Work was commenced 
immediately and has been prosecuted diligently. 

On October 20, this committee, together with the Acting Director of 
Health, Mr. Welch and Mr. John C. Meehan, visited various portions of 
the city for the purpose of investigating their sanitary condition. In 
all, nine districts were visited. These, together with comments thereon, 
were as follows : 

1. Interior of Calle Principe, San Nicolas. — This property evidently 
belongs to the Insular Government, being within the 30-meter strip of 
tide lands. The property is situated within the strong-material district. 
The officials in charge of the issuance of permits for repairs and construc- 
tion have evidently paid not the slightest attention to the various ordi- 
nances covering either construction or repairs and in no single instance 
has the law been observed. There is not a single shelter in the entire 
collection that does not show many cases of very recent repairs. 

2. Interior of 87 Aceiteros. — Here can be found some new ideas in 
model sanitary convenient shambles, erected under license from the proper 
city authority, in the strong-material district. Posts stuck into the 
ground, covered with a varied lot of old tin, sheet iron, sides of old boxes 
and divided into stalls. The ground for a floor and absolutely no sanitary 
conveniences whatsoever. With only three sides covered and no kitchens 
or other quarters, conditions during rainy season are not suitable for 
swine. Absolutely no sanitary arrangements of any kind. The dumping 
of defecation in an adjacent street witnessed. Who issued permits? 
Who inspected premises ? Both these officials should be sent to the States 
for instruction in building inspection. 

3. Calle Folgueras, San Nicolas. — In the hard-material district. 
Building laws entirely violated. Nipa shacks repaired recently and being 
repaired. Pools of stagnant water in the street for over two blocks. 

4. Calle Salinas, Tondo. — In the hard-material district. Building 
laws openlv violated. iSTew nipa roof at present under construction. 

221 



222 

Many other evidences of very recent shabby repairs. All sanitary laws 
set at naught. Possibly all tenants squatters, occupying ground on suf- 
ferance only. No evidence of building inspection. 

5. Santa Monica. — Unsanitary. Building of street without culverts 
causes water to stagnate. Expenditure of reasonable sum would afford 
drainage. Esteros flowing through this district could be deepened and 
the waters would be drained with the tide. No water supply. Im- 
mediate installation of water system imperative. 

6. Antonio Rivera. — Hard-material district. No effort evidently made 
by city authority to enforce ordinance against erection or improvement of 
nipa shacks in hard-material district. District covered with miserable 
class of shacks. No latrines and no water supply. Offal and defecations 
thrown on the ground. Fearful unsanitary conditions in every particular. 

7. Palomar. — Conclusive evidence of the failure of the Municipal 
Board to interpret the building ordinances with any degree of intelligence. 
Municipal Board now granting permits for unsanitary structures not J 
meters high, no floors. 

8. Santa Clara. — In the rear of Bilibid Prison. This is a clo.sed 
barrio and is on land owned by the Insular Government, a part of the 
San Lazaro Estate. Here conditions were found to be frightful from 
a sanitary point of view. Refuse and filth being dumped into pools 
where washing of clothes was also in progress. This district has no 
roads permitting the entrance of vehicles of any kind; garbage can noi: 
be removed by reasonable means. There are no latrines and no paii 
system. City water must be carried a great distance, practically un- 
available so that the inhabitants have been compelled to drink the watei- 
from filthy wells and water holes. Cholera lurks in this neighborhood 
and cases are found here almost daily, notwithstanding that the Health 
Department is making every effort to disinfect and make conditions 
better with the means at their disposal. Infection in Bilibid Prison 
undoubtedly be traced to this source. 

9. Bilihid Viejo in the rear of San Sebastian Church. — In the hearl; 
of the city. If a single municipal officer with any authority whatsoevei" 
ever visited this place and did not immediately take active and violent 
means to cause an abatement thereof his resignation should be demanded. 
All building and sanitary laws are grossly violated. Condition of estero 
demands either immediate drainage or immediate filling. 

Copies of the above were furnished the Hon. D. C. Worcester, Secretary 
of the Interior, and Mr. Percy McDonnell. The discussion that fol- 
lowed seems to have awakened a real interest in the conditions depicted 
and many of the evils that beset us, as far as sanitary conditions are ; 
concerned, seem in a fair w^ay to be remedied as well as is possible 
this late day. 

Interviews were held with Mr. Percy McDonnell and Mr. Felix' 
Eoxas covering conditions as we found them. These interviews developed 



H 



fl 



223 

the fact that there has been a serious lack of cooperation between the 
Bureau of Health and the Municipal Board. The Bureau of Health has 
attempted, as far as we can elicit, to attend to its duties in a careful 
and competent manner. In this they have been apparently handicapped 
by the authority of the Municipal Board. This later body evidenly 
showing an entire lack of good judgment in the enforcement of such 
ordinances. 

The members of the Municipal Board seem to have shown a woeful 
lack of appreciation for sanitary conditions here, both as regards build- 
ings and lands. Regular, personal canvass of the city seems to have been 
thought unnecessary by those whom we interrogated. Wlicn asked the 
reason for the nonenforcement of the ordinances, "pity," was the only 
reply, pity for the poor miserable occupants of miserable hovels. Pity 
that offered no alternative. It is pity that is largely responsible for 
the Board's inaction, pity that is responsible, to a great extent, for our 
last epidemic of cholera. It is this pity that for years has blocked the 
sanitary regeneration of 80 per cent of our population and endanirered 
the lives of the other 20 per cent. 

The improvement of the city in a sanitary way, has been restricted 
almost entirely to the new water and sewer systems. The relief that 
will be afforded on the completion of these will be great; but the 
expenditure of this money will be wasted, as far as general health is 
concerned, unless thorough, constant and immediate attention is paid 
to the nipa barrios and many unsanitary districts within the confines of 
our city limits. 

The public improvements in the Malate and Ermita district have been 
favored to the exclusion of those districts where the. greatest portion of 
our population exists. The filling of unsanitary lands, occupied for 
dwelling purposes, and the building of public latrines, where the pail 
system has not been installed, have been almost entirely neglected. 
Drainage is unheard of. Streets have been built that inclose entire 
blocks of land causing water to stagnate, filth to acumulate and disease to 
breed. Such conditions can best be shown in the San Lazaro Estate 
and in the Santa Monica district. The raising of Calle Azcarraga above 
the level of the surrounding property is fraught with much danger. 
Drains should Be so constructed that interiors contiguous to them may 
drain at all stages of the tide and all seasons of the year. 

Dr. Saleeby, of the University Hospital, in his last annual report, puts 
the question very aptly, viz : 

We find a large portion of the inhabitants of Manila living in marshes and 
in filtli, and no attempt is made to remedy their condition. The poor, if neg- 
lected, invite disease to their homes and convey it to the homes of the rich. 
The poor are bound to remain with us all the time. Their health should be 
of great concern to all. It is important in itself, and it is further necessary 
for the protection of the community as a whole. Once an epidemic finds its 



224 

way into the houses of the poor it gets control of the city and menaces the 
rich as well as the poor. It therefore behooves the city of Manila to give more 
attention to the dwellings of the poor and to the districts where the lower 
class of its inhabitants live. It does not seem wise of proper to be giving so 
much attention to boulevards and parks while a large number of Manila's citi- 
zens have to wade through mud and marsh to get to their houses. It is cer- 
tainly not right to lavishly beautify some streets, while others remain below 
the level of high tide and are, at times, more suitable for boats than carriages. 
We certainly think that regulations for the protection of the city against cholera, 
plague or beriberi are as important and as necessary as regulations against fire. 
It is essential to have our houses proof against epidemic disease as against any 
visible destructive agent. Man's life is more valuable than property and health 
is the best treasure on earth. 

The majority of the people in Manila and the provinces build their homes 
on locations which are damp and marshy for the greater part of the year. 
Refuse is carelessly disposed of underneath and around the buildings. Adults 
and children wade through muddy surroundings barefooted and eat with their 
fingers. In Manila, the filth that surrounds the houses of the poorer classes is 
extreme. In the "nipa shacks" or settlement districts no sanitary rules seem 
to be observed. The land is over-flowed by tide water, is always wet and often 
marshy. The people bathe in dirty, stagnant esteros and drink river water. 
It is a wonder that epidemics cease in the city and in similar localities throughout 
the Islands. 

Dr. Saleeby is not alone in his opinion, for cholera and its other vile 
companions can not live, for any material length of time, in the city of 
Manila. The city of Manila, clean, is not their abiding place. Th( 
Pearl of the Orient, to-day, is their incubator. 

Added to the conditions we find prevailing here, if the statements m 
in "The History of Asiatic Cholera in the Philippines" by Hon. D. C. 
Worcester are half true, it behooves our present Insular Administration 
to solve the question. The present Municipal Board has shown itself 
unfitted to handle the situation. "We have in our midst men who have 
shown their ability to handle public affairs with common sense and 
genuine ability. Let such men take the place of the dead timber that 
encumbers our progi'ess and thereby increase the efficiency of the entire? 
civil list. Merited promotion will greatly add to individual eifort for 
public good. 

Dual authority, covering the health of the city, should be done away 
with. All matters of such great importance to us all should be placed 
in the hands of those who are able to handle the situation. Trained 
engineers and medical men are available here. If the Board of Health 
is able to handle the situation, pass it over to them and make them 
solely responsible. If present conditions continue we will be compelled 
to postpone or discontinue the Carnival for this year. Measures both 
temporary and permanent should be taken and enforced to make Manila 
the training ground for every municipal officer in the Islands; we h 
but little to show them as an example to-day. 

John Gibson, President. 
Arthur Cohn, Secretary. 



L n(; 



1| 



Exhibit H. 

November 14, 1908. 
Mr. S. Erlanger, 

Chairman of Committee of Merchants* Association, Manila. 

Sir : I have the honor to acknowledge receipt of your letter transmit- 
ting the informal reply of Mr. P. G. McDonnell, of the Municipal Board, 
to the first report of your committee. 

I note that you transmit therewith a document entitled "A Compilation 
of the Acts of the Philippine Commission" and that this is referred to 
in your conmiunication as having been furnished by Mr. McDonnell and 
purports to embody the "various ordinances under which authority for 
sanitary work in the city of Manila is based." Permit me to suggest 
that it does embody only those portions of existing laws and ordinances 
which prescribe the powers and duties of the Director of Health and 
other officers and employees of the Bureau of Health relative to sanitary 
matters and that it omits all mention of any one of the various provisions 
imposing powers and duties upon officers and employees of the government 
of the city of Manila. This so-called compilation contains no mention 
of any one of the provisions of the building ordinance, the persistent 
violation of which has played so important and disastrous a part in 
bringing about the present sanitary condition of this city. 

I note that the city engineer has prepared another lengthy memoran- 
dum relative to the specific cases of unsanitary construction which have 
already been so fully discussed. It is evident that we might continue 
this discussion indefinitely but it seems to me entirely needless. We 
should but be following the example of the two ancient Greek philosophere 
who had the acrimonious discussion over the number of teeth possessed by 
a horse without its ever occurring to either of them to open a horse's 
mouth and count its teeth. I suggest that if the committee has any 
lingering doubts as to the unsanitary conditions which have arisen as a 
result of unlawful construction in the cases mentioned it observe for itself 
the conditions as they exist and form its own conclusions. 

I had just dictated an indorsement to the Director of Health forward- 
ing these papers to him for comment when I received a supplement to 
his recent report on the cholera epidemic which covered what seemed to 
me the essential points in the matter now under discussion so fully that, 
in view of your verbal statement to me that time is short and that the 
committee is anxious to have these papers returned as soon as convenient. 
78079 15 225 



2m 

I will return them to you direct together with a copy of this supplementary 
report and the following suggestions which I venture to make. 

In general where nipa shacks have been repaired in defiance of existing 
ordinances, or have been unlawfully constructed, the city engineer ex- 
plains these occurrences by saying that permits for sicch repairs and con- 
struction were not issued by him and that it is difficult to secure evidence 
which will suffice to convict persons who illegally repair such houses. In 
this connection the city engineer says : 

*'A11 that this oftice can do is to refuse permits to repair or construct buildings 
and to call the attention of the police to such violations of the ordinances as 
come to the knowledge of the building inspectors. The work of the building 
inspectors is primarily to inspect the construction of buildings for which permits 
liave been granted and the present force is sufficient for such work only. The 
building inspectors are not authorized to make arrests." 

In a report written on September 3, 1908, the city engineer lias made 
the following statement: 

"Attention is respectfully invited to the fact that the personnel of this office 
devoted to the inspection of buildings, including examination of plans, etc., consists 
of a chief inspector, American, and four assistants, Filipinos. This force during; 
the fiscal year 1908 made inspections on 5,864 applications of which 1,570 were 
for construction and 4,294 for repairs besides 400 miscellaneous permits. In the 
case of construction frequent visits are necessary throughout the period covered 
sometimes several months. It will therefore be seen that this force is taxed to 
its utmost and that it is physically impossible to watch every move made by eveiy 
coniraotor engaged in work on these buildings.*' 

The statement of the city engineer relative to the insufl&ciency of tht 
force authorized or employed by him is no doubt conservative. The 
force is, of course, ridiculously inadequate. It is not an unknown 
procedure, when a law or ordinance is of such a nature that its enforce 
inent is likely to provoke marked hostility, and when those charged with 
the duty of enforcing it desire to escape unpopularity, lo neglect to employ 
a suitable number of men to make its enforcement possible. In view 
of the well-known fact, which I believe no official of the city governmeni 
has denied, that nipa houses are constantly being repaired, and even 
constructed, in defiance of existing ordinances and regulations, and in 
view of the further statements made b}' the city engineer as to the 
insufficiency of his force not only to prevent such occurrences or to 
note them. and make complaint against the guilty persons but even to 
perform the other regular work of his office, it would seem pertinent to 
ask the question: Why has not this force long since been materially 
augmented and what prospect is there that it will he augmented in the 
immediate future to such an extent as to render possible the proper 
performance of the work imposed upon it by law ? 

I am of the opinion that the record for the present year of 160 
complaints and prosecutions and 133 convictions for violations of the 



227 

building regulations i? not one to which the municipal officials can well 
point with pride, particularly when it is remembered that the fine imposed 
for the erection of a nipa house in violation of the law has frequently 
been one peseta, a fact which the city engineer forgets to mention. 

I now come to the other excuse which has so often been given for 
allowing the erection of unsanitary buildings, namely, that the city 
engineer has written across the face of the permit, "not to be used for 
human habitation." 

The city engineer stoutly maintains that he has no right to question 
the good faith of persons making such statements and that so long as 
they say that the buildings are not to be used for human habitation he 
must allow them to be erected and then leave the rest to the Bureau of 
Health. In reply to this contention I beg to say the authorizing of these 
unsanitary structures with the proviso that they are not to bo used for 
human habitation, when the city engineer, if he is possessed of ordinary 
common sense, knows what everyone else knows, that they will be so used 
the moment they are completed if not before, simply results in legalizing 
evasions of the law. So persistently has this policy been followed, in 
spite of the numerous protests that have been made, that I am forced to 
the opinion that it is a procedure followed deliberately for the purpose 
of throwing the onus of this whole matter on the Bureau of Health- 

The extract from existing laws and ordinances relative to the powers 
and duties of the latter bureau and its officers in these premises seems to 
have been submitted by Mr. McDonnell without comment, but it is 
entirely apparent that he either had nothing in mind when he submitted 
it or he had in mind to show that the sanitary conditions of the regions 
under discussion were due to the neglect of duty on the part of the 
Director of Health and his subordinates in the matter of compelling the 
making of repairs or the vacation of buildings too unsanitary to be fit 
for human habitation. As it is fair to suppose that Mr. McDonnell was 
not without purpose in forwarding this compilation of the laws and 
ordinances, we find him apparently explaining the unsanitary conditions 
'of these regions as a result of the failure of the Director of Health and 
his subordinates properly to exercise their powers ; but there really is no 
room for doubt as to his attitude in the matter, for during the inspection 
trip made by the Municipal Board and the undersigned through these 
regions Mr. McDonnell repeatedly called attention to the fact that the 
Director of Health had it in his power to remedy these conditions by 
compelling the abandonment of the unsanitary buildings and sites. So 
much for his attitude when dealing with the Department of the Interior 
and with the committee of the Merchants' Association. 

I now invite your attention to an article in the Cablenews of this date 
purporting to be an account of a speech made by Seiior Mendiola of the 
Municipal Board, and to the statement made in connection therewith by 



228 

Mr. McDonnell. I have consulted Mr. McDonnell by telephone and hdj 
informs me that this article is substantially correct. Briefly, Senor Men- 
diola demanded that the Municipal Board intervene to prevent thd 
Bureau of Health from compelling the abandonment of certain unsanitary 
shacks. Senor Mendiola called attention to the fact that here was an 
opportunity for the city fathers to set themselves right with the public 
and Mr. McDonnell stated that "they disliked appearing as the evil genii 
of the people but that they could not transgress the law" and that "in 
times past they had endeavored to protect the barrio people from too 
harsh an applicaion of sanitary and remedial measures and that they had 
been criticised for so doing." 

It would seem, therefore, that for the purposes of your committee Mr. 
McDonnell, representing the Board, finds that the Director of Health 
and his subordinates have been too lax in the exercise of their powers 
to compel the abandonment or repair of unsanitary buildings, but that 
when talking for publication the view of the Board is that in times past 
the application of remedial sanitary measures has been too harsh; and 
that in effect the one thing that heeps the Municipal Board from inter- 
vening in behalf of the people is the fact that they can not do so without 
transgressing the law. 

Such an attitude serves to render needlessly difficult the position of the 
Director of Health and his subordinates. In point of fact, as is doubt 
less well known to your committee, the latter have compelled the 
abandonment of numerous unsanitary shacks. In practically every case 
such action on their part has been made the basis of savage criticism if 
not of attempts by demagogues to stir up the populace to open revolt 
I submit herewith the translation of a recent article from Los Obreros 
which will show the difficulties thrown in the way of the Bureau of 
Health by irresponsible newspapers. Nevertheless the Bureau has per- 
sisted in this work. 

I now desire to call your attention emphatically to the fact that if its 
efforts are to amount to anything there must be corresponding efforts 
on the part of the city engineer to prevent the unlawful construction 
and repair of nipa shacks and the erection of unsanitary buildings. 

It would seem to be a fact that the people ejected from unsanitary 
houses do not evaporate or otherwise disappear over night, but must go 
somewhere. Were there decently proper observation of ordinances relative 
to the construction and repair of nipa shacks and the construction of 
other buildings we should gradually provide them with suitable places 
to go, but what does happen is that they at first crowd into other nipa- 
shack districts adding the evils of overcroding to those already existing, 
and ultimately erect new shacks for themselves often on forbidden ground 
so that our last state is as bad as our first, if not worse, and the Bureau 



229 

of Health incurs the onus resulting from routing these people out of 
their filthy and unsanitary homes without accoiriplisliing any suhstantial 
good. 

It must be evident to every member of your coiiiiiiittec that such a 
condition of things can not longer be tolerated if we are to stop talking 
and get to work. In view of the apparent disposition of at least some 
of the members of the Municipal Board to strive to please the public in 
this matter, and of the persistent policy of completely ignoring, or in- 
definitely delaying action on, the recommendations of the sanitary 
engineer and the Director of Health, exemplified by the correspondence 
which I have published in my recent cholera report and that which the 
Acting Director of Health furnished in his supplementary cholera report 
transmitted herewith, I strongly recommend that all authority in con- 
nection with the sanitary inspection of buildings and the prevention of 
the unlawful erection and repair of nipa shacks be withdrawn from 
officers of the city of Manila and conferred upon the Director of Health 
and his subordinates so that authority and responsibility relative to 
these matters may not be divided. The Bureau of Health will then be 
left free to undertake to improve the buildings of the city, and I beg 
to assure you that it will do it without fear or favor, while to the 
Municipal Board will be left the more popular role of sympathizing with 
the unfortunate victims of the harsh measures imposed by the Director 
of Health ! If this change is to be made certain provisions of the present 
Building Code must be cut out of it and inserted in the Sanitary Code. 

The work necessary to clean out the esteros and provide street drains 
must, of course, continue to be performed by the city engineer's office, 
but as the performance of this work does not necessarily involve those 
responsible for it in unpopularity that office might not object to continu- 
ing to do it. The Bureau of Health has no machinery for the per- 
formance of such work but it has a sanitary engineer and if he is provided 
with a suitable number of subordinates, which can readily be done, his 
force would be able satisfactorily to perform the work which I suggest be 
transferred to the Bureau of Health. 

Please bear clearly in mind the fact that neither the Director of Health 
nor the Secretary of the Interior hanker for this job. Both of them, 
however, desire to see it done, and I at least am of the opinion that it never 
will be done by the city engineer's office as at present constituted. In 
fact it seems to me to have been demonstrated very conclusively that the 
city engineer's office has not, up to the present time, had the slightest 
intention of seriously attemping to do it. 
Very respectfully, 

Dean C. Worcester, 

Secretary of the Interior. 



230 

P. S. — Referring to your statement relative to the failure of the Bureau 
of Health to insist on the enforcement of the ordinance providing for a 
3 -meter strip at the back of lots in the case of two pieces of property on 
the Escolta, if you will refer to the second paragraph from the bottom of 
page 67 of my recent cholera report you will find that it was on account 
of the decision of the Director of Health to demand the enforcement of 
this provision of law that the Municipal Board repealed it. So long as 
the Director of Health did not insist the Board was willing to let it stand. 



K X H 1 H 1 1 1 . 

[Tiauslatlou. — From Los Obreroa, issue of October 24, 1908.] 
ALWAYS PERSECUTED. 

Two odious Boards ^ proceed in perfect concubinage. The Board of 
Health and the Municipal Board are without doubt attacked by the 
mortally direful virus of the chimera which consecrates blunders with 
lioly oil and with fatuous arrogance places error on the altar. One 
commands poorly; the other obeys worse. The Board of Health goes on 
extracting from the corrupt and slimy chapter of an abortive science 
advice and prescriptions, and our Municipal Board, servile and solicitous 
though being fully convinced that the order is a hygienic heresy, cowardly 
bends its head and, only in order to please the Board of Heiser and 
McLaughlin, sends out upon the streets and into the suburbs of the Bitch 
of the Orient ^ its legions of agents incompetent in learning and experts 
in procedures fully worthy of Kaffirs. 

Aside from the terrible calamities that we residents of Manila are 
suffering, all through the fault of the highly criminal complicity of the 
two Boards, which we support with a patience worthy to be better em- 
ployed, those two guillotines of our well-being, ^vrongly called Health 
and Municipality, we are^ induced to enter the burning arena of the 
topics of the day, full of excitement and noise, by the dreadful question 
of the demolition of the small nipa houses inhabited by poor workingmeu 
without means of any kind. To-day we raise the first patriotic and 
human cry of alarm, and with the rasli valor of pure and honorable 
conviction, we shall, when the times comes, not only accuse the Board of 
Health and the Municipal Board of being stupid, brutal and unsuccessful, 
but we shall also declare them to be "The founders of tenebrous anarchy" 
in the Philippine Islands. How well one can see that both the Board of 
Health and its accommodating sexton the Municipal Board are not aware 
of the volcanic fire of popular indignation, when, foolish and imprudent, 
they wish to play with it I 

* Instead of the word junta (board), the writer uses throughout his article 
the word yunta (a yoke, team or span of draft animals), as a term of derison. 
Note phrases "kick up their heels," "the unproportionately long ears of that other 
team," etc. 

''"Perra del Oriente," a play on the term "Perla del Oriente" (Pearl of the 
Orient). 

231 



232 

But both are right in proceeding in this way, carrying out before our 
eyes and in the blinding light of evidence a programme of ignorance and 
incompetency which redounds to the prejudice and death of the people 
of Manila and also of the entire Filipino people. They are both guilty ; 
those two Boards are alone guilty of the crimes attributed to them by 
public opinion; but we have certain irreconcilables who say that tlu 
Government itself ought not to be considered clear of serious criminal 
and punishable responsibility, because of its having appointed to those 
high offices persons notoriously incompetent and, what is worse, because 
it takes pleasure and pride, with cynical audacity, in securing them in 
their positions after so many clamors of public opinion and of the press 
which have proved and evidenced to satiety that those two Boards, ap- 
parently composed of rational men and therefore obliged to proceed with 
reason, are the first to kick up their heels, without even taking the 
trouble to reflect that by that irrational explosion they might injure or 
destroy sacred interests and respectable entities. 

If the Government in its high wisdom and foresight does not put a 
just and immediate stop to the vandalic excesses of these two Boards 
which constitute the target of the hatred and malediction of the Filipino 
people and of the cosmopolitan population of Manila, it also may come 
fully within our charge and our censures, as co-founder of anarchy in the 
Philippines, We ratify what we have said. Those two Boards unless 
they immediately change their plans and procedure, will set ablaze 
with the fire of death the sleeping and still latent social question in the 
Philippines, to-day inoffensive and unknown to those continually per- 
secuted and trampled upon in all the countries and in all the societies 
of the entire world. We firmly believe that we fulfill a duty of high, 
patriotism in shouting into the ears of our authorities the cry of alarm, 
the sincere warning to be on the watch, to awaken them from their 
profound lethargy and carry to their clear and upright judgment the 
light of wise forethought and a dose of profitable perspicacity. It 
not advisable nor prudent that our unmindful Government should allov> 
those two Boards with which we are afflicted, to play with dangerous 
explosives, such as abuse and outrage, constantly applied to the already 
tired out meekness of the people. 

In the present important matter of the barbarous and inhuman 
destruction of the nipa houses, there is not the least reason for invoking 
the powerful cause of the Salus populi suprema lex. The hurried tearing 
down of those little houses shows once again the supine incompetency of 
our perpetually unwise Board of Health, because the obligating reasons 
of hygiene are based in particular on practices of prevision and not on 
precipitate action at the last moment, applied in the form of despotic 
orders against the unfortunate, against the small, the poor and the 
humble, who suffer and succumb in the most complete abandonment and 



233 

forlornness. If the Board of Health, in its remarJcahh infused science, 
believed that those miserable little nipa houses, if left standing, would 
be perpetual focuses of morbid infection, whether clioloric or not, it 
should have pulled the unproportionately long ears of that other team, 
the Municipal Board, and could have given notice in plenty of time 
that on sucli and such a date thousands of poor wretches would be ejected 
from their little houses who never committed any other crime than that 
of having been bom and having lived honorably without fortune or 
riclies. Then that Municipal Board of our evils and sins should, witli 
foresight, have aided them and prepared the land on which to lodge 
those numerous unfortunates, ejected everjrwhere, eternally fallen from 
grace and victims of a social shipwreck a thousand times more dreadful 
than the horrors of the sea. That Municipal Board should have furnished 
means to the needy class which, lacking even the absolute necessities of 
life, could ill afford the luxury of taking their little houses out for a 
walk or in a procession from one part of the city to the other, merely 
in obedience to the whimsical frown of our mortally sinful Board of 
Health. And this wisest amongst the wise could, with the enormous 
appropriation it has allotted to it for useful and discreet expenses, have 
put the quagmires and pools of the district of Tondo into a sanitary 
condition; could have desinfected the pestilent nooks of so many inte- 
riores; could have converted the bog that is a focus of death, into a florid 
orchard which lends charm to life. Nothing, absolutely nothing of 
rational hygiene was done. Precipitately and even with cold cruelty 
many residents, as much taxpayers as those of Ermita, were left to their 
fate ; their wells were closed without their being furnished with a single 
faucet of potable water; the water which they used for washing and 
cleaning was spoiled with poisonous disinfectants, without being replaced 
by artesian well water; wholesome vegetables to which Filipino stormachs 
were accustomed were abolished and replaced by canned goods of foreign 
origin containing purulent bandaged small fingers; they destroyed the 
truck gardens, paying a ridiculous and insufficient indemnity and when 
the poor man and the laborer were terribly besieged by thirst and hunger 
there comes a ferocious new ukase from our little C^sars to oblige, hastily 
and precipitately, those poor wretches, persecuted by the unsuccessful 
powers of the earth, to live exposed to the inclemencies of the weather 
and to contemplate with unforgettable wrath the destruction of their loved 
though miserable homes. 

This odious question of the little nipa houses should have been decided 
by the Board of Health and by the Municipal Board in any form and 
manner other than by the ejectment of the poor without means, who were 
forced to provide themselves at once with some other habitable place for 
their lodging. The Merchants' Association of Manila obtained a credit 
of 30,000 pesos to be used for the sanitation of the most extensive and 
78079 16 



234 

populous district of Manila. Here again against our wish and without 
looking for it, we stumble against the eternal stupidity, insolence and 
improvidence of our authorities. They have petted, adorned, and made 
sanitary, to an extreme, unjustly in every respect, the district of Ermita, 
to-day converted into a little American Eden, and notwithstanding, 
Tondo, Trozo, Paco, and other districts have received from these two 
Boards, twins in sin and Siamese twins in responsibility, nothing but 
forgetfulness, disdain and abandonment, deserving of hanging or at 
least life imprisonment. 

And now that the cholera, whose choler has risen to its height, 
endeavors to annihilate all the residents of Manila, they are thinking of 
demolishing nipa houses and putting their hapless inhabitants into the 
open air, perhaps in order to prevent their becoming moth-eaten. Those 
two lamentable Boards have adopted the cursed system of not locking the 
door until the horse has been stolen. In free countries and with govern- 
ments which do not scoff at nor despise public opinion, this would be 
more than sufficient grounds for prosecuting and convicting those scien- 
tific nullities of the less scientific of our Boards. It has been thoroughly 
demonstrated that the Board of Health is utterly ignorant of the most 
elementary rudiments of therapeutic hygiene and of other branches of 
essential and indispensable knowledge for physicians, especially for the 
ostentatious Directors of Health brought by cable as something superior 
and magnificent, and it also has been proved beyond a shadow of a doubt 
that the Municipal Board, led by the nose by the former, is the most 
direful plague that we have at the head of the city government, because, 
debased and cowed by fear, it offers not the least opposition to the 
detrimental blunders committed against us by the Board of Health, and 
neither controls the interests of the people governed by it, nor dares to 
come put in defense of the home, the health, and the lives of the derided 
and ever-patient residents of Manila. 



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