Full text of "Proceedings of the first National conference on infant mortality and public welfare; organized and conducted by the Office of the public welfare commissioner and held under the patronage of His Excellency Leonard Wood. Manila, Philippine islands, December 6, 7, 8, 9, 10, 1921"

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DOCUMENTS
DEPT.

THE GOVERNMENT OF THE ^PHILIPPINE ISLANDS

DEPARTMENT OF THE INTERIOR
OFFICE-OF THE PUBLIC WELFARE COMMISSIONER

PROCEEDINGS OF THE

FIRST NATIONAL CONFERENCE ON

INFANT MORTALITY AND

PUBLIC WELFARE

ORGANIZED AND CONDUCTED BY THE OFFICE OF
THE PUBLIC WELFARE COMMISSIONER AND
HELD UNDER THE PATRONAGE OF

HIS EXCELLENCY LEONARD WOOD

GOVERNOR-GENERAL OF THE PHILIPPINE ISLANDS

MANILA, PHILIPPINE ISLANDS
DECEMBER 6, -7, 8, 9, 10, 1921

185611

MANILA

BUREAU OF PRINTING
1922

DOCUMENTS
DEPT-

THE GOVERNMENT OF THE PHILIPPINE ISLANDS

DEPARTMENT OF THE INTERIOR
>FFICE OF THE PUBLIC WELFARE COMMISSIONER

PROCEEDINGS OF THE

FIRST NATIONAL CONFERENCE ON

INFANT MORTALITY AND

PUBLIC WELFARE'

ORGANIZED AND CONDUCTED BY THE OFFICE OF
THE PUBLIC WELFARE COMMISSIONER AND
HELD UNDER THE PATRONAGE OF

HIS EXCELLENCY LEONARD WOOD

GOVERNOR-GENERAL OF THE PHILIPPINE ISLANDS

MANILA, PHILIPPINE ISLANDS
DECEMBER 6, 7, 8, 9, 10, 1921

185611

MANILA

BUREAU OF PRINTING
1922

\\yioo

TABLE OF CONTENTS

Page.

Introduction ., 7

Program of the Conference 8

PART I. — Addresses
Address of the Hon. Teodoro M'. Kalaw, Secretary of the Interior,

Presiding Officer of the Conference 15

Invocation by. Archbishop Michael J. O'Doherty.... 17

Address of welcome. — By Governor-General Wood * j. 18

Address of the Hon. Sergio Osmefia, Speaker, House of Repre-
sentatives — - 20

Address of Mrs. Francisco M. Delgado, President, National Federa-
tion of Woman's Clubs _ 22

Address of Dr. Jose Fabella, Public Welfare Commissioner 25

PART II. — Lectures and discussions

A. THE HEALTH OF THE MOTHER AND CHILD

Faulty maternity practices and their influence upon infant mor-
tality.— By Dr. Fernando Calderon 33

How to organize and operate a puericulture center. — By Dr. Tran-

quilino Elicafio — - 44

How we should take care of our babies. — By Dr. Rebecca Paris.... 54

What mothers and children should eat. — By Dr. Severe Siasoco.... 60
Vitamines deficiency in children's diet and how it may be corrected

with common foods. — By Miss Hartley Embrey 69

Causes for the large death rate among the children of the labor-
ers.— By Mr. Joaquin Balmori 73

Prenatal and maternity care. — By Dr. Honoria Acosta-Sison 77

Common diseases of babies causing high infant mortality. — By Dr.

Jose Albert , 83

Infantile Beriberi. — By Dr. Joaquin Quintos 86

Tuberculosis and the Child. — By Dr. Carmelo Penaflor 95

B. HEALTH AND SANITATION

Community cooperation as an essential factor to disease preven-
tion.— 'By Dr. Vicente de Jesus Ill

The function and duties of a health officer. — By Dr. Gabriel Intengan 122

Refuse Disposal. — By Dr. Andres Catanjal 4 130

Water supply in relation to infant mortality. — By Dr. J. P. Bantug.. 141
The laborers' "barrio" as a factor in reducing infant mortality. —

By Mr. Jose E. del Rosario 150

C. ORGANIZATION OF SOCIAL FORCES

The knowledge a club woman should acquire to make her an effective
leader in her community. — By Miss Trinidad Fernandez 155

Girls' Associations: Their opportunity, organization and manage-
ment.— By Mrs. Josefa Jara Martinez.... 162

The public

;/:-..: 4

:/;...: page.

welfare " nurse and her sphere of action. — By Miss So-

corro Salamanca *. 168

The preparation and duties of the visiting nurse. — By Miss Anas-

tacia Giron :. .... ' *. 178

Training Red Cross aid or child welfare visitor. — By Mrs. Elizabeth

M. Bordman ^ 182

The activities of the Catholic Women's Club. — By Mrs. Irving C.

Hartigan — - 186

The development of our natural resources and its bearing on public

welfare. — By Miss Maria R. Valdez 190

D. GENERAL PUBLIC WELFARE

Relief in time of disaster. — By Mr. Charles H. Magee 199

Charity as dispensed by the Associated Charities of Manila. — By

Mr. Teodoro R. Yangco : 210

The activities of the Asociacion de Damas Filipinos, — By Mrs.

/ Leonarda L. Ubaldo 214

/The care of dependent, defective, and delinquent classes. — By Miss

Ramona S. Tirona 218

The influence of the school on community welfare. — By Mr. North

H. Foreman 224

Home gardening, hog and poultry raising. — By Mr. Silverio Apostol.. 229
How we should protect the mothers and children of our laborers. —

By Mr. Faustino Aguilar 238

PART III. — Miscellaneous

Minutes of the business session of the Conference 251

Closing remarks of the Hon. Teodoro M. Kalaw, Secretary of the

Interior 252

Report of the Committee on Resolutions 255

Distribution of members of the Conference by provinces and organ-
izations represented 258

List of organizations represented 259

Items of information regarding the Office of the Public Welfare

Commissioner . 264

ILLUSTRATIONS

Governor-General Wood and party „ Frontispiece.

Facing page —

PLATE I. Frequency of tuberculosis infection in children 98

II. Possibility of infection while child is playing 102

III. Spreading infection by kissing on the mouth 102

IV. Using a handkerchief in sneezing 102

V. Wiping the mouth of baby with the same handkerchief used

in sneezing 104

VI. Spreading infection by kissing images or objects of

worship 104

VII. The bad habit of taking small children to cinematographs.. 104

VIII. Children with adults in overcrowded sleeping-room.... 104

IX. Our citizens of tomorrow 108

INTRODUCTION

The First National Conference on Infant Mortality and Public
Welfare was held in Manila from December 6 to 10, inclusive,
1921, under the auspices of the Office of the Public Welfare Com-
missioner. It was Governor-General Leonard Wood who, after
his tour of the Islands, initiated the idea of holding the Confer-
ence in order "to discuss matters pertaining to infant mortality,
health and sanitation and other public welfare activities, and
to bring about closer cooperation and coordination of work done
by various social agencies."

All the papers read at the Conference are here published with
their discussions. Many of these discussions were written and
handed in by the members of the Conference to the chairman
of each session, as it had been decided to follow that procedure
whenever it was found necessary to economize time. For this
reason most of the lecturers did not have then and there the
opportunity to answer the questions addressed to them, or to
give their opinion on matters discussed which needed explana-
tion. In the publication of the Proceedings of the Conference
it was, therefore, considered convenient to refer for comment
such discussions to the lecturers concerned, and to include their
comments in this publication.

JOSE FABELLA,
Public Welfare Commissioner.

MANILA, February 28, 1922.

FIRST NATIONAL CONFERENCE
ON INFANT MORTALITY AND PUBLIC WELFARE

PROGRAM

TUESDAY, DECEMBER 6

MORNING, AT 10 O'CLOCK

Honorable Teodoro M. Kalaw, Secretary of the Interior, Chairman

1. Invocation — by Archbishop Michael J. O'Doherty.

2. Address of welcome by Governor-General Leonard Wood.

3. Address by Hon. Sergio Osmefia, Speaker, House of Representatives.

4. Address by Hon. Manuel L. Quezon, President of the Philippine Senate.

(His health permitting)

5. Address by Mrs. Francisco Delgado, President of the National Federa-

tion of Woman's Clubs.

6. Address by Dr. Jose Fabella, Public Welfare Commissioner.
NOTE. — The Constabulary orchestra will furnish the music.

AFTERNOON, FROM 5 TO 7 O'CLOCK

Garden Party at Malacanan Palace given by Governor- General and Mrs.
Leonard Wood.

WEDNESDAY, DECEMBER 7

MORNING, AT 9 O'CLOCK

THE HEALTH OF THE MOTHER AND CHILD

Dr. Jose Fabella, Public Welfare Commissioner, Chairman.

1. "Faulty maternity practices and their influence upon infant mortality,"

by Dr. Fernando Calderon, Dean, College of Medicine and Surgery,
University of the Philippines and Director of the Philippine General
Hospital.

2. "How to organize and operate a Puericulture Center," by Dr. Tran-

quilino Elicano, Medical Officer of the Office of the Public Welfare
Commissioner.

3. "How we should take care of our babies," by Dr. Rebecca Parish of

the Mary J. Johnston Hospital.
8

4. "What mothers and children should eat," by Dr. Severe Siasoco, Senior

Medical Officer of the Office of the Public Welfare Commissioner.

5. "Vitamines deficiency in children's diet and how it may be corrected

with common foods," by Miss Hartley Embrey, Research Food Chemist,
Union Medical College, Peking1.

6. "Why the children of the laborers die," by Mr. Joaquin Balmori,

President, Federacion del Trabajo de Filipinas.

AFTERNOON, AT 3 O'CLOCK

Dr. Jose Albert, Professor of Pediatrics, University of the Philippines
and President of the Liga Nacional Filipina para la Proteccion de
la Primera Infancia, Chairman.

1. "Prenatal and maternity care," by Dr. Honoria Aeosta-Sison, Assistant

Professor of Obstetrics, University of the Philippines.

2. "Common diseases of babies causing high infant mortality/' by Dr.

Jose Albert, Professor of Pediatrics, University of the Philippines
and President of the Liga Nacional Filipina para la Proteccion de
la Primera Infancia.

3. "Infantile Beriberi," by Dr. Joaquin Quintos, Professor of Pediatrics

of the University of Sto. Tomas, and member of the Board of
Directors of the Gota de Leche and Liga Nacional Filipina para la
Proteccion de la Primera Infancia.

4. "Tuberculosis and the Child," by Dr. Carmelo Penaflor, Publicity

Director, Philippine Islands Antituberculosis Society and Chief, Divi-
sion of General Welfare, Office of the Public Welfare Commissioner.

THURSDAY, DECEMBER 8

MORNING, AT 9 O'CLOCK

HEALTH AND SANITATION

Dr. Vicente de Jesus, Director of the Philippine Health Service, Chair-
man.

1. "Community cooperation as an essential factor to disease prevention,"

by Dr. Vicente de Jesus, Director, Philippine Health Service.

2. "Observation on the causes of infant mortality," by Dr. H. W. Wade,

Chief, Division of Pathology and Bacteriology, College of Medicine
and Surgery, University of the Philippines.

3. "The function and duties of a health officer," by Dr. Gabriel Intengan,

Acting Chief, Provincial Division, Philippine Health Service.

4. "Vital Statistics," by Dr. Leoncio Lopez-Rizal, Senior Medical Inspector,

Philippine Health' Service.

5. "Refuse Disposal," by Dr. Andres Catanjal, Chief, Division of Manila

Sanitation, Philippine Health Service.

6. "Water supply in relation to infant mortality," by Dr. J. P. Bantug,

Senior Medical Inspector, Philippine Health Service.

7. "The laborers' 'barrio' as a factor in reducing infant mortality," by

Mr. Jose E. del Rosario, President of the Congreso Obrero de Fili-
pinas.

* * *

AFTERNOON, AT 2 O'CLOCK

Visit to the Settlement House, the Gota de Leche, Mary J. Johnston
Hospital, San Lazaro Hospital, St. Luke's Hospital, the School for the
Deaf, Dumb, and Blind, and the Hospicio de San Jose.

FRIDAY, DECEMBER 9

MORNING, AT 9 O'CLOCK

ORGANIZATION OF SOCIAL FORCES

Mrs. Francisco Delgado, President of the National Federation of
Woman's Clubs, Chairman.

1. "The knowledge a club woman should acquire to make her an effective

leader in her community," by Miss Trinidad Fernandez, Secretary
of the National Federation of Woman's Clubs and Provincial Club
Extension of the Woman's Club of Manila.

2. "Girls' Associations: Their opportunity, organization and management,"

by Mrs. Josefa Jara Martinez, Social Worker of the Office of the
Public Welfare Commissioner and Secretary of the Associated Chari-
ties of Manila.

3. "The Public Welfare Nurse and her sphere of action," by Miss Socorro

Salamanca, Superintendent of Nurses of the Office of the Public
Welfare Commissioner.

4. "The preparation and duties of the Visiting Nurse," by Miss Anastacia

Giron, Superintendent of Nurses, Philippine General Hospital.

5. "Training Red Cross aid or child welfare visitor," by Mrs. Elizabeth

M. Bordman, Supervisor of Nurses, Philippines Chapter, American
Red Cross.

6. "The activities of the Catholic Woman's Club," by Mrs. Irving C.

Hartigan, President of the Catholic Woman's Club.

7. "The development of our natural resources and its bearing on public

welfare," by Miss Maria R. Valdez, Director of Women, University
of the Philippines.

* * *

AFTERNOON

2:00-4:30.— Visit to the Maternity House and the Balik-Balik Welfare
Association at Sampaloc, the Santol Tuberculosis Colony, the City Boys'
Reformatory, Bilibid Prison, Philippine General Hospital, and San Juan
de Dios Hospital.

4:30-6:30. — Reception and tea given by Speaker and Mrs. Sergio Osmena.

SATURDAY, DECEMBER 10

MORNING, AT 9 O'CLOCK

GENERAL PUBLIC WELFARE

Mr. Charles H. Magee, Manager, Philippines Chapter American Red
Cross, Chairman.

1. "Relief in time of disaster," by Mr. Charles H. Magee, Manager of the

Philippines Chapter, American Red Cross.

2. "Charity as dispensed by the Associated Charities of Manila," by Mr.

Teodoro R. Yangco, President of The Associated Charities of Manila,

3. "The activities of the. Asociacion de Damas Filipinas," by Mrs. Leo-

narda L. de Ubaldo, President, Asociacion de Damas Filipinas.

4. "The care of dependent, delinquent and defective classes," by Miss

Ramona S. Tirona, Special Agent of the Office of the Public Welfare
Commissioner.

5. "The influence of the school on community welfare," by Mr. North

Foreman, Bureau of Education.

6. "Home gardening, hog and poultry raising," by Mr. Silverio Apostol,

Assistant Director, Bureau of Agriculture.

7. "How we should protect the mothers and children of our laborers,"

by Mr. Faustino Aguilar, Director, Bureau of Labor.

AFTERNOON

2 : 00-4 : 00. — Business session.

4:00-6:00. — Tea given by the Management of the Conference at the Gov-
ernment Orphanage, San Pedro Macati.

The Honorable Manuel L. Quezon, President of the Philippine Senate,
was unable to address the Conference on account of illness.

Dr. H. W. Wade, Chief of the Department of Pathology and Bacteriology
of the University of the Philippines, could not lecture at the Conference
because of his absence from the city.

Dr. Leoncio Lopez-Rizal of the Philippine Health Service was unable
to prepare his paper on "Vital Statistics," on account of illness.

PARTI

ADDRESSES

PROCEEDINGS OF THE FIRST NATIONAL CONFERENCE ON
INFANT MORTALITY AND PUBLIC WELFARE

ADDRESS OF THE PRESIDING OFFICER, THE HONORABLE
TEODORO M. KALAW, SECRETARY OF THE INTERIOR

MR. GOVERNOR-GENERAL, LADIES, AND GENTLEMEN:

Out of every thousand children born in the Philippine Islands,
three hundred and twenty die under the age of -one year. What
eloquent and distressing figure! The practices of our mothers
who are ignorant as regards the care of infants before and after
confinement, are deplorably backward and are tantamount to
infanticide considering their consequences. Thousands and
thousands of infants die because they have not received any
medical attendance nor even the care counselled by the most
elementary precepts of hygiene. The result is that the popula-
tion of the Philippines has not increased as much as it ought to,
and the development of the Filipino race, which has a potential
faculty for expansion and advancement, is thus prevented by
a serious initial obstacle.

The Government has, from the outset, displayed a constantly
growing enthusiasm and has made ever increasing efforts in
this respect. In 1912 it created the first committee on infant
mortality, which made the first remarkable investigations on
the subject. ^Tiki-tiki -extract, the most efficacious remedy for
infantile beriberi and constituting the finest contribution made
ByThe local medical element to science and suffering humanity,
has been distributed regularly. The Public Welfare Board has
also assisted in this campaign by subsidizing private organ-
izations, such as the League for the Protection of Early Infancy,
the Goto, de Leche, the Woman's Club, and others. In 1916,
the greatest effort until then put forth was made, thanks, espe-
cially, to the initiative of Speaker Osmena, when a million pesos
was appropriated for these campaigns. This legislation ren-
dered possible the creation of twenty-three child welfare centers
and the initiation of a great work. In 1919, the Council of State
took up this vast problem and, as a first measure, determined
to send abroad one of our most efficient young men in this respect
for the purpose of studying the most scientific methods and

modern measures for combating this evil. The person appointed
was Dr. Fabella. At the beginning of the present year, Dr.
Fabella having then returned from Europe, the Philippine Legis-
lature created the Office of the Public Welfare Commissioner,
which is charged with conducting, supervising, and coordinating
all work in connection with that campaign.

The present Conference has been called at the initiative of
our beloved Governor-General Wood for the purpose of discuss-
ing infant mortality and other matters concerning public
welfare in general. It is the first Conference of this kind in the
history of the Philippines. As to its importance for the preser-
vation of the Filipino race, no other can surpass it. It is held
under the patronage of a Governor-General who in Cuba has
achieved fame as a great administrator and organizer. God
grant that when he leaves the Philippines, he may be able to say
that he has reduced infant mortality to its minimum here, just
as he succeeded, according to the world press, in checking the
ravages of yellow fever in Cuba.

Ladies and Gentlemen, the purposes of the Government are
great, its intention is generous and humane, the scientific plan
on which these undertakings are based is magnificent, and the
Governor-General who is behind them is active and enterprising ;
but we can not do a thing, we can not move a step without having
everybody's enthusiastic cooperation. We need the cooperation
of the Legislature, the most brilliant representatives of which
are present here with us, for such supplementary legislation as
may be necessary. We need the cooperation of the several bu-
reaus and offices of the Insular and local governments. We
need the cooperation of private organizations which pursue the
same humanitarian and altruistic purposes. We need the co-
operation of the professional class, especially of the physicians
and nurses, whose advice and technical assistance are necessary.
And, lastly, most especially and in a way which appeals most
strongly to our heart and our patriotism, we need the co-
operation of the woman, be she a Filipina, an American, or a
foreigner — that cooperation which she has already accorded to
us in the past and Which constitutes an achievement and one
more glory for the Filipino woman. We need the cooperation
of women particularly because the purpose of this campaign, the
goal towards which we are striving, is but one: the education
of our mothers.

Ladies and Gentlemen : With the greatest faith in your efforts,
your intelligence, your ability, and your patriotism, I declare
now, with your leave, this Conference open for its deliberations.

INVOCATION
By Archbishop MICHAEL J. O'DOHERTY

Our Father Who art in Heaven, Thy little ones are perishing
amongst us ; and we, who are more favoured with worldly goods,
wish to rescue the children of our poorer brethren.

We desire to do this work in Thy company, under Thy guid-
ance and with Thy 'blessing : without Thy blessing, Oh ! Lord,
nothing can be a lasting success; even the "children of this
world," so wise in their generation are beginning to realize
the truth of Thy words: "Without me, you can do nothing."
(St. John, XV. 5.)

We, therefore, begin this work by invoking Thy name and
with a petition for' Thy blessing.

The desire on our part of saving the lives of the little children
must be specially acceptable to Thee, Dear Lord. For, when
Thou didst dwell with us on this earth, Thou didst well love to
linger with the little ones ; and when others tried to separate
them from Thee. Thou didst gently remind them; — "Suffer
little children to come unto me and forbid them not. For of
such is the kingdom of heaven." (St. Mark, X. 14.)

We therefore ask Thee with confidence to bless the work of
saving the lives of the little children which we begin today.

And bless us also, Dear Lord, bless all of us. The Christian
warfare is always a struggle; to carry Thy cross we need Thy
help. Help us constantly in the struggle, so that our pure, holy
Christ-like lives may be an example and an inspiration to the
little ones as they grow older; help us from on high so that the
little ones may learn through our example to be also Thy faith-
fub followers. Amen.

185611 2 17

ADDRESS OF WELCOME BY GOVERNOR-GENERAL
LEONARD WOOD

LADIES AND GENTLEMEN :

We are assembled today in the First National Conference on
Infant Mortality and Public Welfare. I am delighted to see you
here, and as Governor-General of the Islands, I extend to you
the most cordial welcome and pledge myself to do all that I
can in this most important work. We are ,all interested in it
not only for the Filipino people but also for humanity in general.

The needless loss of lives in the Philippines must be terminated.
The percentage of infant mortality is one-third of all born, very
much greater than it should be, very much greater than is
necessary. We look especially to the women of the Philippine
Islands to bring about better conditions. The men are going
to help also, but the work will concern women mostly. Their
natural instinct will be touched by this unnecessary loss of lives
which no people. can stand. The campaign is going to be largely
one of general education, and we want all the women of the
Islands as wrell as the men to take up this work. Education is
not a very difficult thing. We want you to teach ignorant
mothers how to take care of their children. We need better
centers everywhere in which all that is good for children is
taught, one of them being the matter of proper diet. We have
the means in the Islands for preparing a diet at little cost.

We need in our campaign money, better work, and more nurses.
But we have only 920 graduate nurses. We have practically the
same number of municipalities', so that there is on the average
only one nurse for one municipality of 13,000 people. I wish
there were ten times more than the graduate nurses we have.
Our schools are quite inadequate to turn out within a reasonable
period of time enough nurses to do special work in connection
with this campaign. You must have the courage and enthusiasm
to meet the situation. Encourage the profession of nursing.
We have in the Islands about 1,200 doctors, one doctor to 11,000
people. We need more doctors and more nurses to flbuild up in
the Islands at once organizations of women, or women's clubs,
which will take up this matter. We can give you data. You
have the facility to do this work well. By this day, we take
18

care of our sick, insane, and other defectives, and I know you are
doing these things for the welfare of the children. All we need
now is organization and the necessary instruction to prevent the
unnecessary loss of lives. And this great work is going to be
the first definite step in the educational progress. The Public
Welfare Commissioner, Dr. Fabella, is well equipped in this
work, and I appreciate his enthusiasm and untiring energy. He
will give you every possible help and means in carrying out the
very purpose of this Conference.

We extend to you our sincere congratulation. We all say
with one voice, "God bless your efforts."

ADDRESS OF THE HON. SERGIO OSMENA, SPEAKER, HOUSE
OF REPRESENTATIVES

[Due to the impossibility of publishing the entire address of the Speaker, because of failure
to obtain copy of the manuscript, excerpts of newspaper accounts are quoted below.]

Speaker Osmena delivered a brilliant speech which held the
house spell bound for more than thirty minutes.

"This conference is not the first step in fighting infant mortal-
ity" Speaker Osmena said, "this is the natural results of the
tremendous progress of the Filipino people along the line of
sanitation and public hygiene. The campaign is a part of the
health activities of the Government since its establishment."

The Speaker said he was not surprised that after almost two
decades of progress the Filipino leaders, on the call of their
governor, had gathered in the national conference. The Con-
gress, he said, is a happy consummation of the efforts of the
people and their government for bettering themselves.

He traced the beginning of the campaign early in the year
1903 when, official records show, the Government first took
the necessary steps to protect human life from the diseases
that claimed big death toll every year. Gradual steps were
made, he stated until through private initiative the Gota de
Leche was organized to help the children of the poor. Subse-
quently the National League for the protection of infancy was
also organized. Speaker Osmena paid a glowing tribute to the
founders of these two institutions who, he said, have rendered
and continue rendering service to the public without expecting
monetary reward or honor for the sacrifices they are making.

The government has not been blind to the need of a cam-
paign for public health and sanitation and has not been indiffer-
ent to the activities that would conserve the Filipino race and
put it on equal level with the most civilized people of the
world, Speaker Osmena said. At the organization of the
Philippine government public health was among the first thing
to be attended to and the Legislature has time and again ren-
dered not only moral but financial help for this purpose.

He gave out figures to show that the Government has
done everything it could in improving the health conditions
20

in the Philippines. He said that the Government appropriated
in 1909 only f*l,521,530.36 for public health and in 1921
^8,053,000; in 1909 there were only 46 doctors in the public
health service, in 1921 there were 114; in 1909 there were only
49 nurses, in 1920, 503; in 1909 there was no laboratory now
there are 31; in 1909 there was only one water system and
that was in Manila the Carriedo system, but in 1920 there were
30; there are now over 2,000 artesian wells in the municipal-
ities and barrios; and throughout the provinces and towns the
Antipolo sewerage system has been adopted.

The steps taken by the Government were gradual, he said,
because the ideas had to be spread and extended to the masses
in the country. But those ideas have so radiated to all parts
of the Islands, thanks to the activities of private individuals
and the Government in the last few years, that now the people
are ready to launch a national campaign for saving children.
The idea having been accepted by the people through past
activities can now be pushed in a general campaign managed
by a central office in Manila.

Mention was also made of the creation by the Government
of the board of public welfare and the appropriation of one
million pesos for the protection of infants and the creation of
the Office of the Public Welfare Commissioner whose head was
sent by the Government to foreign countries to study the
different systems in vogue there in fighting mortality. — The
PHILIPPINES HERALD, December 7, 1921.

Speaker Osmefia emphasized the fact that public health and
sanitation in the Philippines have gradually developed, quoting
figures to prove his statement. "No impartial critic of our ins-
titutions— of the administration of justice, of public works, of
public instruction, of public order, — can say that we have not
progressed along these lines," he emphasized. "You are here
not for the purpose of creating a sentiment against infant
mortality and lack of sanitation, for that sentiment already
exists and has existed in the past, but rather to coordinate
scattered forces in order that our work may be more effec-
tive."— MANILA DAILY BULLETIN, December 7, 1921.

ADDRESS OF MRS. FRANCISCO M. DELGADO, PRESIDENT,
NATIONAL FEDERATION OF WOMAN'S CLUBS

MR. CHAIRMAN, His EXCELLENCY, SPEAKER OSMENA, LADIES AND
GENTLEMEN :

Not being accustomed to public speaking I would have hesi-
tated to accept the honor of addressing you today were it not for
the fact that I consider this invitation a high compliment to
Filipino womanhood and the woman's clubs all over the country.

In behalf of the National Federation of Woman's Clubs I beg
to endorse the idea of Governor Wood in suggesting the calling
of this Conference on Infant Mortality, which is indeed one of
the paramount problems that we must face today. Its impor-
tance can not be measured in dollars and cents, for it is primarily
of a higher plane; but were we to judge it by a material
standard, the present lack of population with which to people
and develope our vast tracts of virgin lands, our mines and our
industries would be sufficient to show the economic advantage
of conserving the lives of our babies until they reach a mature
age.

It is indeed very pleasing to note the great interest shown by
our women on this subject, as evidenced by the activities here-
tofore undertaken by the woman's clubs and the great numbers
present here today; and it is but natural that it be so, because
the baby's care and training, from the time of its birth and
unto its death, is truly, first and last, a woman's care.

It is also highly encouraging to see that the Government is
taking more and more interest in this problem ; and although the
woman's clubs all over the Islands have for some time now been
trying to organize a systematic way of improving conditions,
they would welcome most heartily all assistance preferred, offi-
cial or otherwise, because they realize the need for united and
concerted action as well as the indispensability of material help,

I take it that the prime object of this Conference is to enlighten

those present on the different phases of infant mortality and its

prevention as well as to devise means to systematize and unite

the efforts of all towards the reduction of the great percentage

of infant mortality and the proper conservation of the lives of
our children. This is clearly along the lines of endeavor here-
tofore undertaken by our woman's clubs in Manila and the
provinces; and consequently we can not but be most thankful:
to those who initiated and are now patronizing this movement.

While of course we would hesitate in accepting any courtail-
ment of the present absolute freedom of action on the part of
our clubs in this or any other endeavor heretofore undertaken
by us, I am sure I am voicing the sentiments of all the members
of the National Federation of Woman's Clubs when I say that
we not only will not refuse any assistance from the outside but
on the contrary will court and seek the cooperation of all for a
united effort. In other words, without in any .way sacrificing
our respective individualities, we stand for a concerted action
or "team-work" among the different organizations, official or
otherwise, on the same field of activity; absolute and sincere
cooperation between the different entities and personalities doing
the same work; personal contact of the different elements in
order to bring about a mutual and sympathetic understanding
among all; and, above all, absolute subserviency of individual
interests and opinion, or that of any one club or organization, to
the common good of the cause which is being served by all. In
this particular respect, I hope I may be permitted to suggest
that we should emulate more and more the example of our
American sisters cooperating with us in our work.

All will agree, I believe, that the most effective means of
decreasing infant mortality here or elsewhere, is through the
education of the mothers and the would-be mothers in the mod-
ern scientific ways of caring for the babies and children.
While the different lectures to be delivered during this Confer-
ence will be indeed most instructive and useful, I venture to
suggest as one of the ways most effective to this end, the graphic
demonstration of modern sanitary ways of taking care of the
babies and children in the barrios and municipalities of the
different provinces. Again, the formation of "little mothers'
clubs" among intermediate girl-students of the different towns
would indeed be another good means to educate the mothers and
mothers to be.

I believe firmly that the appalling rate of our infant mortality *
in our country is largely due to lack of proper and intelligent
care of the babies. Therefore, in educating the mothers and
the mothers to be along modern ways in this regard, its reduction
may be assured.

In conclusion, I wish to assure the Government and the officials
present that the National Federation of Woman's Clubs of the
Philippine Islands, the members of which are freely giving their
time and best efforts for anything and everything which is for
the uplift and progress of our people, can always be counted
upon to support heartily any movement towards that end.

May the deliberations of this Conference result in the success-
ful reduction of infant mortality and the proper conservation
of the lives of our babies and children.

ADDRESS OF DR. JOSE FABELLA, PUBLIC WELFARE
COMMISSIONER

LADIES AND GENTLEMEN :

On an occasion like the present one, we feel like congratulating
ourselves from the Office of the Public Welfare Commissioner, for
the unusual opportunity in expounding our work and in address-
ing this distinguished gathering, composed of -the high author-
ities of the Philippine Islands from whom we have received
encouragement and support; and of the representatives of
social service organizations from all over the country, who have
come purposely to get new ideas so that they may direct their
efforts more effectively toward bringing about prosperity and
well-being upon the people in their own respective communities.
The occasion is certainly worthy of notice and comment, but, as
well-chosen words fail me, please accept our gratitude and
appreciation.

In the preparation of the program for this Conference, persons
who are authorities on their respective lines were selected to
read papers on the causes and the remedies of our present high
infant mortality, and on the needs of combating it in these
Islands; hence, it will be out of the question for me to discuss
these subjects here. I would like to take the privilege of point-
ing out to the members of this Conference some of the phases of
child conservation which I consider of great importance; but as
these subject-matters will be taken up separately in the program,
allow me only to ask you to pay particular attention to them, so
that when you return home, you may be able to apply the knowl-
edge acquired here in remedying your own local problems in the
most profitable and effective way. The war against infant mor-
tality is being fought right in the cities, towns, and barrios from
which you, distinguished members of this Conference, come. As
it is in the cities, towns, and barrios where children are born ; it
is also there where they live, suffer and die. Our main work
therefore must begin, and must be done right there.

What are the favorable conditions whereby mothers can
be helped and babies saved? Their view, expressed by the recent

International Congress for child welfare held in Belgium this
year, implies that the establishment of consultation centers for
babies constitutes one of the best means of combating infant
mortality; and for this very reason, it went down on record that
the establishment of such centers be favored and encouraged by
all means possible. Our experience has also proved that the
establishment of these centers for mothers and babies is the
cheapest means of combating infant mortality. It is therefore
essential that in every city, town, or small community, a con-
sultation center — be it a puericulture center, a health center, a
public dispensary, or a hospital — should be established and made
available to all who are in need of the service ; for in these places
alone can the ways and means of remedying certain unfavorable
conditions for mother and child be given by competent physicians
and nurses in charge of the work.

In going over the common causes of infant mortality, we find
that a great majority of our babies die during the first months
of life. This fact indicates that the mother has been subjected
to some unnecessary neglect and risk. Protection of these women
is of the utmost value to the nation, for they are the highest
potential factor in the bringing of healthy children into the
world. The lack of proper care and advice for mothers during
pregnancy and the employment of unfit and untrained helpers
to assist them during the critical child-bearing period, need
our immediate attention. Our efforts, therefore, should be
directed mostly toward maternity care, for the conservation of
the health of the mothers will result in the bringing into this
world not only of a greater number of babies but also of a
stronger race of people.

Other causes of high infant mortality in our country are easily
prevented. Take beri-beri, for instance, and diseases affecting
the stomach and intestines; these can be avoided by proper
diet. Deaths caused by diseases of the lungs and air passages
can also be prevented by proper care and proper clothing. Pre-
vention of infectious diseases thru the observance of simple
rules of hygiene and of sanitary regulations would also reduce
infant mortality. Such knowledge may be imparted to the pub-
lic thru propaganda, be it in the form of consultations, house-
to-house visits, lectures, publications, posters, or other means
of giving out general information concerning health preserva-
tion in any given community.

One of the most potent factors in combating infant mortality
is undoubtedly the service rendered by visiting nurses familiar
with the methods, and properly trained in maternity and child

welfare work. Our present corps of nurses is not sufficient to
meet the demand. This shortage in nurses is keenly felt by
us, for there are many a puericulture center and a woman's
club which are in need of their services. It is, therefore, one of
our strongest appeals to the members of this Conference to
interest sensible and sympathetic young ladies in their respective
communities, to take up the noble profession of nursing.

All that has been said so far, has a direct bearing on the
protection of mothers and babies. However, the reduction
of infant mortality cannot be accomplished by such a protection
alone; but must be aided by the observance of general health
and sanitary regulations, and by the presence of a good water
supply in every city, town, and barrio. General public welfare
will help remedy all undue suffering, and will help protect the
poor, the weak, and the defective ; but it must work side by side
and hand in hand with other activities in order that it may cope
with the alarming situation.

This brings us to the point, that in order to effectively reduce
infant mortality, there must exist coordination and cooperation
of all efforts and influences tending to improve this important
activity. Summarizing the facts above mentioned, your atten-
tion, therefore, should be directed to the form of organization
and means of managing puericulture centers; to the adequate
provisions and methods of insuring good maternity care ; to the
education of girls and mothers in personal and child hygiene;
and to the ways and means of improving general sanitary con-
ditions.

In dealing with the public, in your limited community, town,
city, or province, you will find that on many occasions your
energies and sacrifices may be misinterpreted; or by reason of
animosity that may exist in your particular locality, you may
encounter continuous opposition on the part of certain elements.
This, is only natural and of common occurrence. You must not,
however, feel that you should stop and abandon the good work
that has just been started, and disregard the cries for help of
thousands of babies ; but on the other hand, you and I must all
lend a helping hand to the numerous mothers who are in need
of assistance. Cultivate in yourselves the virtue to meet the
exigencies of the situation with firmness; and the courage to
pursue and continue your work. Remember that you will not
be alone in your struggle, for the Government agencies, working
on this line, will see to it that you are not left unguided in your
undertaking; and will also see to it that suitable help and
assistance within their power are extended to you.

Those of you who are representatives of woman's clubs, we
wish to assure you once more, that our Office is ever willing to
encourage and help you in the continuance of your work. The
former Public Welfare Board in 1915 showed such faith and
confidence in the possibilities of woman's club organizations in
the Islands, that it requested the Woman's Club of Manila to
establish similar ones in the provinces; and since that time the
Government, thru this agency and its successor, has continued
nurturing the same confidence that your organization will, some
day, be one of the biggest factors in the uplift of your community
through public welfare work. The Government gives financial
aid to any organization, equivalent to the amount raised from
all other sources, on condition that the administration and the
expenditure be subject to inspection; and that suggestions for
a wise and effective way of carrying out their purposes be offered
to them. This Government contribution is also offered on a
basis as submitted by an organization if approved by the Secre-
tary of the Interior through the Office of the Public Welfare
Commissioner. Our experience has shown that social service
organizations which have carried on their work with funds raised
mostly by their own efforts, have been more successful than
those whose main sources of income have been derived from the
Government. We are, therefore, taking as our policy, the giving
to any charitable or social service organization, mostly those
devoted to maternity and child welfare, of a sum not exceeding
one-half of the approved items in the total expenditures.

In conclusion, you may wonder what the possibilities are in
reducing the high infant mortality in the Philippine Islands;
and when that desired goal will be reached. Comparing the re-
sults obtained in other countries, I may tell you this : New York
City, during the past thirty-one years up to 1915, was able to
reduce their mortality rate from 273 to 94 per 1,000 births.
This means that infant mortality was reduced to 5.7 per 1,000
births yearly. In England, statistics in 1914 show that there
were eight consultations for mothers and babies, and an infant
mortality rate of 105 ; while in 1920 the consultation centers were
increased to 1,937, and the infant mortality rate dropped to 80,
which means that within seven years, they were able to reduce
their infant mortality rate by 35 per 1,000 ; this further means
that the reduction was at an average of 5 per 1,000 births yearly,
making it similar to the figures quoted for New York. In re-
ducing infant mortality, both New York and England resorted
to the establishment of the consultation centers for mothers and
babies — the very same procedure that we are carrying out and

encouraging in our couritry — the establishment of puericulture
centers. You may be assured, therefore, that by establishing
more puericulture centers under proper management and stand-
ard, the desired aim towards which all of us have been working,
will be accomplished. Let us hope that we can have better results
than those obtained in other countries, and these can be made
possible only by constant working together. Then, and only
then, can we markedly reduce the high infant mortality in the
Philippine Islands.

PART II

LECTURES AND DISCUSSIONS

A. THE HEALTH OF THE MOTHER AND CHILD

FAULTY MATERNITY PRACTICES AND THEIR
INFLUENCE UPON INFANT MORTALITY

FERNANDO CALDERON, M.D., Dean of the College of Medicine and Surgery,

University of the Philippines, and Director of the Philippine

General Hospital.

In our country, as well as in other parts of the world, there
are many superstitious and faulty maternity practices based
on the ignorance of the people. The influence of such practices
upon infant mortality is pernicious. These faulty practices
are prevalent among the lower classes of our people ; but even
among our so-called cultured classes, there are found those who
are devout followers of these practices. We may observe the
performance of these practices during pregnancy, during labor,
and during lactation.

Among the ignorant, there are women who believe in the
existence of a very active evil spirit which is troublesome to
women who are pregnant, or are in labor; and also to newly
born children. This spirit is known by the name of "aswang. "
The "aswang" is similar to the vampire of Europe and is be-
lieved to harm pregnant women and their offsprings as it sucks
their blood while they are asleep. The "aswang" is also believed
to be more troublesome at night than during the day time ; and
for this reason, the pregnant women are afraid to go out at
night. Should occasions require them to leave the protection
of the house at night, they let their hair hang down, for in so
doing, they frighten the "aswang" away and prevent it from
approaching them and transforming their children into "as-
wangs" before they are born. It is customary for pregnant
women to keep a light or fire burning under the house all night
as it is believed that the evil spirits are frightened away by this
method.

The "aswang" is supposed to be a very clever spirit but in
spite of that it can not see a person who is covered with a

185611 3 33

black cloth, and so pregnant women are always advised to sleep
under a blanket especially during the latter months of preg-
nancy.

The ignorant women are so imbued with their superstitions
and so afraid of the "aswang" that many of them become ner-
vous, can not sleep well at night, lose their appetite, and become
thin and very weak. When they deliver, their babies are found
to be small, weak, and an easy prey to the numerous diseases
occurring during the first days of life.

There are many other superstitions observed among our wo-
men during pregnancy which could be cited here; but having
no influence upon infant mortality, though some of them are
very singular and interesting, I am not going to mention them
here in order not to abuse your kind attention. There is an-
other pernicious practice during pregnancy that deserves men-
tion as it may be the source of a serious trouble during labor.
This practice is called in Tagalog, "pagbubunkal ;" and it is
a maneuver consisting in moving the baby inside the womb
so as to place its head along the median line of the abdomen
during the last three months of pregnancy. This maneuver is
delicate and dangerous, and when it is needed for some reason
or other, it should be performed by doctors only so as not to
endanger the life of both the mother and the 'baby. Therefore,
when this operation is done by midwives and "curanderos," it
may lead to a bad position of the baby and consequently it is
one of the causes of infant mortality.

During parturition, the practices which are usually observed
among our ignorant women are those resulting from advice
given by intruders, unqualified and superstitious midwives, and
"curanderos." The remedies used to facilitate the expulsion
of the child consist in the administration of certain medicines
and the application of certain mechanical means. Of course
the administration of medicines, ordinarily made up of certain
leaves, roots, salt and other substances, is ordinarily harmless;
but the mechanical treatments employed by them are, in many
instances, very dangerous, such as strong and brutal application
of pressure upon the abdomen of the parturient woman, which
may cause several lesions on her sexual organs and even injuries
to the child inside the womb. The person in charge of this
violent manipulation is known by the name of "salag." While
the woman is in labor the "salag" pushes the fetus down into
the pelvis, in order to hasten the expulsion of the child.

This maneuver is ordinarily done by a robust person, man
or woman, but preferably a man, who can force the expulsion

of the fetus with all his might either with his hands or with
a piece of wood in such a manner that oftentimes the body of
the woman in labor and that of her child are full of contusions
and lacerations of all sorts. As the baby is expelled by force,
big lacerations of the organs of the mother, involving even the
anus, are produced, or else, the womb of the woman is ruptured
and both the mother and the baby die. Many women date their
suffering and invalidism from the time of their confinement, and
this is because the injuries which they receive during their
deliveries make them suffer from various diseases difficult to
cure.

A great many of the unqualified midwives and quack doctors
never clean their hands when they attend a case of labor; and
while they touch the sexual organs of the parturient woman
with their dirty fingers with long and dirty nails, they also
handle dirty clothes; scratch their heads; rub the abdomen of
the patient with dirty oil from time to time; smoke cigars and
cigarettes; chew buyo, and spit right and left inside the house.
If they need water, they use any water they can get, and put
it in any basin or receptacle they can find without cleaning it.
They do not care whether the pillows, blankets and other things
needed by the parturient woman are clean or not. The conse-
quence of this custom is that, on many occasions, the parturient
woman and the newly-born child become infected.

WHEN THE CHILD IS BORN

After the birth of the^ child the cord is not cut until the
placenta is expelled. The child is therefore exposed for several
hours sometimes; and while waiting for the placenta, the poor
new-born child gets cold and becomes sick.

If the expulsion of the placenta is delayed, the midwife pulls
on the cord while other persons push the uterus down. This
method is dangerous because the cord may be torn off the pla-
centa; or else the placenta may be forcedly detached from the
wall of the womb, leaving behind portion of it; or the womb
may be pulled inside out.

As soon as the placenta is delivered, the cord is cut and the
placenta is buried in the ground. It is believed to be a bad
practice to throw it away. A hole is made for it and care is
taken to make it just large enough to hold the placenta, because
if the hole is too big the baby will become voracious, and if
it is too small the baby will have small intestines and a poor
appetite. Some think it better to throw the placenta into the

river as this will make the baby alert, healthy, and strong.
Others believe that if the placenta is buried together with a
pen or a book, the baby will grow into a bright man. The
placenta may be also used as medicine. It is cut into pieces,
boiled, and then given to the parturient to eat for the purpose
of preventing many kinds of diseases during confinement.
Sometimes the cord is cut into pieces which are then hung on
the eaves of the house in order to keep the child healthy and
strong. While these practices are just mere superstitions and
therefore entirely harmless, the way the child is separated from
the placenta is dangerous as it is done by cutting the cord
with a sharp piece of bamboo, preferably "buho," or sometimes
with a "bolo," or a pair of scissors. As can be supposed, all
these instruments are dirty, being soiled with earth or dust,
and, consequently, they are responsible for the frequent cases
of tetanus in the newly-born children. In like manner, the way
in which the cord is dressed which consists in covering the
cord with ashes and then wrapping it in a piece of paper or
linen which usually is dirty, leads to tetanus. This disease,
which is one of the most mortif erous infections in the new born,
occurs very frequently, and has a disastrous effect upon infants
among the lower classes.

In some parts of Luzon, as in Nueva Ecija, for example,
before dressing a male child, a barbarous maneuver is performed
which consists in fracturing the penis by folding it over at its
middle. The reason for this, it is alleged, is for the charitable
object of preventing the child from becoming erotic or fond of
women when he grows up into a man. ' There is a more common
but less dangerous practice. It is the so-called "minamainitan"
which consists in applying a hot piece of flannel of other materials
over the abdomen, umbilicus, and sexual organs of the child
as a prevention for hernia. If the child is male, the cloth should
be rubbed upward over the sexual organs. Leaves of "romero"
may also be used for this purpose.

After cleaning and dressing the newly born baby, the midwife
administers a purgative, or a bitter juice, as the juice of "am-
palea," which is sometimes mixed with a few drops of the
mother's milk. The juice is squeezed out from the leaves of
a bitter plant and then given to the child to drink. As the
substance is bitter, it causes almost always a continuous vomiting
which renders the baby weak. The leaves of the plant must
always be of uneven number, otherwise the juice will not become
effective.

. 37

DURING LACTATION

The woman must not nurse her baby if she has just been
cooking or ironing, because her milk is supposed to have ^een
altered by the heat. If she has not nursed her child for several
hours, her milk is also supposed to have become unfit for the
baby, and so she must squeeze out the supposed bad milk before
putting again the child to the breast. Anything that is sour
is considered bad for a nursing woman because it coagulates
her milk and it may give rise to colic in the child. The mother
must also be careful that no lizard drinks her milk, otherwise
the secretion of her milk will stop. Hyperlactation, or excessive
secretion of milk, is prevented by the use of a key as an amulet,
or by papaya flowers suspended from the neck.

Besides these superstitions concerning the milk of the mother,
I may mention also some practices which are dangerous to the
life of the new-born baby. For instance, the air is responsible,
according to our grandmothers, for many troubles and alter-
ations in the health of the new-born. It is believed that there
is a certain kind of air which is essentially injurious to the
child and which produces certain diseases and even causes sud-
den death. For this reason, it is a common practice to close
the windows of the room of the child, and as a consequence, the
room is deprived of good ventilation so indispensable to the
health of the baby.

When the child becomes sick, it is subjected to certain prac-
tices which are also prejudicial to life. On many occasions,
saliva is rubbed all over the body of the child and naturally
when the saliva is from a tubercular person, there is danger
in the child contracting tuberculosis. Sometimes, urine mixed
with vinegar is applied to the body of the child, and at the
same time a little amount of this salivary solution is given to
the child to drink in order to produce profuse sweating; thus
exposing the child to such infectious diseases as typhoid fever
and even gonorrhea. In some Tagalog towns, this custom is
still more repugnant than that I have just described because the
people rub the body of the child with their hands moistened
with saliva which is produced by chewing "canela," "sangki,"
or "malaube." Instead of this manual application, there is an-
other method called "buga" which consists in spraying the body
of the baby with the saliva which accumulates in the mouth
while chewing leaves of "romero." The most popular "buga"
is the one in which the saliva produced by chewing "buyo" is
used, so it is considered to be the most powerful remedy for

all kinds of skin disease. This practice is also very dangerous
because it serves to carry the germs of tuberculosis to the baby.

There is another remedy which is used when the child has
high fever and convulsions. It is what is called "paso" or
"halik" which consists in burning several points of the skin
around the mouth, or navel, of over the ears, hands, feet, or neck,
and sometimes all over the body. For this purpose, the "chi-
reta," or a pointed piece of coconut shell, or a small bar of iron,
is burned to white heat and then applied to several parts of
the skin. It is unnecessary to say that oftentimes the baby is
so thoroly treated by this method that instead of getting better,
it dies.

Among the medicines for diseases during childhood, the ig-
norant people use the bile of certain animals and the juice of
bitter plants, mixed with milk, and used ordinarily to induce
vomiting; but all the remedies so far enumerated none is so
repugnant, so dirty, and so dangerous as the eggs and feces of
the cockroach which are crushed in a small amount of milk
and then given to the child. This practice is very pernicious
in its effect because in the dntestines of the cockroach is found a
large number of amoebas, not to mention the fact that this insect
lives ordinarily in such dirty places as the letrinas and stables,
and is a carrier of many bacteria.

When the child's mouth is dripping with saliva during denti-
tion, the ignorant mother secures the portion of the feces of the
child, dilutes it with water, and applies it, to the gum. It is
a well known fact that feces contain all kinds of microbes and
when they are swallowed they give rise to various kinds of
diseases.

Allow me to mention also the custom among our ignorant
people of taking their small children along when they attend
processions held during church festivities, thus exposing them
to the weather until nine or ten o'clock in the evening. As a
result, the children catch cold and then contract intestinal or
pulmonary diseases. I have observed this custom in the several
districts of this city, and thousands of these small children can
be seen with their parents or relatives taking part in the pro-
cessions. I suppose the same custom prevails in the provinces.
Another source of danger to the small children is the bad
custom common among our people of kissing the children and
of allowing them to put toys into their mouths. These customs
should be stopped because they are the causes of tuberculosis
and other diseases.

Finally, I wish to call your attention to another undesirable
custom of many families who think that the best way to keep
their children healthy and well developed is to give them all
sorts of foods, as for instance, banana, rice, meat, etc., when
the only food suitable for them, on account of their tender age,
is milk. It is not only the question of what is given but also
the question of how much is given that is faulty. Oftentimes,
foods are given in such large amounts that they can not be di-
gested properly by the small and delicate stomach of the child.
Apropos to the quantity of food that should be given to the
child, I wish to call your attention to the fact that, according to
the life-size photographs of the stomach at the different periods
of infancy, the capacity of the stomach at birth is one ounce;
at two weeks, 2 ounces; at three months, 4| ounces; at six
months, 6 ounces ; at twelve months or one year, 9 ounces ; and
at eighteen months or one and a half years, 12 ounces. Having
this in mind, the mothers should see that the quantity of food
that is given to the child ought to be in accordance with its
age so that its stomach holds only the amount that it can digest.

Ladies and gentlemen, I am going to close my paper with
this remark : That in spite of the fact that public education has
spread all over the Islands and that many of the superstitions
and undesirable practices I have mentioned have already dis-
appeared, it is an undeniable fact that in the remote towns
in the provinces and even in certain places in our large cities,
there are still several faulty maternity practices or customs
which are up to us to combat. I believe that the centers of
puericulture and the woman's clubs established in all parts
of the Islands will help very much in destroying and eliminating
these practices inasmuch as through propaganda and education
of our masses, which are of little cost, these welfare organizations
can be a powerful factor in decreasing the high infant mortality
in the Philippines.

DISCUSSION

Mr. TEODORICO DOMINADO (Delegate, Dumangas Puericulture Center,
Iloilo). — I have observed that the priest in baptizing the baby, administers
his saliva into its mouth. I wish to know whether this is harmful or not.

Dr. ANTONIO HERNANDEZ (Delegate, Provincial Board, Sorsogon) .— In
connection with Dr. Calderon's lecture, I wish to know if it is possible
for health officers in the towns to give instructions to those desiring to
study maternity care; and I suggest that midwives who never had any
training in that work should not be allowed to practise.

Mrs. SEVERA PAREDES (Delegate, Sta. Cruz Woman's Club, Ilocos Sur). —
I wish to say that Representative Lucero has introduced in the Philippine

Assembly a bill asking for the appropriation of f*l, 000,000 for maintain-
ing one nurse for each town or every two towns to help instruct the
public.

Dr. SUMBITO (Occidental Negros). — Sometimes the mass is not to blame
for the bad practices in connection with maternity care. For example, the
services of a nurse cost i*25 and that of a physician, f*50; and the average
weekly salary in the .provinces is f*6. Can you blame the mass for not
securing such services? I have also observed that the nurses devote
very little time to the poor; on the other hand, they attend the wives
and children of the "higher-ups" in the towns. How can we then help
the poor?

Mr. JOSE CATINDIG (Delegate, Provincial Board, Bulacari). — I believe
that the establishment of mother's institutes will help in solving the
problem of infant mortality. Teachers' institutes have contributed a
great deal toward making an efficient teaching force in these Islands,
and I see no reason why such an institute for mothers will fall far
from preparing women for efficient motherhood. If such an institute is
operated in every town, for, say a month, the mothers and expectant
mothers may be given practical instructions along sanitation, care of
babies, etc.

Miss ANATOLIA P. GALANO (Delegate, Batac Puericulture Center and
Woman's Club, Ilocos Norte). — We have heard a great deal about the
bad practices of midwives, but in my town the services of doctors and
trained nurses are impossible to secure. I request the authorities to
prepare and distribute circulars that will enable mothers to go thru
childbirth safely.

Mrs. ROSARIO B. FERRER (Delegate, Cagayan Woman's Club, Misa-
mis). — In our town we have a nurse who has to inspect three munic-
ipalities. This nurse gives occasional lectures to the "parteras" pointing
out to them their bad practices. Every time she visits a barrio, she
notifies the "teniente" three days in advance, and the "teniente" in turn
notifies the "parteras" of that barrio to meet at a certain place. The
"parteras" at the appointed time and place, meet the nurse who influences
them to discontinue their faulty practices. I believe that this is one
good way to teach the midwives, so that they can assist mothers safely
at childbirth.

Dr. ROSENDO R. LLAMAS (San Juan de Dios Hospital, Manila). — After
hearing Dr. Calderon's paper on the "bad practices" still prevalent in
the islands, I suggest to this Conference, as a means of combating these
bad practices, the establishment of a central office where institutions,
associations, etc., engaged in social service work, can be united. In San
Juan de Dios, some maternity patients were never heard of after their
discharge. I think this problem can be solved by having a central office
where all institutions of this kind may come in contact with one another
for the unification of their work.

Dr. S. RAMOS* (Delegate, Provincial Board, Occ. Negros). — I would
like to suggest that the district nurses in cooperation with the nurses
in charge of the puericulture centers should see to it that all "coma-
dronas" are registered. This work can be carried out by the president

of the sanitary division. Once these "parteras" are registered, they are
known. The "parteras" should be required to report all deliveries
attended by them.

Miss ANATOLIA P. GALANO (Batac, Ilocos Norte). — Since it is- the
practice of the majority of our people to have infants baptized a few
days after birth, subjecting them to such unnecessary exposures injurious
to their health, I recommend to the Philippine Legislature the passing
of a law prohibiting the baptism of infants under one month of age
unless the ceremony is performed at the home of the parents.

Mrs. MARIA V. ALMOJUELA (President, Pandan Woman's Club, Catan-
duanes, Albay) .—I suggest that a nurse be appointed to instruct the
ignorant midwives and parents in my locality.

Dr. CESAR MERCADER (Delegate, Puericulture Center, Dumanjug,
Cebu). — I suggest that municipalities pension yearly beginning this
coming year, some intermediate graduates to study midwifery as follows:

Fensionados.

First class municipality 4

Second class municipality 3

Third class municipality 2

Fourth class municipality 1

I further suggest that the expenses be equally shared by the Insular
and the Municipal Governments, that the requirements be only the com-
pletion of the intermediate course; that the midwives serve the munic-
ipality which sent them for as many years as they were pensioned at
a salary half as much as the designated salary; and that such "pensio-
nados" be from barrios as approved by the Superintendent of Schools.

Miss EULALIA R. DE LEON (Delegate, Villasis Woman's Club, Pangasi-
nan). — Since infant mortality is high in many localities, and since many
pregnant women and many babies die due to ignorance of midwives, I
then suggest that the Legislature pass a law, compelling every munic-
ipality to provide each district with a physician and a midwife.

Miss GRACIA B. QUERUBIN (Delegate, San Esteban Woman's Club, Ilocos
Sur). — Accidents and many sufferings during labor are met with very
frequently due to ignorance and carelessness of local midwives. Accord-
ing to our municipal death record, out of fifty-six deaths during the
year, 26 were under 2 years of age; 17 under one year; 2 from tetanus
and 1 from hemorrhage. This shows that more than one half of the
deaths were of infants. I believe that this high infant mortality and
many of these needless sufferings can be reduced if we have a trained
and preferably a registered nurse to help us.

Mrs. ANON R. BORROMEO (President, Woman's Club, Surigao). — As one
of the causes of our high infant mortality is the ignorance of midwives,
many of whom have never had any instruction on that subject, I suggest
that the Philippine Legislature regulate the practice of midwifery, and
make it the duty of the District Health officers to give practical demon-
strations to them once a week. The Health Officer should also require
them to report all cases particularly the difficult ones. After a certain
period, if the Health Officer thinks that they are deserving, then they
can be given certificates entitling them to practice midwifery.

Miss CONSUELO VILLANUEVA (District Nurse, Cam. Sur).—l suggest
that all midwives be given instructions in maternity care and infant
feeding by nurses employed by the provincial government; and that such
midwives be given certificates after they have received the course of
instruction, as approved by the provincial nurse and the president of
the sanitary division. Midwives not holding certificates should not be
allowed to assist any delivery; thus they would be encouraged to come
for the instructions.

Miss LOURDES ICHON (Secretary, Urdaneta Woman's Club, Pangasi-
nan). — The majority of deaths of mothers is due to ignorance on their
part and on the part of those who attend them during child birth. Many
of our babies can also be saved if trained midwives take care of mothers
during child birth, and the newly born are given proper care.

I therefore suggest that the Legislature pass a law taxing all able
bodied Filipino women between the ages of 18 and 60 years, fifty centavos.
The money thus collected should be set aside for the establishment of
maternity and puericulture centers.

Mr. E. GONZALES (Mariveles, Bataan) . — I suggest that physicians and
nurses instruct the "hilot" in all the towns so that they may be better
prepared to help in the general welfare work, and to help reduce the
high infant mortality.

Mr. A. P. ANUNCIACION (San Ildefonso, Ilocos Sur). — I suggest that
a law be passed prohibiting the old type of midwives from assisting
women during delivery, for their insanitary methods kill many of our
babies.

Mrs. SALVACION B. LONDRES (President, Oton Puericulture Center,
Iloilo). — Inasmuch as the services of untrained midwives are indispensable
in the community, I suggest that the authorities concerned take the proper
measures in giving these midwives instructions in the hygienic and sani-
tary methods of caring for both mother and child.

Mrs. MATILDE A. DE GOMEZ (President, Calbayog Puericulture Center,
Samar). — I recommend to the proper authority, thru the Public Welfare
Commissioner, the reopening of the school of midwifery at the Philippine
General Hospital, or any other hospital. As has been pointed out in
this Conference, there are not enough nurses to supply the demand;
and as the course in midwifery is short, the midwife can take the place
of the regular nurses while the latter are still in training.

Miss SOCORRO CASTRONUEVO (President, Calinog Woman's Club, Iloilo). —
Due to superstitions prevailing among the quacks such as the influence
of bad fairies over mothers and children, I suggest that measures be
taken to rid the country of such superstitious quacks.

Dr. ALFREDO HERRERA (Delegate, Puericulture Center, Cebu, Cebu). — I
suggest that midwives be registered before they receive instructions, and
that such instructions be given them by a competent personnel from the
Office of the Public Welfare Commissioner.

Miss ANATOLIA P. GALANO. — I suggest that regulations be made pro-
hibiting the baptism of infants under one month of age. As we kno\v,
in our barrios far away from the municipal center, babies are taken

to the chur

the church for baptism when they are only a few days old, exposing
them to the weather, and placing them in the hands of ignorant women.

Mr. ONOFRE SISON ABALOS (Calasiao, Pangasinan). — I suggest that
from now on articles regarding the care of poor working mothers before-
and during delivery be published in local newspapers once or twice a
week. I further suggest that circulars be sent to presidents of all
woman's clubs who will in turn pass these instructions on to intelligent
members who should personally give the instructions to the public, giving
the cause and effects of the actual existing and unfavorable conditions.

DR. CALDERON'S ANSWERS

Regarding the question on saliva during baptism, I do not think there
is any danger in it. That is different from rubbing the body of the baby
with the saliva of a priest suffering from tuberculosis.

No doubt the problem of hygiene and sanitation which confronts us
requires money for its solution; and the ideal way of handling the situa-
tion is to have one nurse for every barrio, one physician for every one
or two towns, and one hospital for every province. Since we cannot
have the funds to meet the needs, it is the duty of puericulture centers
and woman's clubs to cooperate in the propaganda for instructing the
poor and the ignorant.

HOW TO ORGANIZE AND OPERATE A PUERICULTURE CENTER

TRANQUILINO ELICANO, M.D., Medical Officer of the Office of the Public

Welfare Commissioner

Wherever institutions interested in maternity and child wel-
fare exist, such agencies usually establish preventive stations,
with scope more or less broad, known under various names in the
United States as Child Health Station, Child Welfare Center
and Babies' Center, and in the Philippines, by the names of
Health Center and Puericulture Center.

A puericulture center is a place or station where mothers
and expectant mothers can take their babies and children in
order that the condition of their health and development may be
ascertained and in order to secure such advice as is necessary
for the proper care and prevention of the common ailments of
infancy and childhood.

The main purpose of a puericulture center is to keep babies
well by furnishing mothers with the knowledge of the ways of
preventing needless sickness. It also aims to promote intel-
ligent motherhood in order to give the baby a good start in life.
The diet of babies and children, as well as that of the nursing
mother, is given special attention, as ignorance regarding this
important subject is one of the chief causes of illness during
infancy and early childhood. Maternal feeding is especially
advised as the mother's milk is the magic liqueur for the baby,
the one food that cannot be substituted for by any other kind.

Before establishing a puericulture center in a town, there is
needed an organization interested in its purpose and ready to
back it up morally and financially.

Local initiative with or without Government aid. — The best
agency that can establish a puericulture center is a woman's
club or any other organization that exists in the town doing
some philanthropic work. In the absence of such an organiza-
tion, at the call of the Municipal President, the local health
officer, the local physician, or anybody in the town, a corporation
may be formed which will conduct the establishment of a pueri-
culture center.

A „

An organization intending to establish a puericulture center
should be, more or less, familiar with the undertaking. The
local health officer or any other person known to have had some
experience on this matter may be consulted ; or information may"
be secured by studying the procedures of a successful puericulture
center in a neighboring town ; or it may be secured from any
Government agency in Manila engaged in child and public
welfare work, such as the Philippine Health Service, the Red
Cross, the Office of the Public Welfare Commissioner, and others.

The interest of prominent persons and of the community in
general should be aroused in order to secure their full coopera-
tion. To do this, all the influential men and women, irrespective
of their religious or political affiliation should be made ac-
quainted with the projected plan and must be invited to co-
operate in the movement. They should be asked for their opi-
nion and suggestions which must receive due consideration from
the organization that is initiating the movement.

After securing the full cooperation of the prominent men
and women, that of the public in general should be enlisted, and
for this purpose a mass meeting should be called. The plan
of the puericulture center and the benefits that can be derived
from it should then be explained. Appeal should be made for
financial and moral support ; that is, the people should be asked
to become members of the puericulture center or to contribute
for its maintenance.

In the case of a woman's club taking the initiative, the step
to be taken regarding the organization is simple. The only
need is to make the necessary provisions in thier by-laws for the
establishment of a puericulture center.

If no organization to take up this work is available, a mass
meeting should likewise be held at the call of the Municipal
President or other prominent persons in the town. Besides
inviting the people to cooperate, the Articles of Incorporation
and By-laws of the association to be organized should be sub-
mitted for discussion and approval on this occasion. It is there-
fore essential that these documents be prepared beforehand.
Immediately after, the election of the Board of Directors and
other^ officers of the association should take place. It is advisable
to incorporate the association in order to put it on a stable
basis and to be entitled to whatever financial aid the Government
has to offer for maternity and child welfare work.

After the work of organization is completed, the next essential
step to be taken before a puericulture center can be established
is the raising of funds. Inasmuch as there is practically no

limit to the activities which the organization may undertake in
connection with the reduction of infant mortality, any amount
that can possibly be collected for such purpose will never be
too much. However, to begin with, the main items of expendi-
tures to be taken into consideration are the salary of a full-time
nurse and 'of a part-time physician and the equipment and rental
of the place used. For a small town, at least 1*1,000 should be
raised in order that a puericulture center could operate according
to the proper standard. This amount, together with the insular
aid (in case this is solicited) would be sufficient to meet the ex-
penditures for one year. In making the campaign for raising
funds, the organization may, besides collecting membership dues
and voluntary contributions, give benefit shows, dances, box
socials, or adopt any other measure which they believe will give
the best financial results in their locality. Besides voluntary
contributions, aid may be requested from the municipal, pro-
vincial and Insular funds.

In some places difficulty is met in connection with the raising
of funds on account of the actual financial crisis, or lack of per-
severance on the parts of the members, or at times, the lack of
confidence on the part of the public.

As to the first cause — the present financial crisis — that is
beyond our power to remedy. But the second depends wholly
upon the members of the organization. In this kind of work,
it should always be borne in mind that we are guided by the
spirit of service and it is to be understood that no personal
benefit is expected therefrom. I believe that if we are imbued
with the proper spirit, we will readily acquire patience, con-
stancy and perseverance.

As regards the confidence of the people, that depends mainly
on the character and integrity of the Directors; also on the
purposes of the investment and on any other guarantee that can
be offered by the organization.

Government aid. — The Insular Government encourages wo-
man's clubs or any other organizations interested in maternity
and child welfare by appropriating one million pesos designed
to give financial aid usually equivalent to the sum that the
local organization has raised for the purpose. Application for
government aid should be sent to the Office of the Public Welfare
Commissioner in Manila, which helps the organizations to estab-
lish puericulture centers and other institutions by which infant
mortality can be combated.

In order that a puericulture center may be entitled to the aid
offered by the Central Government, it must be incorporated

and its Articles of Incorporation and By-laws should be made
to conform in their essential parts to the requirements contained
in Order No. 10, series 1921, of the Department of the Interior.

Having the organization and funds ready, our attention is
directed towards the establishment of the puericulture center
and its operation.

The center should be located, if possible, in the heart of the
town, or in its most thickly populated portion. A room in the
municipal government building or a vacant room in a school-
house or any fairly good-looking house, may be utilized as center.
If possible, two rooms should be secured, one room to be utilized
for reception, lectures and demonstrations, and measuring and
weighing; the other to be used for examination and treatment
room.

In case more rooms are available, the following arrangement
may be made :

1 receiving and recording room
1 demonstration and lecture room
1 weighing and measuring room
1 physician's office
1 dressing room

The room near the entrance will make a good receiving room
where mothers and children are to be registered and the prelimi-
nary data to be taken. It should contain a writing table for the
nurse or clerk, 2 chairs, and a filing cabinet for the records.
The largest room should be utilized for lecture and demonstra-
tion and should be provided with two small tables, one for the
articles to be used for demonstration and the other where the
demonstration may be made. The walls may be lined with in-
structive posters which may be used as topics for lectures.
There should be enough benches to accommodate the audience.

A small room is provided with a table on which to undress
the baby for weighing and examination by the physician. Close
to this room should be the physician's office provided with a
writing table, two or three chairs, cabinet for instruments and
a washstand. In one corner hidden by curtains, a table for ex-
amining prenatal patients may be placed.

There shoud be a treatment room where minor surgical cases
may be treated and dressed. If only one room is available,
screens or curtains may be used to make the necessary divisions.

Personnel and duties. — The technical personnel are a part-
time physician and a full-time nurse for a center established in
a town of about 3 to 5 thousand inhabitants. It is essential to
have a physician who can devote sufficient time to the work.

Hence, he should be paid for a definite number of hours to be
spent in the center. In many places, the physician voluntarily
offers his services free, taking into account the civic purposes of
the organization and, perhaps, its small funds. Whether free
or paid service is rendered, it is essential to the success of the
center that the physician be regular and punctual in his attend-
ance at the center. The physician should not make the work
merely a routine one. The examination of the babies and chil-
dren should be done as thoroly as possible. The individual needs
of the child should be discussed with the mother at each visit to
the center or to the home. He should also cooperate with the
Health Officer or with any charitable organization. He should
give conferences at least once every week and should avail him-
self of all the opportunities offered to him in public meetings
to say something on child and public welfare.

The nurse, besides helping the physician in the center and
giving lectures and demonstration, should also visit the homes
of the clientele and invite them to go to the center regularly.
She should follow up the cases to see whether or not there is any
improvement in the home care and whether or not the advice of
the physician is being carried out. Volunteers interested in the
progress of the center can be of great assistance to the nurse
and will help much in increasing the attendance in the center, in
receiving mothers, in the preparation of the proper clothing for
the baby, in giving them instruction in hygiene, and in weigh-
ing and measuring the babies.

Operation of a puericulture center. — The opening of the center
may be celebrated with a short program to which the whole town
should be invited. On such an occasion, the public should
be informed once more of the purposes of such institution,
of the days of consultation in the center, and of other activities
that it will undertake. The number of consultation days per
week may be fixed according to the need.

The names of the babies and children brought to the center
are to be registered by the nurse who at the same time takes
data regarding the baby and its parents. The baby is then
stripped, measured, and weighed and is taken to the physician for
a thoro examination. If found ill, the proper treatment should
be administered in case the parents of the patient are not able
to pay ; if well-to-do, it should be referred to the family physician.
If the baby is sound, the mother should be praised for the good
care she has taken of her baby and should be given such advice
as she needs regarding care, diet, sleep, clothing, etc., in order
to preserve the health of the baby. The mother is to be requested

to bring the baby and other children to the center once every
week.

The weight, measurements, and other findings about the baby
are to be put down in record forms so that any deviation frimr
normal development could be noted readily and its cause inves-
tigated and corrected before the health of the baby is greatly
impaired.

An expectant mother should also be invited to go to the center
periodically, especially the primipara, to ask for medical advice
concerning her condition ; also to enable the physician to detect
and prevent any complication of pregnancy or any defect which
may endanger the life of the mother and baby during delivery.

On certain days of the week, lectures and .demonstrations
should be given by the physician or by the nurse.

The nurse should make a house-to-house visit every afternoon
in case the center is opened in the morning, for the purpose of
observing whether the advise given at the center is being followed
or not; to invite more mothers to go to the center; and also
to show, if necessary, how the homes and their surroundings
may be made more hygienic.

Other activities. — The puericulture center may initiate any
movement conducive to the improvement of the community. In
places where no other physicians are available, the physician and
the nurse of the center can attend gratuitously to delivery cases
outside. It may conduct a baby contest to promote the interest
of the people in the health and development of their babies. The
activities of the center are not confined to the town only. On
certain days the barrios must be visited, and lectures, demon-
strations, and consultations given.

In case more funds are available, a maternity house and hos-
pital may be established in connection with the puericulture
center.

To summarize, we have the following to remember :

1. The best agency which can establish a puericulture center
is a woman's club or any duly organized entity.

2. If no organizations exist, a corporation may be formed at
the call of the Municipal President or other prominent persons
in the town with the main purpose of establishing a puericulture
center.

3. The Insular Government encourages woman's clubs and
any other organization to operate puericulture centers or other
institutions for maternity and child welfare. It also gives finan-
cial and technical aid for such purpose. The puericulture center
may also solicit aid from municipal and provincial funds.

185611 4

4. For a town of 3 to 5,000 inhabitants, it is necessary to raise
at least ?*1,000 — excluding Insular aid — in order to be able to
operate a puericulture center for one year.

5. The center may consist of one room or more, but it should
be located in, or near the center of the town.

6. The technical personnel are a part-time physician and a
full-time nurse. Volunteer members are a valuable asset to the
success of the center.

And finally, it should always be borne in mind that a puericul-
ture center is an institution, established for every mother and
child regardless of social standing, and therefore, in order that
it may reach its maximum degree of usefulness and development,
everybody should be invited to avail himself of its services and
to cooperate in its maintenance.

A puericulture center is one of the cheapest as well as one of
the most effective means of reducing infant mortality and of
raising the standard development of our children. I believe
that the appalling mortality of our children is a fact familiar
to everybody and, therefore, we hope that the response of the
people will be as readily obtained as when it is asked for in the
suppression of epidemics.

DISCUSSION

Mr. T. DOMINADO (Delegate, Dumangas Puericulture Center, Iloilo). —
We know that a puericulture center, before it can secure aid from the
Insular Government, must be formally organized and incorporated, the
incorporation fee being f*27.20. I suggest thru the Public Welfare Com-
missioner that the puericulture center be exempted from the incorpora-
tion fee and that the equivalent amount be turned into the puericulture
center fund. To encourage the people in the organization, I further sug-
gest ^ that the Office of the Public Welfare Commissioner furnish any
town which can operate a puericulture center a nurse to begin working
at once at the expense of the Office of the Public Welfare Commissioner
until the puericulture center has sufficient funds to pay for her services.

Miss SOFIA GALERA (Delegate, Currimao Puericulture Center and
Woman's Club, Ilocos Norte) . — As we have a puericulture center in our
town, we shall be very thankful to the Public Welfare Commissioner if
he would send and support an experienced nurse to take charge of our
organization until our club will be able to give her financial support.

Mr. ESTANISLAO RAMOS (Delegate, Hermosa Puericulture Center,
Bataan). — To help reduce infant mortality, I suggest that all towns in
which puericulture centers do not have sufficient funds, be furnished a
physician or a nurse paid by the Office of the Public Welfare Commis-
sioner. The physician or nurse should give lectures and should give the
local midwives proper training. ,

Miss ROSARIO MANAHAN (Balanga, Bataan). — Inasmuch as every pueri-
culture center is entitled to receive financial aid from the municipality,

I suggest that a resolution be sent to the Legislature requesting that
at least 5 per cent of the land tax be set aside for the use of the pueri-
culture center. I further suggest thru the Public Welfare Commissioner
that provincial and municipal officers be instructed to lend official help
to puericulture centers.

Mrs. S. B. LONDRES (President, Oton Puericulture Center, Iloilo). — I
would like to know whether the puericulture center can temporarily utilize
the services of the president of the Sanitary Division during the time
such a center does not have any funds from which to pay a nurse.

Miss ROSARIO MANAHAN (Balanga, Bataan). — What methods should we
use in raising funds if in spite of all efforts the directors fail to collect
the amount needed for running a puericulture center?

Mr. M. CARAGAY (Delegate, Abucay Welfare Association, Bataan). —
The raising of local fund is very difficult, and for this reason, I suggest
that any puericulture center or woman's club which has discovered a
practical method of raising funds communicate with the Public Welfare
Commissioner, sending in their data, so that in turn the Office may send
such data to other centers and clubs for information and guidance.

Mr. FELIPE FUENTES (Limay Puericulture Center, Bataan). — As we
have observed that voluntary contributions and monthly fees of members
are difficult to collect and do not constitute a permanent revenue, I re-
quest the Legislature, thru the Public Welfare Commissioner, or other
official channels, to authorize the passing of a municipal ordinance, taxing
the heads of families not less than f*2 nor more than 1N5 a year. The
money thus collected plus that collected by the Board of Directors through
voluntary contributions or otherwise should be set aside for the use of
the puericulture center.

Miss TRINIDAD MORALES (Solsona, Ilocos Norte). — In case there is a
center in a town, I suggest that a physician who could offer his services
free of charge in case of emergency should be detailed there.

Miss ALBINA CARPIO (Currimao, Ilocos Norte). — I suggest that those
who contemplate organizing puericulture centers, be given by-laws so
that they may have full understanding of the subject before they attempt
to organize one.

Mrs. EMILIA JARA (Delegate, La Paz Puericulture Center, Iloilo). — The
most speedy way of securing funds is to tax women between the ages of
20 and 50 years, one peso a year to be divided as follows:

50 per cent for Puericulture Center fund.

25 per cent Red Cross.

25 per cent for Associated Charities.

The Public Welfare Cojnmissioner is requested to station a doctor or a
nurse to start clinics in towns not having sufficient funds, for at least
six months.

Miss EMILIA PONCE DE LEON (Delegate, Provincial Board, Palawan). —
To help check the high infant mortality rate, I suggest that a puericul-
ture center or a day nursery be established in every municipality with
a population of 10,000.

Miss FIDELA C. ROBERTO (Delegate, Orani Puericulture Center, Ba-
taan). — To hope for the prolongation of the existence of puericulture
centers in all provinces means to give more financial help and attention
to the poor provinces.

Miss SOFIA GALERA (Delegate, Currimao Puericulture Center and
Woman's Club, Ilocos Norte). — In case a puericulture center is established
in connection with a Woman's Club in any municipality, I suggest that
a nurse be sent to take charge of such an organization at the expense
of the Office of the Public Welfare Commissioner till such a club is able
to give her financial support.

I further suggest that the Office of the Public Welfare Commissioner
issue regulations to the Woman's Clubs regarding "Care of babies," "Diet
for mothers and children" and others with provision that mothers dis-
obeying such regulations may be subjected to investigation and be fined.

Mrs. NATIVIDAD G. FELIN (President, San Jose Woman's Club, An-
tique).—I suggest that the Office of the Public Welfare Commissioner
send out physicians to inspect puericulture centers at least twice a year.
This will not only help encourage the centers but will also help in deter-
mining the progress of its work from year to year.

Mr. TEODORICO DOMINADO (Delegate, Dumangas Puericulture Center,
Iloilo). — I suggest that a baby contest be held every year in each munic-
ipality under the auspices of the puericulture center, and if there is no
center, it should be under the auspices of the president of the sanitary
division with the cooperation of the municipal officials and public school
teachers. The date of the contest should be set and the prizes be pur-
chased by the Office of the Public Welfare Commissioner.

I further suggest that puericulture centers be exempted from the pay-
ment of incorporation fees.

Mr. V. I. GALVEZ (San Rafael, Bulacan). — It is suggested that this
Conference should find out how many woman's clubs are using their funds
according to the original objects for which they were raised.

Many woman's clubs in Bulacan are inactive and so it is suggested that
the Conference do something to put these clubs once more into action.

Mr. TEODORICO DOMINADO (Dumangas, Iloilo). — The hardest problems
encountered in connection with the puericulture center are the operation
of that association in accordance with the principles of the corporation;
the raising of funds; and the soliciting of membership.

However, if the public can be actually shown the good that a physician
or a nurse can accomplish, in a community they will not hesitate to
cooperate and contribute. Therefore I suggest that the Office of the
Public Welfare Commissioner support a nurse for a period of three
months to work in any newly organized puericulture center without suf-
ficient funds, and to serve as propagandist.

Dr. A. HERRERA (Delegate, Cebu Puericulture Center, Cebu). — We all
know that it is in the poorest towns that infant mortality is highest, and
since many of these towns are too poor to give any financial support
to the puericulture centers, I suggest that the Legislature enact a law
providing financial aid to such towns to be approved by the Secretary of
the Interior and the Public Welfare Commissioner or his representative.

DR. ELICANO'S ANSWERS

The idea of exempting puericulture centers from the payment of in-
corporation fees is a good one. Puericulture centers are civic and non-
stock corporations. I do not see any reason why they should not be
exempted, just as the Rural Credit Associations are. I hope that a
bill to this effect will be submitted at the next session of the Legislature.

As to the suggestion that the Office of the Public Welfare Commis-
sioner furnish any town that can operate a puericulture center a nurse
to begin the work, I regret to say that at present the Office can not
afford to follow such practice on account of its small appropriation and
the shortage of nurses. Th same may be said in connection with the
requests for nurses for town organizations that are not yet financially
able to defray the expenses of employing their nurse.

The center may utilize the services of the president of the sanitary
division with the consent of his superiors, but when required by the
Secretary of the Interior, as per Sec. 3 of Act No. 2988, he shall render
services in the center.

The sending of physicians to inspect the work of puericulture centers
is part of the program of work carried on by the Office of the Public
Welfare Commissioner.

Pamphlets on the care of babies, diet for mothers and children, etc.,
as well as on organization of puericulture centers are now distributed
free by the Office of the Public Welfare Commissioner and may be had
any time by asking for them.

The method of raising funds depends upon local conditions and inclina-
tions. From the reports received from various organizations regarding
this matter, we gather that the most usual means are a benefit dance
with box social and sale of flowers; benefit performances or shows, such
as drama or cine; and popularity contests — these, besides soliciting mem-
berships and donations. The method of going from house to house every
day for the purpose of collecting small contributions is not a very suc-
cessful one. A drive to last one week, or two, however, may be tried.
The drive may be carried out in this way:

1. The directors should decide the amount they need to raise.

2. Divide the amount by the number of directors and barrio commit-
tees and let each one raise the amount that corresponds to* him.

The idea suggested by Dr. Herrera is very good, and I hope that it
will be considered by our Legislature. The approval of such measure
will enable many poor towns to operate a puericulture center and will
insure the maintenance of the centers already established.

HOW WE SHOULD TAKE CARE OF OUR BABIES

REBECCA PARISH, M.D., Superintendent, Mary J. Johnston Memorial

Hospital

It is a great pleasure to greet this first infant welfare con-
ference, a host arrayed against our common foe — the prevailing,
permitted conditions responsible for the ' 'slaughter of the in-
nocents/*

We glibly say "a nation's resource is its children" and "mo-
therhood is God-given" but do we act as though we really be-
lieve what we say — do we take to heart the fact that the nation
is wasting its resource, and that our motherhood does not always
carry out its high and holy opportunity?

According to the statistics of the past year or two, if radical
measures are not adopted it is but a question of time until the
Philippines will be depopulated ; our death rate is too high, and
especially among our babies and small children.

Into the hut and the slum as well as the palace of royalty,
comes this divine gift to the mother, that makes the care of the
helpless little one not a burden, but a joy and pleasure.

But in lands where infanticide is almost the rule (albeit it be
not carried out by merciful suddenness, but by neglect, igno-
rance, infection, starvation, and preventable poverty and depri-
vation) it would seem that the mothers are failing in their high
calling and that they would appear murderesses to intelligent
fatherhood ; if the result of all this were only death it would not
be quite so bad — the wailing, suffering, emaciation, and long-
drawn-out wasting away, are a crime against the helpless and
innocent, even when we leave out of the question the loss of life.

In one sordid district of Manila, I saw one, day, a large and a
small coffin in front of a funeraria, as an advertisement; sad
commentary, but true; these helpless conditions all too fre-
quently take away both mother and baby.

HOW WE SHOULD NOT TAKE CARE OF OUR BABIES

We should not live in stables, nor under houses flushed daily
by esteros, nor under dark and damp houses where grown people
cannot stand erect, nor in tenements where the lancape or papag
54

system is used, nor in nipa-house sections where huts are
crowded together over mud flats.

We should not crowd together, with many families, in one
house or room, with not enough space, air or privacy.

We should not feed babies too frequently, too much, or im-
proper food.

We should not use infected or impure food and drink.

We should not feed babies turnips, hard corn, etc.

We should not carry and constantly shake the babies.

We should not allow the babies to be naked and exposed.

We should not expose babies to infectious disease.

We should not neglect slight ailments in babies and children
until they become serious maladies.

We should not allow babies and children to tie tormented by
eruptions and infections.

We should not starve babies.

HOW WE SHOULD TAKE CARE OF OUR BABIES

We should begin the proper care of our babies by premarital
examination for fitness to become parents. The expectant
mother should have thoughtful care devoted to her; she should
have proper surroundings and professional care during con-
finement.

The new baby requires proper surroundings, a cleanly home
and intelligent parental care. It needs baths, given for clean-
liness. They are refreshing and stimulating to the skin. It
needs air at all times.

Babies require exercise. Remove the garments for some short
time during each day, that the baby may throw its limbs about.
Crying, except when caused by illness or pain is not discourag-
ing or harmful.

Babies ought to be weighed each week, as a means of watching
their health. They should gain at least 100 grams weekly.

Young babies should sleep 22 hours out of the 24 ; and they
should sleep alone, in the open air, but not in drafts. They
should be protected by warm sleeping garments and mosquiteros.

BABY'S CLOTHING

The clothing of a baby ought not to be especially designed
for ornament or decoration. It should be for protection from
weather and insects — and for the inculcation of morals; for
privacy, looking toward the development of morals.

BABY'S FOOD

Food and feeding of babies are of the first importance. Proper
food, and proper feeding, at regular intervals, and strict observ-
ance of cleanliness will save most babies' lives.

Mother's milk is the natural food for the baby. It is sterile,
it is safe, it is vital ; it is properly proportioned as to the neces-
sary elements; it is the most convenient food. Some one calls
it the "precious maternal fluid." Better than to give milk direct
to nursing infants, is to give milk and other nourishing food to
the mothers. This increases their nursing ability. It is possible
in most cases to stimulate this to an extraordinary extent.

Nursing of infant is contradicted, of course, when (1) the
mother has beriberi, unless her food can be supplemented, or
else the baby can be given the tiqui-tiqui extract; or (2) she
is tubercular; or (3) she has a severe or acute disease; or (4)
when she suffers from a long continued disease; or (5) when
she is debilitated; or (6) when she is anemic.

But do not discontinue breast feeding on slight pretext or
cause. Many mothers report that even doctors tell them, "Per-
haps your milk is not good for the baby; stop nursing him."
There is no "perhaps" about it; and no one knows whether the
milk is good or not without examination. Therefore give up
maternal nursing very reluctantly, unless there are definite
indications for so doing.

BABIES AS INDIVIDUALS

If imperative, and many times it is so in the Philippines, con-
sider each baby as an individual and have a special formula. It
is best to have a doctor examine the baby thoroughly, and pre-
scribe the milk to be used. Then prepare this milk as ordered,
and try to follow professional advice absolutely. There should
be no experimenting with a baby's stomach. It is much easier
to keep it in order than to relieve any derangement,

In caring for bottle-fed babies, keep all bottles and nipples
clean and sterile. Feed only at regular intervals, and for only
15 or 20 minutes. See that flies and other insects never have
access to baby's food.

The new-born baby's stomach holds but 30 grams; therefore,
do not overfeed ; it is imposible to put 100 grams of milk into a
30-gram stomach!

About 2 hours are required for digestion; then the stomach
needs to rest a little before the next feeding; we allow even the
horse or carabao some time for rest — why" not do as well by the
baby's stomach?

The objects of food are — to build up daily, to promote growth;
the food must develop muscles, bones, teeth, nervous system,
blood, etc.

Indications that a baby is doing well on his food are:

He is satisfied and happy; he has no vomiting; he gains in
weight, steadily; he has regular bowel movements, no constipa-
tion or dysentery; no gas, or pains; no undigested particles of
food in defecation.

A baby even in bad surroundings that cannot be altered, can be
saved and can gain as much as one and one-half pounds a week !

A case of milk a month will feed a baby; if it is the crucial
month, a baby's life can be saved for W.5.

A baby gets thirsty as well as hungry, and needs water, even
though its food is liquid; give a small quantity of boiled water
between feedings, say only a teaspoonful for new babies.

Dr. Dennett, an eminent specialist of New .York, says the
second year of life is the most difficult feeding period of a child ;
therefore do not think as soon as a child can eat, it needs no more
attention.

Now, the way to take care of a baby, is to take care : do it !

We can reach our Filipino mothers, if we hasten; give them
individual attention; take them one by one, not en masse.

LET US BE IMMEDIATE

In action — locate one need, and meet it; that particular need
requires no more investigation. It is already known, apply the
remedy.

In teaching — teach one thing, then put it into practice.

In cleaning up — clean up one place, and keep it clean.

In prophylaxis, which means prevention, some one has said
that a fence at the top of a precipice is better than an ambulance
at the bottom.

Mothers need to know just how to do best, the ordinary, every-
day things ; there is a definite need for specific and simple direc-
tions for the daily care of the baby; it is infinitely easier to
prevent illness than to cure it.

Mother should learn to cook proper food in the home; a
balanced, clean, wholesome diet, that little children can partake
of as soon as the milk stage is past or partly so.

Mothers need a keen sense of duty toward the care of the
baby, to bring the child through infancy and childhood, sound
in body and mind. Even if the mother keeps a nurse-maid, she
herself must know, as she is responsible, and she must direct the
care of the baby.

Mothers who realize their high privilege and accompanying
responsibility will appreciate the vital importance of knowing
how to save the baby.

Fathers, realizing their responsibility, will give solicitous care,
both prenatal and postnatal; will have tender concern for the
nursing mother; will provide home, shelter, food; will share in
the cares and responsabilities, and discipline of the children;
will in reality be the head of the family.

Fathers and mothers will unite in feeding, clothing, housing,
teaching, and developing the child; will form habits of cleanli-
ness, health, obedience, refinement, and morality.

We must all cooperate — every person is concerned in the
saving of babies. Do you not hear the cry of the children? As
Browning says "The child's cry curseth deeper in the darkness,
than the strong man in his wrath."

DISCUSSION

Miss JOSEFA MORALES (Numancia, Capiz). — In connection with Dr.
Parish's speech, I believe that the Woman's Clubs can render better service
to the community if they can set aside at least one period a week in
which to discuss the "Pre and the Postnatal care of Babies."

Mr. FAUSTINO PUGEDA (Cavite). — I suggest that in all municipal-
ities, classes be held, to teach mothers how to take care of their babies
and how to lead a sanitary life. Such classes may be conducted by a
district nurse or by the president of the sanitary division.

Mr. EMILIO DE GALA (Candelaria Puericulture Center, Tayabas). — We
have all heard Dr. Parish's statement in regard to poverty which forces
people to live in stables. What are the most eficacious means and ways
of combating such a situation?

Mrs. C. A. OLGADO (Romblon, Romblon). — How sad it is to witness a
child from five (or even less) to fifteen years of age smoking! I suggest
that there be strict prohibition of the use of tobacco by growing young
children.

Mrs. HONESTA E. LOMIBAO (Dagupan Woman's Club, Pangasinan). —
I suggest that a law be passed prohibiting mothers to gamble so that
they may have more time to devote to their children.

Mrs. RAMONA BULLO (Mariveles Puericulture Center, Bataan). — To re-
duce infant mortality in these Islands, I suggest that a circular regarding
"Proper Care of Children," and "Proper Feeding" be issued in Tagalog
for the Tagalog provinces.

Miss VICENTA POSADAS (Pozorrubio Woman's Club, Pangasinan). — To
reduce infant mortality, I suggest that every municipality be provided
with a nurse to help and guide the mothers in the proper care of their
children.

In this connection, I also suggest that woman's clubs take an active
part in interesting young women in the study of nursing, for at the pre-
sent time, we do not have sufficient nurses to meet the demand for their
services.

Miss PRESENTACION V. OBADO (Baccara, Ilocos Norte). — I suggest that
pamphlets dealing with the proper care of children be published and issued
to the public in different dialects and languages,

Miss LUCILA MATAMORORA (Naga, Prov. Delegate, Camarines Sur). —
As the provinces can not afford to furnish all the doctors and nurses
needed in all the towns, I suggest that every municipality send a "pen-
sionada" to Manila to study "Infant Care," so that we may succeed_in_
our campaign against infant mortality and against diseases of early
childhood.

Miss FIDELA C. ROBERTO (Orani, Bataan).— One of the. most important
factors in the improvement of the health of our mothers, and in the re-
duction of infant mortality is the publication and wide distribution of
pamphlets regarding maternity and proper care of infants, in different
dialects.

Miss ROSARIO SALAS (National University). — In connection with what
Dr. Parish has said about the clothing of our children, I suggest that the
Public Welfare Commissioner make arrangement with the Secretary of
Public Instruction or any branch of the government concerned, whereby
the domestic science department include in its curriculum the making of
model clothing for children between 2 and 10 years, and that girls taking
the course be given one day a week in which to make a house to house
visit especially among the poor to instruct the mothers how to make the
proper clothes.

Mr. MARCELINO C. SOTELO (Delegate, Pilar, Abra). — I recommend to
the Legislature, thru the Office of the Public Welfare Commissioner the
passage of a law prohibiting the Catholic clergy to perform the baptismal
ceremony on infants under 3 months of age in the hot part of the day.

Many parents travel over great distances by foot with the babies 1 or
2 days old for baptism.

Miss N. ABASTILLA (Baguio Woman's Club). — I suggest that pamphlets
relating to mother and child welfare be written in English, then translated
into the different Philippine dialects, for publication and for distribution.
In this way, I believe that we can reach at least half of the masses, for
those who cannot read English can read the pamphlets in their native
dialects.

DR. PARISH'S ANSWERS

I heartily approve of all suggestions in points noted, — namely, for
woman's clubs to set aside definite times to teach prenatal and post-
natal care; to have circulars printed in all dialects, setting forth the
simplest and most pertinent points regarding the care of children; to
have the continuous services of a graduate nurse in each municipality
to guide and teach; to interest young women in the study of nursing
and to influence them to take up child welfare work on graduation; to
have definite provision made for domestic science sewing classes to make
models of children's clothing and go into the homes to teach the mothers
to make these simple garments; to prohibit the use of tobacco among
minors; and to enact a law looking toward the turning of mothers' minds
from gambling toward the caring for their children. I feel that these sug-
gestions should be put in immediate operation. If they were followed, re-
sults of the right kind would be apparent everywhere within a few months.

The point regarding "poverty forcing people to live in stables" may
be answered by the statement that I do not believe this is the result of
poverty, but rather, indigence, and such residence for little babies and
children should be prohibited by executive order.

WHAT MOTHERS AND CHILDREN SHOULD EAT

SEVERO SIASOCO, M.D., Senior Medical Officer of the Office of the Public
Welfare Commissioner

The destiny of the race is in the hands of the mothers, and
the safety of nations is not a question of the gun alone, but also
of the man behind the gun, and he is mainly the resultant of the
grit and self -sacrifice of the mother.

The health of the offsprings is determined by the health of
the parents.

A child without a sound and healthy body is greatly handi-
capped, and such neglect of physical health is unpardonable.

It is, then, for us now to cooperate with them and teach them
the proper selection of the fuel which they need in their different
modes of living. By the fuel, we mean the foods which make a
mother healthy and strong enough to meet the hard task and
duties of motherhood in order that she may give to the country
a robust, healthy, and useful man.

In order to give due consideration to both mother and child
we shall first discuss the mother's dietetic needs which may be
subdivided into what she should take during the time she is
carrying or bearing the child and what she ought to take after
the child comes into the world ; second, we shall consider the
foods of the child, laying special stress upon the kind of foods to
give, when, and how to give them.

But before entering into the details, I should like to present
to you some common errors in the mothers' and children's diets.

1. That the expectant mother should "eat f6r two."

This is absurd. The carrying of a full term baby means only
a small increase in the mother's weight, yet she often over-eats
because she thinks she must take in food for the unborn child
also. The real essentials of health are the same for all condi-
tions ; namely, care, moderation in regard to eating and drinking,
regularity of bowels, pure air and daily outdoor exercise. Over-
eating and indolence upset health.

2. That the nursing mother needs to eat frequently.

Most nursing mothers overeat or take in food frequently
under the mistaken notion that such practices induce increase
flow of milk.
60

In reality, "stuffing" and taking craps or sips at all times tend
to ruin digestion and spoil the milk. By taking food only three
times a day, nutrition and milk secretion are better promoted
and sustained than if the digestive organs are irritated ami-
overtaxed by frequent eating. A glass of water in the morning,
in the evening, and between meals is good for the nursing
mother.

3. That mothers, during the first month of the puerperium,
must not eat vegetables and sour fo]ods.

Only boiled water with plant roots should be ingested during
this period.

This kind of diet may be the principal underlying reasons why
our mothers suffer so much from beri-beri, anemia some forms
of indigestion, and constipation.

4. That if the milk does not come by the third or fourth day
it will not come at all.

Quite wrong ! A week or more should elapse before a mother
should give up putting the baby to the breast every 3 to 4
hours in the day time. Furthermore, the breast should be stim-
ulated by sponging and massage; and everything should be
done to keep the mother from worrying about herself and the
baby. The best frame of mind conducive to the secretion of
milk is one of trustful faith in Nature who will do her part and
provide what is needed.

5. That when a baby cries, the natural and proper course to do
is to give him the breast, a bottle or a "chupon" to comfort or
pacify him.

There is no surer way of ruining baby's digestion and con-
verting him into a fretful, exacting little tyrant than this, for
he knows he can have his way by merely crying. Feed your
baby by the clock at the duly appointed feeding times. "Com-
forters" spoil digestion and give rise to defective teeth, deformed
jaws, and "adenoids."

6. That "piecing" between meals does no harm.

In reality, this habit is very injurious. Natural digestion
needs certain times for carrying on its process and there is
nothing better to upset the child's digestive system than to give
him pieces of bread, cake, sweets, etc., outside of the regular meal
hours.

DIET DURING PREGNANCY

The food of a woman during pregnancy need not differ mate-
rially from that to which she has been accustomed, provided
that her previous diet has been chosen with due regard to its
suitability.

There are, however, certain general principles which she
should take into consideration. One of these is that the excretory
organs — the bowels, the kidneys, and the skin should be kept in
the best possible condition, because during pregnancy the mother
must get rid not only of her own waste products but also of
those of the unborn child. It will be found, therefore, that a
light, laxative diet which is at the same time satisfying and
nutritious, will tend to keep her in health. An ideal diet includes
a relatively large proportion of liquids, a small proportion of
meat, and a corresponding generous proportion of fresh fruits
and vegetables. The proper amount of water that a pregnant
woman should take in 24 hours is from four to eight glasses.
A laxative diet will include fresh fruit, such as oranges, pine-
apples, bananas, ripe papayas, etc.

Fresh vegetables, especially green ones, have a laxative effect.
Among these are peas, tomatoes, lima beans, string beans, and
lettuce. Others may be eaten also.

Highly seasoned foods should be avoided.

DIET OF THE NURSING MOTHER

The nursing mother needs a simple but nutritious diet, in-
cluding fruits, vegetables, and plenty of fluids but no alcohol.

While the mother is confined in bed, the so-called "light milk
diet" is best, but this should not exclude some dry foods such
as crisp toast besides bread and butter, fruits and vegetables.
The diet must be gradually increased day by day. By the third
day a little fish may be given. Eggs, rice, bread or toast with
fish and meat in moderation may safely be given from the
fourth day on, provided she is in a perfectly normal condition.

The nursing mother must have plenty of fluids — an average
of from one-half to one liter. Her fluid intake must exceed that
when she is not nursing her baby.

The best method is to eat only three times a day; this means
that nothing should be eaten between the regular meal hours;
and to take in the fluids with the meal or immediately after it.
Foods which upset the mother or the child must be avoided, but
care should be taken that the nursing mother gets a variety of
foods to her liking, and that there is no wide departure from
the diet to which she has been accustomed.

Condiments, such as pepper and mustard, may be used in
moderation, but pickles and curries should be avoided.

INFANTS' FOOD

There is no other food more suited to an infant than mother's
milk, for the following reasons :

1. There are no contraindications per se to maternal nursing.
No matter what sickness or conditions the mother may be suffer-
ing from, the real test for its efficiency is the effect on mother
and infant. Even tuberculosis in the mother should be consi^
dered a contraindication only when nursing injures the mother
or there is obvious danger of infecting the little one and only
then is the baby removed from the mother. If the baby is to
remain in the mother's care, it may just as well nurse, as the
chance of infection is just as great whether it nurses or not;
while if it is weaned, it is deprived of the resistance and immunity
that may come from breast feeding.

2. It is created for the baby, and the first duty therefore, of
the mother is to insure by foresight a proper supply of the only
perfect food — the baby's birthright, i. e., the Natural Feeding.

3. There is a special and intimate relationship between the
milk of the mother and the digestive and nutritive needs of her
own offspring.

4. Investigators have shown that the milk of each animal is
different from that of any other; and each is especially adapted
to the requirements of the young of that particular species.

5. Statistics show that breast-fed babies have a much greater
chance at life than those who are bottle-fed.

These are the impelling reasons why mothers should nurse
their babies. Other less important reasons are that if the
mother takes care of the baby herself it is much easier for her
to nurse than to feed it by a bottle ; that breast milk is practically
free from disease germs; and that it is fed to the baby at a
uniform temperature from the beginning to the end of each
nursing.

Regularity of nursing. — The baby should be nursed regularly,
by the clock, from the very first and should have nothing be-
tween meals except water to drink. The baby should not be
allowed to remain at the breast over 20 minutes in any case.
Give the baby breasts alternately; and do not allow it to go to
sleep while nursing.

Intervals of feeding. — Most babies thrive better if the interval
between feedings is fairly long. This interval may be six hours
until the flow of the milk is established. From that time on,
the baby may be fed at three-hour intervals until he is six months
old. Thereafter, four, hours should be allowed to elapse be-
tween feedings.

Night feeding (after the 10 o'clock nursing) should be omitted
when the child is four months old.

The following table shows the nursing interval and the num-
ber of feedings in 24 hours according to age.

Interval

Night

Age.

Nursings
in 24 hrs.

by hours
during

Nursings
10 p. m.

day time

to 6 a. m.

FIRST DAY — (.Nothing but boiled water)

Second day - - _-

Third day

Fourth day to li m _

Ij to 6 months _ ...

6 to 12 months

Proper way of nursing an infant. — The mother should be in
the sitting position when giving the breast, holding the infant
with the arm corresponding to the breast given, while the other
hand holds the breast so that the nose of the infant is not covered
and the proper breathing of the infant, not interferred with.
In case the milk from the mother flows too rapidly, the head of
the infant should be held higher than the breast.

One of the causes of vomiting in the infant is the wrong
procedure that the mother usually follows in giving the breast;
and that is, she lies down on the bed, leans over the infant which
lies flat upon its back. The result is that the infant gets the
food too fast causing it to vomit.

WHAT FOODS OTHER THAN MILK CAN BE GIVEN DURING THE FIRST

YEAR OF LIFE

1. Orange juice can be given to breast-fed normal infants
from the age of 4 months up, giving it a teaspoonful once a day,
one hour before a feeding, preferably at 8 a. m. In case of
normal bottle-fed infants, it can be given at six weeks to two
months of age.

Infants who take orange juice well, thrive best. They gain
faster; their cheeks, mucous membranes and lips are rosier;
their muscles and flesh are firmer; their skin is smoother and
more velvety ; their hair is more silky and their bones are better
shaped.

Occasionally, infants have loose undigested stools; have colic
or vomiting when orange juice is given. Such infants, in the
minority, are usually bottle-fed and are difficult to feed.

2. Give baby a bone. At six months of age, a chicken bone or
chop-bone (from which all but a trace of meat has been re-
moved) may be given to the baby at mealtime, as the munching
tends to promote a free flow of blood to the developing teeth
which are rapidly growing and pushing- their way out under
the gums.

3. After nine months the so-called solid food such as crust
or properly prepared toast may be gradually introduced into

the baby's dietary as part of the meal and not between meals.
It is especially beneficial because of the exercise it affords to the
muscles of mastication, jaws, teeth, and salivary glands.

TECHNIQUE OP WEANING AN INFANT

1. An infant should not, if possible, be weaned during the
warmest months of the year, as this period is particularly dan-
gerous especially to the artificially-fed babies.

2. Weaning should begin on the average between the ninth
and the twelfth month of age. Solid food should form part of
the meal and should be given about ten minutes before any milk
is given.

3. Weaning should be gradual, that is, the breast feedings
should not be supplanted by artificial feedings at once. It
should be effected by taking off one breast feeding at a time,
preferably the 2 p. m., and substituting it by any well cooked
cereal, such as rice water (thick) with milk (carabao), etc.
Cereals should be changed daily. After one week, another
breast feeding can be omitted, and so on till all breast feedings
are replaced. These foods should be given by spoon and not by
bottle, to avoid the second weaning from the bottle.

Complete weaning should be finished at the end of one year
of age.

Feeding in second year. — This being the period of childhood
most vulnerable to gastro-intestinal diseases brought about by
faulty administration of diets, I shall discuss in detail some
general rules for feeding children.

1. Food shall be given at regular hours; nothing between
meals.

2. Plenty of time should be given for each meal. On no
account should the child bolt his food down.

3. The child must be taught to chew his food well.

4. Children should not be continually urged to eat if they are
disinclined to do so at the regular hours of feeding; or if
their appetite is habitually poor.

5. Indigestible foods should never be offered to the child, to
tempt the appetite, when the ordinary simple food is refused.
Food should not be allowed between meals just because it is
refused at mealtime.

6. One serious objection to giving young children highly
seasoned food, as jellies, pastry, sweets, etc. — even in such
small amounts as not to upset the digestion, is that they soon
learn to indulge in it and lose appetite for the simple food
which they formerly ate with relish.

185611 5

7. Simple articles of diet, such as milk, meat, cereals, or
vegetables, which a child habitually refuses should always be
given at the beginning of the meal; other foods should be
withheld until the former are all consumed. Children readily
form habits of eating only certain things and refusing others.
Such an inclination should be checked early. List of foods
that can be given to children from two to six years of age
may be secured from a specially prepared pamphlet.

In connection with the faulty diet of children after the first
year of life, I may as well mention here that clinical entity which
is important — that definite affection of childhood observed not
only among the underfed children of the poor but also of the
well-to-do. That entity is called Malnutrition.

CHARACTERISTICS OF MALNUTRITION

1. The child is usually underweight for its age and height.

2. Such children are hard to please or to entertain and are
frequently considered "bad" or "spoiled."

3. A capricious appetite should always arouse suspicion.

4. They drag at play or tire easily.

5. School work may become a burden, and they may fail to
keep up with the work.

6. They posses a lowered resistance to disease. They take
cold easily and recuperate slowly.

7. They have anemia, varying in degree.

CAUSES OF MALNUTRITION-

1. Long continuance of breast feeding produces malnutrition.

2. An excess of milk over the solid foods during the second
and third years is hardly less potent in producing the same bad
effect.

3. Irregular feedings as well as too frequent feedings do not
permit the stomach to empty regularly or completely, with the
result that loss of appetite is almost sure to ensue, leading to
a consequent loss of weight.

4. The prevalent custom of sweetening many foods, especially
cereals, not only impairs digestion but destroys the appetite for
any other form of food which is not sweet.

CONCLUSION

For the purpose of this paper I believe that we have covered
the essential points, viz., the common errors in feeding; the
kind of food mothers should eat; and the proper way of feeding
their babies — hints which I hope will be of practical help to

mothers and expectant mothers in the performance of their
sacred duties.

We should not lose sight of the fact that from improper
feeding-, the resistance of the body becomes impaired, thus-
making it a suitable soil for the development of diseases. In
infants, feeding may be considered the keystone to health and
should, therefore, receive due consideration if we aim to im-
prove the health standard and development of children.

We can no longer ignore the fact that unless we give our
babies and children the right kind of food and in the right
way, we shall fail to markedly reduce infant mortality, and
moreover we shall fail to produce able-bodied and able-minded
Filipino citizens.

DISCUSSION

Dr. HERNANDEZ (Sorsogon). — Since the importation of the polished
Saigon rice, our children have suffered from many illnesses. I suggest
therefore that the Government continue prohibiting its importation. As
the use of polished rice is the source of infantile beri-beri, I suggest
that the welfare committee appoint a representative, a physician or a
nurse to go from province to province to warn the people of this danger.

Mrs. MATILDE A. DE GOMEZ (President, Calbayog Puericulture Center,
Samar). — It is known that in all municipalities, there are certain or-
dinances prohibiting the herding of certain domestic animals, including
goats. Goats are not harmful; they thrive well in the provinces because
of abundant vegetation, and their milk can take the place of human milk
because of its excellent composition. Therefore I request the central
Government to make amendments to such ordinances allowing families
with children to raise a limited number of goats for the benefit of the
babies.

Miss JULIANA P. PATRIARCA (Guinobatan, Albay). — In order that the
poor mothers may nourish their babies properly during infancy, I suggest
that the Public Welfare Commissioner and the Red Cross provide all
clubs especially those which have small funds, with a milk center.

Mrs. HONESTA E. LOMIBAO (Dagupan Woman's Club, Pangasinari) . —
There seems to be a growing tendency on the part of mothers to use
artificial feeding due to ignorance.

Because of the many advantages of maternal feeding over artificial
feeding, I suggest that a pamphlet dealing with the advantages of ma-
ternal feeding and the disadvantages of artificial feeding be published
and put in free circulation throughout the Philippine Islands.

DR. SIASOCO'S ANSWERS

To Dr. Hernandez: It would be an ideal thing to stop the importation
of polished rice in these Islands if the Government deems it best; it-
would also be an ideal thing if the Government would see to it that
native rice is sold unpolished. But even if the nursing mother is suf-
fering from beri-beri, infantile beri-beri can be prevented with proper

and timely administration of tiki-tiki extract. As to the suggested com-
mittee, I think that the municipal and district doctors and nurses can
help us a great deal in educating the people in this matter to avoid
duplication of work and thus economize time, efforts*, and money.

To Mrs. Gomez and Miss Patriarca: Artificial feeding has not been
purposely mentioned in this paper because of its manifold disadvantages
as compared with maternal feeding. Therefore I object to the distribu-
tion of milk.

As to the assertion of Mrs. Gomez that goat's milk can take the place
of human milk because of its excellent composition, I do not agree with
her, for the following reasons:

1. The chemical composition of goat's milk is similar to that of the
cow's, which differs greatly from human milk.

2. Goat's milk is much more indigestible for an infant than human milk.

3. In the process of milking, contamination cannot be avoided.

4. And last but not least, in case the mother cannot really nurse her
baby and no wet nurse is' available, the preparation of the milk for the
baby's food should be under the immediate supervision of a trained
physician.

To Mrs. Lomibao: The aim of my paper is to impress on the minds
of the audience and those of its readers the importance of maternal
nursing and its advantages over artificial feeding and other kinds of
artificial foods used, in order to abolish artificial feeding.

r!TAMINES DEFICIENCY IN THE DIET AND HOW IT MAY BE
CORRECTED WITH COMMON FOODS

HARTLEY EMBREY, Research Food Chemist, Union Medical College, Peking

Did you know that it is more dangerous to be a baby than
a soldier in a front line trench? That a baby under one year
is a less good insurance risk tjhan a man of eighty? These
conditions are true even in America, and here in the Philippines,
the infant's chance is much smaller than in the United States.

The baby's first food is milk and if conditions are normal the
breast-fed baby has a better fighting chance than those fed
any sort of cow's milk, fresh or tinned or any variety of
prepared foods for infants. At least it is generally true that
breast-fed babies are stronger than other children, but here
in the Islands the contrary is true. Strangely enough the breast-
fed babies in the Philippine Islands have a higher death rate
than the babies fed on cow's milk. The explanation of this
curious phenomenon is of course to be found in the physical
condition of the mother. In most cases it is due to the small
quantity and poor quality of the mother's milk, which in turn
is caused by the poor diet of the mother.

The first step towards improving the health of the child is
to improve the diet of the mother.

What, then, is lacking in the average Filipino woman's diet?
Vitamines, and minerals mainly. Often the quality of the pro-
tein is deficient, and not infrequently, she has not enough to
eat.

Every member of this audience knows that certain substances
of unknown chemical composition are found in many foods
which have an extraordinary influence on life. These substan-
ces are called "Vitamines," the word being coined from "vita,"
life, and "amine" which is an organic compound containing
nitrogen.

There are at least three different kinds of vitamines which
protect from at least three different deficiency diseases. One
type prevents scurvy, another in connection with a balanced
calcium and phosphorous diet prevents rickets; it also prevents
xerophthalmia, an eye disease, and the third sort of vitamine

prevents beri-beri. Then, too, there are many other diseases
such as pellagra which seem to be caused by a number of com-
bined deficiencies : such as low protein, low calcium, low vitamine
content. The exact cause of pellagra does not appear to be
definitely established yet, but it is known positively that it
is a disease due to a poorly balanced diet.

Of all of these deficiency diseases the one which is the most
prevalent in the Islands is beri-beri. Undoubtedly the death
of many children is due to the fact that the mothers are suf-
fering from incipient beri-beri and cannot nourish their children
properly.

The disgraceful part of this beri-beri scandal, for it is a
scandal — is that it is a disease which is absolutely unnecessary.
It can easily be prevented and can be readily cured in its early
stages by the use of many common and cheap foods.

The following are some of the foods which will prevent beri-
beri: the whole grains of rice, wheat, or corn. It should be
emphasized and stressed that polished rice — that is, rice with
the outer layers removed, white wheaten flour, and pure corn
flour, prepared from the soft white interior of the grain, are
very dangerous foods for a people living on monotonous and
limited diets, and that all three of these foods unless the vitamine
be supplied from other sources, will inevitably lead to beri-beri.
Millet, dried peas, lentils, mongo, soy beans, sprouted peas,
beans or cereals, fresh or cooked cabbage, lettuce, spinach,
carrots, potatoes, camotes, oranges, bananas, tomatoes, nuts,
coconut, coconut press cake, lean meat, liver, kidneys, heart,
brain, fresh milk, some brands of tinned milk, eggs, yeast,
especially brewer's yeast, and perhaps many other fruits and
vegetables which have not yet been investigated, all contain the
water-soluble "B" — the vitamine which protects from beri-beri.
Ordinary fish has little if any of this valuable vitamine, and
polished rice none at all. If the people of the Islands deliberately
plan to get beri-beri, they could not choose two foods more
suitable for this purpose than polished rice and fish. Remember
that these two articles, unsupplemented by other foods, form
the diet of thousands of Filipinos ! Are you surprised that the
mothers here are unable to nourish their children?

The diet of every one especially the mother should include
daily some of the substances which I have just mentioned. The
child of a healthy, normal mother requires nothing else but
mother's milk until he is weaned at the 7th or 8th month.
It is advisable, however, to start vegetables and fruits as early
as possible. Orange juice may be given as early as the second

month, and should not exceed one teaspoonf ul daily. This daily
amount may be increased by one teaspoonful each week, until
the juice of a whole orange is given.

When the mother is unable to nurse her child, and when
tinned or powdered or pasteurized cow's milk is used, it is
absolutely necessary to add something which will protect from
scurvy. This vitamine is found naturally in the fresh milk of
cows that have been fed on green foods, but is absent from the
milk of a cow fed on dry fodder, and since it is the most
unstable of the vitamines, it is always impaired and often
totally destroyed by the processes involved in canning, drying,
etc. The other two vitamines, water-soluble "B" and fat-soluble
"A" protecting from beri-beri and xerophthalmia respectively,
are not seriously affected by ordinary methods of cooking.

Some of the best foods to be used as a protection against
scurvy are oranges, lemons, limes, spinach, cabbage, tomatoes,
apples, etc. Experiments which we are now carrying out at
the Bureau of Science show that papaya, chico, guava, pomelo,
pepino or cucumber, camote leaves and cancong leaves all pos-
sess the antiscorbutic vitamine and are therefore valuable local
foods as protection against scurvy.

At the age of seven to twelve months orange juice may be
replaced by the strained juice of one of the fruits mentioned
above. In many cases fruits may not be available, and the
strained juice of steamed spinach, cabbage, carrot, camote leaves,
cancong leaves might be used advantageously. At the seventh
month one could easily begin with one teaspoonful of strained
steamed vegetable juice daily. This amount should be increased
each week so that by the twelfth month the child may be
having 2-3 tablespoonf uls of vegetables a day. For people who
are traveling and who are unable to obtain oranges or spinach
it is interesting to know that the juice of canned tomatoes still
retains an appreciable amount of the anti-scorbutic vitamine.
The acidity of this fruit seems to have protected the vitamine
from the usual destruction by heat.

Another deficiency disease common to childhood is rickets.
Recent experiments establish that this disease is produced by
a diet which is low in fat-soluble vitamine together with a high
calcium content in relation to the phosphorus.

This disease may be avoided by adding to the diet those
substances rich in this vitamine: butter, cream, cod liver oil,
mutton fat, liver, kidneys, heart, fat fish, cheese from whole
milk, eggs, whole grains of wheat, corn or rice, millet, cabbage,
lettuce, spinach, tomatoes, etc. Of the above foods the ones

best adapted to the infant's delicate stomach are cream, and
cod liver oil. Spinach juice or tomato juice may also be used
in small quantities. The early administration of spinach or
tomato juice not only adds vitamines to the diet, but it increases
the appetite and is an entering wedge for increasing the diet
later on by the addition of simple solids, such as potato, rice
gruel, fruit, eggs, meat broth, etc.

In general, the recipe for avoiding deficiency diseases is a
simple one : EAT SOME FRESH FRUITS AND VEGETABLES EACH DAY,

AND, IF POSSIBLE, AT EACH MEAL.

DISCUSSION

Dr. ANTONIO S. HERNANDEZ (Sorsogon). — It is suggested through this
Conference that in order to reduce infant mortality, polished rice factories
be closed, and importation of Saigon polished rice be prohibited; or else
the price of polished rice be raised so that the poor will not wish to pur-
chase it.

CAUSES FOR THE LARGE DEATH RATE AMONG THE CHILDREN
OF THE LABORERS

JOAQUIN BALMORI, President of the Filipino Federation of Labor

Thanks to the initiative of the present Governor-General of
the Philippines, the Hon. Leonard Wood, who knows full well
the far-reaching consequences of the present infant mortality
in this country, this public welfare conference has been called.
This work of the Chief Executive, eminently cultural in its
nature, and under the direct charge of the Office of the Public
Welfare Commissioner composed of young, enthusiastic phy-
sicians dedicated to the work of inculcating in the minds of
the mothers the necessity for taking proper care of their chil-
dren, should leave an indelible impress upon our minds and
hearts, not only because of the innumerable blessings it bestows
upon the Filipino race, but also because of the high and lofty
ideal behind the enterprise itself.

It is self-evident that among the various problems now en-
gaging the attention of our officials, professional men, thinkers,
writers, and laborites — men accustomed to work on behalf of
the interests of the community — there is nothing more important
than the problem of infant mortality, especially in these days
of constant activity and national up-building. This problem
of infant mortality is one beset with many obstacles and diffi-
culties.

Herein lies the reason, perhaps, why the new Governor-Gen-
eral, Leonard Wood, directed his attention to this vital problem
immediately after he assumed the responsibilities of his present
position. And I believe that the Governor is animated only
by the noblest of motives in so acting: that of promoting the
common welfare of the Philippine Islands, and of removing all
those obstacles which serve only to hinder the advancement of
the social whole. He turns his eyes on the deplorable condition
in which the children of the laborers of this country find
themselves, children who, though poor, yet constitute the pillars
of our future. The Chief Executive desires all the able men
of the country to study the best and most adequate methods by
which the problem of infant mortality can foe immediately
solved, and through which children may be transformed into

robust, healthy, and vigorous creatures, sound in body and in
mind. All the sacrifices and the efforts that we may spend
for the proper solution of this problem are very small, con-
sidering1 the enormous benefits which will come afterwards, in
the not far distant future.

In the development of the life of nations and of peoples, the
child is a most important factor. Well may we adopt here
that proverb of life which runs: "As the seed is, so will the
tree be. As the child is, so is the man/' If our children can
only grow in health and strength without any interruption, if
their lives can only be prolonged by solicitous and proper care,
if we can only prevent them from dying so soon, our scanty
population will grow not only in number but also in vigor and
in vitality, thus making of the Philippines one of the strongest
nations of the earth.

The National Conference on Infant Mortality and Public Wel-
fare has been called for the main purpose of developing a
scientific and at the same time a patriotic work. But all this
meritorious task to which we have consecrated all our best
efforts would be useless if at the outset, we do not remove the
causes of the -excessive infant mortality in the Philippines.
Until recently, there was no central organization to take charge
of this undertaking, as a result of which, the work could not
be carried out to the extent desired in accordance with all the
scientific principles necessary.

I should like to touch on the excessive mortality among the
children of the laborers, who form an integral part of our
community. The children of the poor and destitute families die
on a great scale and in the most scandalous manner due to the
lack of care. It can not be doubted that the greatest amount
of benefit derived from a campaign against infant mortality
goes to the laboring classes, because they are always found
among the needy ones in view of their natural lack of means
for the children's support.

This is the main reason why I want to congratulate the Gov-
ernment for its firm decision to cut out this evil which saps the
vitality of our children, the future workers of the country.

The main cause which contributes to the gravity of the situa-
tion is the bad habit followed by the majority of our laboring
women of not observing the rules of hygiene during the months
of pregnancy. Despite their state of pregnancy, they disregard
the elementary principles of good health, and work in the fact-
ories and shops just the same, thus exposing the little one to
the danger of being born under unfavorable physical conditions.

The excessive work to which the women subject themselves at
times in order to help their husbands earn the daily bread,
weaken their organism, and engender weak and emaciated chil-
dren easily susceptible to all kinds of disease, and for whom an
untimely grave later opens. But what is still worse is the
habit of our laboring women of going to work immediately after
giving birth to a baby. The very willingness to utilize every
minute of the day is also very instrumental in the commission
of this act. In the majority of cases, these women have to
adopt such a practice in view of the frequent requirements of
their creditors, principally the Chinese. Should their credit be
closed, then, these women would run the risk of not eating food-
stuffs supplied by the Chinese retailer. Hence,, all manner of
sacrifice is made in order, to make the extended credit good. It
also frequently happens that the mother does not have enough
quantity of milk with which to feed the little child. In such
cases, the poor mother has to earn and work at all costs. The
children of the poor are left in the house to the charge of per-
sons who do not feel a personal interest in their welfare. This
is the cause of the sickness of many children — this complete
abandonment to which they are subjected. This is the sinister
cloud which darkens the life of many a young boy and girl who
otherwise would have led happy and contented lives.

There is also another important consideration which should
be taken into account in this connection, and that is, the un-
healthy conditions found in the homes of the laboring classes.
Generally, these laborers' houses' are crowded, dirty and low,
surrounded by stagnant water where mosquitoes breed. Other
houses still are so dark that during all the day the rays of the
sun can scarcely enter. These conditions at present existing
in the homes of these mothers are also powerful agencies for
the spread of infant mortality in the Philippines, and while the
laborers' barrio does not come into being ; while we do not have at
our disposal sufficient number of houses for our laboring classes
where hygienic conditions are beyond reproach; we would just
waste our efforts in the fight against infant mortality.

There is still one important point which I should like to mention
in this connection, and that is, the common practice adhered to
by many of the mothers belonging to the laboring classes, which
consists of hiring the services of a "quack'' midwife known in
the native dialect as "hilot" who does not even know the ele-
mentary principles of midwifery. Our duly licensed mid-wives
cost money, it is true, and their number is limited at the present
time. Would it not therefore, be rather proper for us to suggest
to our women that they dedicate their attention more to this

profession which will give them a chance not only to earn a
good amount of money but also to help in saving the lives of
many of our children? It is true that the Philippine General
Hospital has a similar service but it is no less true that not all
the mothers necessitating the efficient services of a midwife can
have those services at their disposal when time comes.

I shall not attempt to analyze the causes of this in my address,
inasmuch as I know that the Filipino laborer by temperament is
humble and submissive, and he does not usually appeal to the
General Hospital for help in cases of delivery. But it is for us to
educate the laborer to the extent of convincing him that it is
his duty to let the General Hospital authorities know cases of
delivery so that he may help in the campaign against infant mor-
tality. Many of our laborers are so ignorant that they do not
even know that such a thing as a Philippine General Hospital
exists.

It is therefore clear that the causes of the evils which so far
I have pointed out have a social rather than a medical origin. As
long as the conditions of our working women are not improved
by the concession of certain privileges on the part of the capi-
talist, as, for example, a certain vacation with pay prior to the
delivery of a child; as long as mothers do not take proper care
of their children ; as long as good houses are not provided for ;
we can not hope to succeed in our campaign against infant mor-
tality in the Philippines.

I hope in my capacity as President of the Filipino Federation
of Labor, and as a humble Filipino citizen interested in the
well-being of thousands upon thousands of the children of the
laboring classes, that this Conference will be productive of much
good for the people of the Philippine Islands. I also hope for
the adoption of practical measures, for the betterment of educa-
tion and the improvement of the conditions of the mothers* of the
laboring classes, for the conservation of the lives of children, for
a greater number of hospitals for children especially, for a
greater intensity in the campaign against venereal disease, and
for important changes in legislation on behalf of children. All
these measures tend to invigorate the Filipino race.

Welcome to you, delegates to this Conference, you, who volun-
tarily came here from distant provinces in order to help in a
work whose fruits will be enjoyed by our children and our chil-
dren's children.

From the bottom of my heart, I give you my fraternal embrace
and ask of you to work for our children, the future workers of
the country and defenders of its. honor. Then will Heaven,
Country, Labor, and Humanity rise to bless us forever and ever.

PRENATAL AND NATAL CARE

H. AcoSTA-SisoN, M.D., Assistant Professor of Obstetrics,
University of the Philippines

I am not going to dwell on the imperative need of the preven-
tion of our infant mortality for this is patent to all of us. Let
me only mention that our infant mortality per 1,000 is approxi-
mately three times as much as in other civilized countries. This
figure alone should awaken in us enthusiasm to help eradicate
this vital evil that sucks the very life fountain of our nation. All
foreigners agree in conceding to us a marked progress made in
every line of activity but, in the spirit of our eminent patriot Dr.
Jose Rizal, who believed that the evils of a nation should be
exposed for their remedy, we must confess that, with all our
rapid advancement in things that are superfine in our tastes for
costly limousines, gorgeous silk dresses, the fashionable intoxi-
cating jazz and in the cultivation of our scene of acute pleasure
and wild enjoyment in boxing especially when there is a splash
of blood in one or both of the contestants, with all this pro-
gress of civilization, let me repeat, our yearly death toll of
young lives is alarmingly high.

What is the cause of this deplorable condition that has wrung
untold agonies from almost every home?

Poverty is a factor and a very great one. Superstitions, and
the attachment to old traditions is another. The lack of trained
physicians and nurses especially in the provinces is a condition
that can not be ignored. But the main cause, and the one that
can be most combated provided there is enough zeal and coopera-
tion among us, is ignorance. Ignorance and poverty are the
twin sisters that breed filth and disease.

THE PROPOSED REMEDY

Fortunately we have a number of public spirited citizens, many
of whom as is to be expected are physicians, who have organized
themselves with the view of conserving the lives of our little
ones. The greater part of their activity consists in furnishing
milk to a limited number of babies who because of maternal

disease or death can not be breast fed. These organizations
are undoubtedly of great value to the community and should be
multiplied throughout the whole Archipelago but it seems to me
that we have not yet fully realized the fact that if we wish to
have a healthy robust child, and if we wish that, that child
should grow to healthy responsible manhood and womanhood,
we must have first a healthy, robust, and educated mother.

"The mother is the keystone of the family unit and the whole
arch of human welfare and progress is sustained by the weight
which rests from all sides on that keystone" so that the establish-
ment of a maternal welfare program is of the utmost import-
ance.

The Legislature should enact laws to protect the health of the
family, to promote economic independence and to prevent any
invasion by moral or social diseases.

The mother should not be forced into a condition of existence
which will be detrimental to her health and her offspring. There
should be some legislation to provide the licensing and proper
inspection of institutions and individuals to whom the care of
mothers and babies is entrusted.

Every maiden that has reached the age of puberty is a poten-
tial mother and the elementary rules of hygiene should be taught
her early in the public schools.

Every young woman contemplating marriage should know her
future duties and responsibilities. One of these duties which
she owes to herself and to the next generations is that her future
husband be as good, healthy and moral, a man as he expects his
future wife to be. In some of the cities of the United States
marriage cannot be effected unless each of the contracting par-
ties presents a certificate of clean health free from any contagious
disease or bad habits. This, certainly, if carried in good faith,
can do much in eliminating many congenital ailments.

The health of the mother, her morality and her education have
a powerful effect on the welfare of the offspring ; but the health
and the morality of the father has no less effect on the tender
being. How thoughtless and irresponsible is that young man
who being care-free just for the pleasure of the moment puts at
stake the health and happiness of his future family !

Sex education among the masses has been proposed to eliminate
many evils. However, the manner of its presentation to the
public has given rise to a diversity of opinion even in the very
United States. The giving of sex education to a group of young

adults by one not qualified and especially trained for the subject,
is a very delicate question which may cause harm rather than
good to the very young sensitive minds. And this is specially
true in our Philippines where the climate, the psychology and
temperament of our people are such that one has to be very
cautious and tactful lest a greater evil be the result. Matters
pertaining to sex should be discussed only by the parent who
should know best the character and tendencies of the young
individual. The instruction should be given by the father if
the individual is a boy, or the mother, if the young person is
a girl. There should be, however, well planned talks by com-
petent lecturers on sex line for parents alone so that these may
be more able to do their part in educating their children.

There should be what are called prenatal clinics or clinics
where prospective mothers should regularly visit. These clinics
should be properly equipped with the necessary material and
conducted by qualified physicians and nurses who should take
a careful record of the symptoms and treatment of each case
from the beginning of pregnancy. The nurses should be able
to visit the patients at home to see that the doctor's advise is
being carried out, and to study each patient as an individual
case. This should be done gradually, persuasively and kindly
for there are still a few recalcitrant persons who look at every
innovation with distrust. The main function of these clinics
should be the education of the woman to take care of herself
and of her home and to encourage her to shake off the shackles
of old superstitions and the traditional sense of false shame
before any male physician, that sense that compels the woman
to die rather than be treated by a male doctor. The fact that,
she had been successfully attended by a hilot in a previous labor
does not mean that she will ever be free from unforseen com-
plications not remediable by the old midwife. The educational
part in these prenatal clinics may be conducted by talks and
demonstrations before a group or, better still, by individual
instruction in the homes. And the spirit which should pervade
thruout this work should be that of the greatest possible kindness
and consideration for, quoting a grateful son, "the mothers are
the ones that make the greatest possible sacrifice for others."

At least one maternity hospital should exist for each province.
It should be properly financed and managed by competent physi-
cians and nurses. These hospitals should care for their patients

until at least two weeks after a normal confinement, should in-
struct them how to take care of themselves and their babies, and
should refer them to the postnatal clinics on discharge.

In the post natal clinics, the mother and baby should be exam-
ined six weeks after confinement and twice every month there-
after, or oftener if necessary until the end of one year. If the
patients fail to appear at the clinic, the follow-up nurses should
visit them at their homes to see that they and their babies are
well and should report to the physician in charge of her findings.

The work in the antenatal clinics, maternity hospital and post-
natal clinics should be so related that the records of one partic-
ular case in the antenatal clinic may be easily accessible to the
workers in the maternity hospital or in the postnatal clinic.

In conclusion, let me emphasize the greatest and the most in-
dispensable element in the creation and preservation of a
vigorous race, namely, the mother! It is the interest of the
nation to make it safe for her to perform the noblest mission
God has entrusted her, the mission of motherhood — that ideal
motherhood capable of not only transmitting vigor and health
to the offspring, but also of inspiring and cultivating the moral
growth which should be the armor and safeguard of her child
in his struggles later in life.

ROUGH SKETCH OF A MATERNAL WELFARE PROGRAM

LEGISLATION

Laws:

1. To protect the health of the family.

(a) Good water supply.

(6) Segregation of contagious diseases.

2. To promote economic independence.

3. To prevent invasion by moral or social diseases.

4. To compel those who employ woman labor to give the prospective

mothers at least one-half of their salary without work in the last
two months of pregnancy and the first two months after confine^
ment.

5. To provide license and proper inspection of institutions and in-

dividuals to whom the care of mothers and babies is entrusted.
Young girls to be instructed in:
Hygiene.

Physical culture.
Home economics.

By the public schools.

Home management.

Dietetics.
Young adults to be instructed on sex education:

By either of the parents according to sex of child. Very delicate ques-
tion. These parents should receive instruction on sex lines by a
competent lecturer.

At the prenatal clinics
conducted by a com-
petent physician and

nurses.

Prospective mother:

Should be instructed most kindly by talks or
demonstrations :

How to take care of herself.

How much work and rest she should have.

What food to eat.

The danger signals of pregnancy.

How to take care of her baby.

What to prepare for her confinement.

What to prepare for baby layette.

To be confined at the hospital or

To be assisted by an obstetrician if she is to)

deliver at home.
Should be encouraged.
Should make regular visits or should be
regularly visited by nurse if unable to go.
Should be examined.
Should be treated until confinement.
Should be followed up.
Should have complete record.
Should be given all the necessary help and
advice. /

Parturient women:

To be confined at a hospital if feasible.
To be assisted by a competent physician if at home.
Maternity hospital:

To have the necessary equipment.

To have competent obstetricians and nurses.

Not to allow patient to get out of bed earlier than eight days.

Not to discharge patient sooner than two weeks after confinements

Should give instruction to mother on how to take care of herself

and her baby at home.

Should see that patient is able to take care of herself before dis-
charge.

Should make final examination on the day of discharge.
Should refer her to postnatal service when discharged.
Confinement at home:

Treatment should be based on the same principles as sketched for

the maternity hospital.
Mother should not be allowed to do heavy work for at least three

months after confinement.
Postnatal clinics:

Should be conducted by doctors and nurses.

Doctors, should examine each case at the completion of six weeks

after labor.

Nurse should visit mother and baby at home twice or thrice a month
until the end of one year.

DISCUSSION

Mr. F. POBLADOR (Cadiz, Occidental Negros). — I do not believe in the
organization of a Maternity Hospital in each provincial capital, since it
will be of benefit only to those residing there. While it is of scientific

186611 «

value to physicians and nurses, it will not be a practical solution of the
problems of infant mortality which exist in the homes of the poor families.
Government funds may better be employed in paying nurses and physicians
who should reach the homes of the needy mothers in barrios as well as in
towns.

Miss ROSARIO MANAHAN (Balanga, Bataan). — As it was pointed out by
Dr. Acosta that our high infant mortality in the Philippines is due to ig-
norance on the part of the mothers, I suggest that the Public Welfare
Commissioner do everything in his power to help the ignorant mass of
people.

Miss AURORA LIUANAG (Mexico, Pampanga) . — All the provinces should
have maternity hospitals so that mothers can be saved from dangers
occurring during confinement.

Mrs. ELENA PAREDES (Delegate, Tayasan Woman's Club, Oriental
Negros). — In connection with what Dr. Acosta has said, I suggest that
it is very important to have one doctor and a nurse for every two munic-
ipalities far away from a doctor or a hospital

Miss JOSEFA MORALES (Numancia, Capiz) . — In order to give mothers
the proper prenatal and maternity care, I suggest that each municipality
be furnished a nurse who should hold classes for the local midwives, who
in turn will help her in her work.

Mr. ESTANISLAO RAMOS (Hermosa, Bataan). — As there is no maternity
house in our town, and as the mothers are so poor that they cannot even
afford to pay servants, I would like to suggest that the Office of the
Public Welfare Commissioner furnish us temporarily with a physician, a
nurse and a free dispensary while we are trying to raise funds.

I wish also to ask for suggestions for raising funds.

Mr. D. TABLAN (Tarlac, Tarlac). — I suggest that a circular regarding
pre and postnatal cares be distributed among women, by those authorized
to perform marriage ceremonies. This circular should treat with what
people who contemplate on marriage should know; those who ignore it
should not be allowed to marry.

Miss LOURDES TUASON (Philippine General Hospital). — Most of the
provinces of Luzon are in great need of maternity hospitals and free
dispensaries, therefore I suggest that a free maternity hospital and a
free dispensary be establishd in every province of Luzon under the manage-
ment of a physician and a nurse.

Miss CLARA AGANA (Tarlac, Tarlac). — I suggest that a law be passed
prohibiting young people to marry under 20 years of age, and also pro-
hibiting those who suffer from contagious diseases, to marry.

DR. ACOSTA-SISON'S ANSWER

In answering Mr. Poblador, I wish to state that the main purpose of a
provincial maternity hospital is to be a center of the visiting physicians and
nurses throughout the province, and to provide a convenient place where
abnormal cases needing special attention can be cared for and where
obstetrical operations may be safely performed. The services of this
hospital should not be confined to the town in which it may be located but
should extend to the remotest corner of the barrios. The beneficiaries, of
this hospital should pay, if able to do so, a reasonable fee for the medicine,
to help defray the expenses.

COMMON DISEASES OF BABIES CAUSING HIGH INFANT

MORTALITY

ALBERT, M.D., Professor of Pediatrics, University of the Philippines
and President of the "Liga Nacional Filipino, para la Proteccion de la
Primera Infancia."

In discussing- the subject assigned to me, I shall limit myself
to the statistics of death rates of babies in the city of Manila and
the most common causes of their deaths. I have prepared three
tables which I am going to read to you. Then I shall try to
explain in as brief a way as possible how such causes of infant
mortality may be reduced or eliminated.

Table I shows the infant mortality rates and deaths caused
by tetanus and beri-beri during the last ten years, 1911-1920.

TABLE I

Year.

Infant
mortality
per 1,000.

Tetanus.

Beri-beri.

1911

413

1,039

1912

378

'102

850

1913

339

102

751

1914 ...

309

831

1916

345

103

1,008

(Average for 5 years)

(356)

(98)

(898)

1916 ..

292

803

1917

245

102

872

1918

238

594

1919

202

314

1920 ~

201

550

(Average for 5 years) .

(235)

(77)

(526)

As the table shows there has been a steady decline in the death
rate during the last five years. Comparing the death rate of
these last five years which was 235, with the death rate of the
other five previous years which was 356, we have a substantial
decrease of 121 per thousand.

This remarkable reduction is due to the decrease of deaths
caused by two preventable diseases — tetanm and beri-beri. And
this decrease is the result of the efficient child welfare campaign
inaugurated on June 3, 1913, by the establishment of the first
puericulture center of the Liga Nacional Filipina para la Protec-
cion de la Primera Infancia, with the successful cooperation of

the public health nurses of the Bureau of Health and the free
distribution of the extract of tiqui-tiqui since 1914, the marvel-
ous remedy against beri-beri, which is the scourge of the Fili-
pino breast-fed babies.

We may reasonably hope that further reduction, if not total
elimination, of the unnecessary deaths caused by these two
diseases alone — tetanus and beri-beri — will be acomplished in the
coming years, due to the great awakening of the public con-
science and better organization of maternity and child welfare
work, demonstrated in this First National Conference on Infant
Mortality. Our death rate of infants then will stand on the
same level with that of the most advanced nations.

Table II gives the mortality rates and number of deaths for
babies under 30 days old who died in 1916, 1917, 1918, 1919 and
1920.

TABLE II

Year.

Infant
mortality
rate per
1. 000.

I.
Congeni-
tal

II.

Tetanus.

III.

Convul-
sion.

IV.
Beriberi.

•y

Respira-
tory.

VI.
Diarrhea.

1916...

292

508

1917

245

471

102

1918

239

656

1919

201

540

1920

201

548

I. The highest figures for each year are those deaths caused
by congenital diseases. Congenital disease which includes con-
genital malformations, congenital debility, and premature birth
may be reduced with proper care during pregnancy and confine-
ment. Education on the importance of prenatal and neonatal
care is necessary to reduce congenital diseases.

II. Tetanus is the outcome of criminal care of the umbilical
cord. Deaths resulting from this disease can be eliminated
thru education of the parents.

III. Convulsion is only a symptom, not a disease.

IV. Beri-beri may be stamped out with adequate diet of the
mother and good doses of tiqui-tiqui to the little patients, without
weaning them. This problem is solved by education.

V. Respiratory diseases may be decreased by avoiding expo-
sure and contact. This is again a matter of education alone.

VI. Diarrhea is closely related to faulty feeding. Education
will decrease this mortality.

Table III gives the mortality rates and number of deaths for
babies at the age of from 30 days to under 1 year, during the
same period I have already mentioned.

TABLE III

riberi.

II.

Respira-
tory.

III.
Diarrhea.

IV.
Menin-
gitis con-
vulsion.

V.
Conge-
nital.

VI.
Conta-
gious.

VII.
Tuber-
culosis. .

758

582

268

303

169

342

271

238

220

159

648

911

322

211

296

288

a 18Q

316

477

193

160

142

•10

478

647

237

181

167

a Smallpox.

You will see that beri-beri and respiratory diseases figure as
most conspicuous in the number of deaths for each year.

The explanation I have so far made of the causes of deaths
under columns I, II, III, IV, and V, in Table II, and the means
by which they may be reduced or eliminated holds true also in
this table.

Death resulting from contagious diseases, as in tuberculosis
(columns VI and VII) are due to wicked exposure and contact.
The great number of deaths from smallpox in 1918 was due to
gross negligence of vaccination. Here again we see the impor-
tance of education as the means of stamping out the disease.

The infant mortality rate of the city of Manila has been grad-
ually reduced from 292 in 1916 to 201 in 1920. We should try
to keep the rate as small as possible. With education and
good mothercraft in tetanus and beri-beri our decreasing infant
mortality may still be reduced by 10 per cent.

DISCUSSION

Miss GRACIA B. QUERUBIN (San Esteban, Ilocos Sur) . — According to my
observation, many babies die from mere carelessness and from lack of
proper care. Our mothers do not know the scientific methods of caring for
their little ones, and if they know how, they do not have the proper means
of doing it. According to the diagnosis of the assistant Sanitary Inspector
of our town, 9 deaths of infants were due to bronchitis; 11 to convulsions;
3 to gastroenteritis; 2 to tetanus and 1 to meningitis.

From the above, we can see how necessary it is to train our mothers in
the modern and scientific ways of caring for the children ; how necessary it
is to have practical demonstrations in infant care and feeding; and to do
away with the superstitious beliefs of our people.

Also, since nearly all the people especially the children are infected with
intestinal parasites thru drinking unboiled water and eating raw foods,
I suggest that plenty of medicines for such diseases be given to the people.

Dr. E. P. SANCHEZ (Delegate, San Nicolas, Pangasinan). — I suggest
that the making of Pertussis vaccine be recommended to the Bureau of
Science. In case the Bureau of Science is not expert enough in its making,
I suggest that the Government should pension one Filipino bacteriologist
to study the preparation of this vaccine.

INFANTILE BERI-BERI: ITS CAUSES AND ITS REMEDIES

JOAQUIN QuiNTOS, M.D., Professor of Pediatrics, University of Sto. Tomds,
and Member of the Board of Directors of the "Gota de Leche" and "Liga
Nacional Filipina para la Protection de la Primera Infancia."

Among the determining factors in the deaths of infants from
0 to 1 year of age, infantile beri-beri exerts the saddest in-
fluence, at least in this capital.

Going over the statistics of the Health Service, we find, in
fact, that the average mortality from infantile beri-beri is 30.1 ;
whereas that from the diseases of the respiratory tract, the
digestive tract, etc., which, in other countries, are important
factors causing very high average mortality, is represented by
figures much less, namely, 19.9 and 7.2.

Said statistics show us that the children who fall victims to
infantile beri-beri are more than those who succumb to the
diseases of the respiratory tract, the digestive tract, meningitis,
tuberculosis and tetanus combined.

This, on one hand. If, on the other hand, we consider that
among the congenital diseases and among convulsions and bron-
chitis there are included, through diagnostic error, many cases
of death from infantile beri-beri, we can affirm that the figure
above cited for this disease, namely 30.1, is not exaggerated.

Therefore, if we can but eliminate beri-beri from the many
causes that influence infant mortality, it would result that the
total average for said mortality, which, actually, is almost 59
per cent, would be reduced to an average of only 20 per cent;
that is to say, we shall have reduced infant mortality by its
three fifths.

But, is this feasible? Gentlemen, I would say it is, for, at
the present time, not only the nature of the disease but also
the means, which are almost infallible, upon which we can de-
pend for its prevention and cure, are perfectly known.

It is an undeniable fact that said disease continues to stand
out as an important factor in infant mortality ; but, that is due
to the fact that the remedies to which we refer are not suf-
ficiently popular, neither are they within the easy reach of the
masses, or, among the different elements composing these, the
86

remedies have been distributed with the necessary profuseness;
and, also, because not all those constituting the medical class,
or all the nurses, have come to know perfectly the real nature
and remedy of the disease. We make this affirmation according
to the report submitted to the Philippine Legislature on October
15, 1918 by the Liga National Filipina para la Protection de la
Primera Infancia, in conformity with Act No. 2714. The re-
port runs as follows:

"Said results cannot be more flattering, confirming thus our
prediction in 1916 that, theoretically, no child suffering from
infantile beri-beri and treated properly should die.

'The ulterior deaths from this terrible scourge should be at-
tributed to the unpardonable neglect of mothers who apply for
medical assistance too late."

HISTORY

Infantile beri-beri is also known to the people by the name
of "suba" and "taon." Physicians of the past generation identi-
fied it with infantile eclampsia or with digestive disorders.

Its appearance in our country seems to date as far back as
the years 1880, at which time, according to Dr. Benito Valdes,
there developed a pseudo-epidemic of "beri-beri," coinciding
with the first importation of rice into these Islands from Saigon.

This epidemic, developed among the adults, had to exert its
destructive influence on the children of tender age. In fact,
it so happened, so that the Honorable Ayuntamiento of the City
of Manila, in session held on December 14, 1886, agreed to
hold a contest on "the eclampsia" and the causes that brought
about the excessive number of children dying from this disease
and the means of reducing the mortality.

The first work, however, which gave to the physicians of the
capital a knowledge of the nature and origin of the "taon" was
a memorandum read on October 10, 1904, before the Colegio
Medico Farmaceutico of the Philippines by Dr. Manuel S. Gue-
rrero.

In said memorandum, Professor Guerrero affirmed to his col-
leagues that the "taon" was the beri-beri of breast-fed infants,
just as it had been discovered by Hirota in Japan.

In 1916, the same Dr. Guerrero, in his inaugural speech at
the opening exercises of the University of Sto. Tomas of this
city, dwelt for the second time on the same disease, and proved
that the excessive infant mortality in these Islands was, in a
great measure, due to the "taon," for which reason, more deaths
occurred among breast-fed infants than among the artificially
fed, just the opposite of what was taking place in other countries.

Later discoveries of Doctors Albert (J.), Guerrero (L.),
Gavieres (J.), Andrews, Calderon, and Gabriel, and above all,
the wise experiments accomplished by the Liga para la Protection
de la Primera Infancia, have come to confirm the assertions
of the aforesaid Dr. Manuel S. Guerrero and to establish, beyond
all doubt, that the "taon" was the infantile beri-beri, that said
disease comes from the milk of a woman suffering from beri-
beri, and that it is cured and prevented with the tiqui-tiqui
extract.

HOW BERI-BERI DEVELOPS IN INFANTS

Infantile beri-beri is a disease that attacks infants less than
one year old. It may exist in a serious form from the first days
after birth, especially, in women who deliver for the first
time. The greater number of cases corresponds to the ages
from one to four months, after which, it begins to decrease, the
disease seldom appearing in infants more than eight months
old.

Cases of beri-beri are registered more frequently in the
months of September, October, and November, due, perhaps, to
the fact that in said months beri-beri in adults is more frequent
and the greater number of women who give birth at this time
contract the disease and are disposed to transmit it to their
children by means of their milk.

Infantile beri-beri is observed solely and exclusively in breast-
fed infants, the reason being that it is acquired by means of the
milk of a mother suffering from beri-beri. Infants nursed on
artificial milk or cared for by women free from beri-beri do not
suffer from the disease.

Therefore, a child may be born of a woman suffering from
beri-beri and still not contract the disease if from the day of
its birth it nurses on cow's milk or takes the breast of a wet-
nurse free from beri-beri ; while, on the other hand, a child
born of a sane mother may get the disease if it takes the breast
of a wet-nurse with beri-beri.

The reason most accepted at the present time to explain this
fact is that in the milk of a woman suffering from beri-beri
there is wanting a substance called vitamine which is indispen-
sable for the nutrition of the nerves of the child, that is, for
the nourishment and sustenance of these important parts of
the body.

The lack of vitamines in the milk of the mother suffering
from beri-beri is due to the lack of vitamines in the body of
said mother, a fact which occurs when the mother lives for a
long time on articles of food deficient, in minimum quantities,

in certain nitrogenous substances which are indispensable for
the preservation of a perfect health, substances which are known
by the name vitamines and which exist in food, in greater or
lesser quantity.

Vitamines are found in abundance in legumes, such as the
mongo, beans, lentils, "patani," etc. Also they are found in
cereals, being especially abundant in the fine film that covers
the grain of rice, so that it can be said that when this grain
is polished well, said substances are eliminated entirely.

It is, therefore, easy to understand that a person who uses
polished rice as the principal basis of his food, without adding
to it other substances which, like the legumes already mentioned,
are rich with vitamines, renders himself predisposed to contract-
ing beri-beri, or, if a mother or a wet-nurse that is to give milk
to a child, is easily converted into an appropriate source of in-
fection with beri-beri for the child.

This is the reason why, during many years, there has existed
among physicians the belief that beri-beri is traceable to the
consumption of rice from Saigon which is the most polished rice
known in the country, and that a more bulky importation of
this rice would effect an increase in the already high average
death rate of infantile beri-beri.

SIGNS OF BERI-BERI

Knowing now the origin of infantile beri-beri, we shall pass
on to describing the signs of the disease, so that mothers may
know when they are attacked and when the disease begins to
develop in the child.

Signs of beri-beri in mothers. — Bulletin No. 3 of the Liga
para la Proteccion de la Primera Infancia, speaking on this sub-
ject, gives the following points:

"It is difficult to point out the signs of the beginning of beri-
beri in mothers.

"When the mother becomes aware of the disease, this has
already established itself in an advanced stage.

"But a mother who, during pregnancy or in the course of
the puerperium, that is to say, in the weeks following the child-
birth, observes in herself: loss of appetite, constipation, palpi-
tations, pain on the left side of the breast, some fatigue in going
up-stairs, and, more especially, a sensation of hardness or
constriction of the stomach and swelling of the legs or of the
fingers or around the lips, or insensibility at these places, or
all these disorders simultaneously, must send for a doctor or
go and consult him, in order to verify if what trouble her are
the symptoms of beri-beri.

"This is what will enable a mother to suspect the probable
existence of beri-beri in her.

"But, certainly, only a doctor, examining her, will be capable
of determining whether or not the disease exists."

Signs of beri-beri in infants. — The same bulletin has the fol-
lowing to say on this point:

"The appearance of beri-beri in a child may be suspected
when the child vomits persistently and without cause (premon-
itory symptom) .

"We say that the vomiting has to be persistent and without
cause in order to indicate that they are not caused by a bad
way of nourishment, that is, frequent or abundant sucking not
contained in the nursing schedule, both as to the number of
breast feedings and as to the length of time the child is allowed
to suck.

"Repeated and abundant vomiting occurring involuntarily
shortly after the child begins to suck is a symptom which a
careful mother should take as a warning for her to pay a closer
attention and to think on the possibility of infantile beri-beri.

"Sometimes, it is not the frequent or abundant vomiting of
such intensity which attracts the attention of the mother; in
that case, paleness is a symptom which, accompanied with feeble
and moaning (halinghing) , indicates the beginning of beri-
beri in the child.

"Occasionally, the first sign that the mother observes is an
alteration in the voice; the child lies awake and becomes
aphonic. This already indicates an established beri-beri in the
child. The mother has overlooked the first symptoms and when
she notes the disappearance of the voice, the disease has already
established itself for some time.

"There is another important symptom with which mothers
are perfectly familiar, and that is the persistent, prolonged, and
repeated crying. It is not the crying' from colic or gastralgia
which is calmed with warm lotions applied on the stomach or
with a small dose of bicarbonate of soda or with enema, but
that crying which is indicative of the noxious, almost always
fatal attack of beri-beri.

"In short, the mother should suspect beri-beri in her child if

this VOMITS MUCH, CRIES MUCH, COMPLAINS CONSTANTLY, TURNS
PALE OR LOSES THE VOICE."

THE CAMPAIGN AGAINST BERI-BERI

In the mother. — If the cause of infantile beri-beri is the nurs-
ing of the child on the milk of a woman suffering from beri-

beri, we should draw out the conclusion that the campaign should
not be limited to protecting the children only, as has been done
up to now, but should also be directed to extirpating beri-beri
from the adults.

It is, therefore, urgent to undertake a real crusade in order to
educate and convince the masses of our people of the necessity
of a slight change in their nourishment, not only to avoid beri-
beri, but also to secure a higher general standard of nutrition.

To diversify the nourishment, it is not necessary to increase
the expenses; it is sufficient to abandon the faulty custom of
eating too much polished rice and to substitute for it other suc-
cedaneous elements which, in general, are cheaper than rice it-
self; for, in fact, this big consumption of rice is simply a
question of custom and habit which gives rise to an invisible
harm — more specifically, to physical resistance, to capacity for
work, and to the general welfare of the race.

We feel sure that with a campaign of this nature undertaken
by the Office of the Public Welfare Commissioner which, with
its nurses and puericulture centers, could well watch over and
advise mothers during their antenatal career, and supported
by the combined efforts of doctors, nurses, schools, the Red
Cross, woman's clubs and other social activities of the country,
we could banish, or at least reduce by its two thirds, this disease
of beri-beri which constitutes a terrible scourge for our children
in their infancy.

In the child. — Coming to this point, allow us to say that we
lack adequate words with which to make prominent the gigantic
work undertaken in behalf of our people by the Liga para la Pro-
tection de la Primera Infancia, which, unselfishly and perserver-
ingly, has investigated the beneficial results produced by the
tiqui-tiqui extract in the prevention and treatment of infantile
beri-beri.

This work, realized from 1914 to 1918 immediately after the
discovery of the tiqui-tiqui extract by the American Doctors
Chamberlain and Wadder, gave so positive results that said
Society, in a report sent to the Legislature on October 15, 1918,
established the following conclusion:

"With all that has been expounded, this Directory believes
and holds that the period of computation and experimentation
of the treatment of infantile beri-beri by means of the tiqui-
tiqui extract can be considered terminated and that this remedy,
discovered in January of 1911 by Drs. Chamberlain and Wadder,
administered in convenient doses, is the most efficacious and
reliable medicament that the medical science is possessed of
nowadays in order to combat this terrible disease which deci-

mates more than one thousand lives of innocent suckling babes
every year in Manila and which is responsible for 30 per cent
of the infant mortality. In this respect, it can be affirmed that
the resolution of the Second Regional Assembly of Physicians
and Pharmacists of the Philippines (Segunda Asamblea Regio-
nal de Medicos y Farmaceuticos de Filipinas), converted into
the Angeles Bill which was approved on February 28, 1914,
assigning funds for the manufacture and free distribution of
the tiqui-tiqui extract among the needy class, is one of the laws
most beneficial and of immense transcendency for the future
of the Filipino people, for said law tends to solve in part the
dreadful problem of infant mortality and population."

The tasks, on the other hand, carried through on this same
subject by the distinguished doctors M. S. Guerrero, J. Albert,
J. Gavieres, F. Calderon, P. Gabriel and V. L. Andrews, have
demonstrated, beyond all doubt, that in these days no child
should die of "taon" or infantile beri-beri as the efficacy of the
tiqui-tiqui extract as a preventive and curative medicament of
the disease is not unknown.

NATURE OF THE TIQUI-TIQUI

The extract obtained from the tiqui-tiqui or bran of rice is
a sirupy, dark brown liquid, of a pleasant taste when well pre-
pared and when in its preparation a bran of good quality has
been used.

Children tolerate it and take it with pleasure. It keeps well
for some months at ordinary temperature.

The preparations used more frequently in this city are: The
extract of tiqui-tiqui prepared by the Bureau of Science and
that which is manufactured by the laboratories of M. Zamora,
of Hizon and Rodriguez, and of Santos & Jahrling.

HOW THE TIQUI-TIQUI SHOULD BE ADMINISTERED

As curative. — The tiqui-tiqui extract, whenever possible,
should be given to the child in accordance with the prescription
of a physician; but, when, under special circumstances or by
the urgency of the case, the mother is obliged to give the medi-
cine to her child, she should administer it in the proportion
of five (5) grams, or one teaspoonful, every three hours, while
the serious symptoms persist, and continue giving the treatment
afterwards for three (3) consecutive months at the rate of three
(3) teaspoonfuls daily.

As prophylactic. — The child should never be weaned under
the pretext that the mother is suffering from beri-beri and that
her milk may give rise to the disease in the child ; for, then, we

would be exposing the child to the serious consequences incident
to artificial feeding.

When a mother is suffering from beri-beri or has suffered
from it formerly ; when she has lost several children of less than
seven (7) months old; when, lastly, due to any circumstance,
it is believed or suspected that the child is liable to fall victim
of beri-beri, the protection should not consist in weaning the
child, but in administering the tiqui-tiqui extract to it, leaving
the mother to continue giving her breast. Moreover, in order
to avoid mistakes which may afterwards give rise to fatal
consequences for the child, we would propose the systematic ad-
ministration of the extract to every new-born child for three
months, in the same manner as, by custom, the. instillation of
silver nitrate solution is now used in order to prevent ophthal-
mia in the new-born.

There is no serious motive for not doing it, for the tiqui-tiqui
extract is an inoffensive substance which is favorable to diges-
tion, and the most that it may produce is a light, harmless
diarrhea, a condition which can be obviated by choosing a de-
finite kind of tiqui-tiqui extract.

As preventive. — The tiqui-tiqui is given to children three (3)
times a day in the dose of five (5) c. c., from the second day
of birth.

CONCLUSIONS

From all that has been made manifest, we can deduce the
following conclusions:

1. Infantile beri-beri claimsJSO per cent of the mortality of
infants from 0 to 1 year of age. It is, therefore, the factor
which presents a higher average of mortality, causing more
victims than bronchitis, tuberculosis, gastroenteritis and teta-
nus combined.

2. It is a disease both the nature and remedies of which are
known, and which can be eliminated from among the factors
which influence infant mortality.

3. The campaign against beri-beri should not be confined to
the child alone but should cover the antenatal period as well,
and therefore, puericulture centers, through their visiting nurses,
should watch over and advise the mother during her pregnancy.

4. An intensive propaganda to change the form of nourish-
ment of the poor class is necessary.

5. To condemn, without exceptions, the use of polished rice
and to generalize the use of brown rice and fresh legumes.

6. The tiqui-tiqui extract is an efficacious remedy in the
curative and preventive treatment of the disease.

7. The weaning of the child even when the mother is suffer-
ing from beri-beri is unnecessary, whether for preventive or
curative purposes.

8. The extract should be distributed free in all the munic-
ipalities of the Archipelago, so that it would be convenient to
amend Act No. 2714 in order to authorize the Bureau of Science
to manufacture all the necessary quantity of the product.

9. The extract should be administered in sufficient doses (15
cubic centimeters daily) for a time not less than three months ;
otherwise, the dose is insufficient and as such does not stop the
disease.

10. Systematic administration of the extract to all children,
even if the mother is not suffering from beri-beri, from the
date of birth up to the age of three (3) months.

DISCUSSION

Miss L. SANCUEZ (Pozorrubio, Pangasinan) . — I suggest that the impor-
tation of Saigon rice be prohibited in order to reduce infantile beri-beri;
and I further suggest that the woman's clubs in all the provinces help
distribute tiki-tiki extract among the poor.

Miss GUILLERMA LOPEZ (Delegate, Lingayen Woman's Club, Pangasi-
nan).— As tiki-tiki extract is highly recommended for infantile beri-beri,
and as its supply is limited, I suggest that the authorities concerned, give
out the formula for its preparation.

Miss GERONIMA ARRIBAS (Nurse, Philippine General Hospital). — In
order to eliminate infantile beri-beri, I suggest that all mothers be encour-
aged to eat the vegtables containing the proper vitamine, from the second
month of pregnancy till after the birth of the child.

TUBERCULOSIS AND THE CHILD

CARMELO PENAFLOR, M.D., Publicity Director, Philippine Islands Antitu-
berculosis Society and Chief, Division of General Welfare, Office of
the Public Welfare Commissioner.

Every year in this country about 30,000 people die of a disease
that has been duly labelled and reported as tuberculosis. For
every person who dies of tuberculosis there are five, may be ten,
may be twenty other persons who are suffering more or less
from permanent disability, because of the activity of the bacillus
of tuberculosis they harbor within them. We cannot tell its
exact number, but it cannot be less than five nor more than
twenty. Furthermore, we can confidently conclude that 500,000
Filipinos have received their sentence of death from tuberculosis,
or, in other words, 5 per cent of our population is always below
the peak of efficiency, because the germ of tuberculosis shows
enough activity in them.

Here are given in a nutshell the ravages of tuberculosis in our
adult population. Now, to what extent is tuberculosis respon-
sible for our excessively high infant mortality ?

If we search thru the scanty amount of records that we have
been able to gather for data with which to answer the question
above propounded, we shall be surprised to find that tuberculosis
amounts to a sort of rara avis among the causes catalogued in
the death lists of infants. To be more precise, according to the
Annual Report of the Philippine Health Service for 1920, there
have been during the last year only 205 cases of death among
children from tuberculosis.

And yet, everyone of these 30,000 persons killed by tubercu-
losis every year, and everyone of these 500,000 Filipinos who
are doomed to die from tuberculosis received their first infection
with tuberculosis during their childhood! Let everybody take
note of this. Every adult Filipino who is sick or dies from
tuberculosis received the infection while he was a child.

This is not mere guesswork. This is a true and cold fact, a fact
that is supported and backed up by actual findings of thousands
of autopsies, by the weight of statistical figures and by the
authority of foremost investigators in tuberculosis work.

Gaffky perfomed autopsies in 400 children, and found 78 of
them, or almost 20 per cent, tuberculous.

Beitzke, of Berlin, found tuberculosis present at the postmor-
tem examination in 10 per cent of children in the first year of
age.

Hamburger and Gohn, of Vienna discovered among 318 post-
mortem examinations of children who died within the first year
of age, the following percentages :

Per cent.

Died within the first trimester 4

Died within the second trimester 18

Died within the third trimester 23

Died within the fourth trimester 23

Levett Morse states that large series of autopsies in children
under 15 years of age, show tuberculosis in from 25 to 33 per
cent.

Newmayer reports that tuberculosis claims annually in the
United States 50,000 adults and about 400,000 infants.

Of the 25 million pupils in the public schools of the United
States, 5 per cent have pulmonary tuberculosis.

According to Holt, almost 26 per cent of infantile death are
due to tuberculosis.

Perkins of Providence, Rhode Island, says that 20 per cent
of children are infected with tuberculosis before they reach 15
years of age.

Martha Wollstein in investigating 882 cases in Holt's Children
Hospital in New York, has found the following percentages of
tuberculosis in children before the first year of age :

Per cent

In the first trimester 2

In the second trimester 11

In the third trimester 16

In the fourth trimester 23

One of our well-known local physicians, Dr. Sison, says that
death from tuberculosis occurs in 9.5 per cent of children from

I to 5 years.

Our work in connection with the Traveling Clinic of the New
Mexico Public Health Association has unearthed the fact that

II per cent of the 1,700 pupils of the rural schools of that state
have actual manifestation of tuberculosis.

Many good authorities, particularly the French and some
Germans, believe that most cases of tuberculosis are acquired in
early life — in childhood, and that during this period the disease
remains latent or inactive showing no symptoms. When the

child, however, undergoes the stress and strain of study and
confinement in school, or in adult life enters into the struggle for
earning a livelihood with all the coincident depressing influences
upon health, the tuberculous infection before latent, becomes
active and tuberculosis in some form develops.

No less an authority than Allen K. Krause in one of his
lectures at the Trudeau School of Tuberculosis while we were
attending a post-graduate course, has stated that "it is no sup-
position that the infection occurs in the early years of life."
"Today, "he said," this is one of the real and absolute certainties
of tuberculosis lore."

"The harvest of tuberculosis disease in mature life," says Dr.
Kelinack, "is oftentimes dependent on a tuberculous seedsowing
in early days." "Tuberculosis in early life," he continues, "is
responsible for many far-reaching disabilities, and not a few of
life's long-postponed disasters."

We may repeat with Rockford that we are not justified in
looking upon the early infection of childhood with so little
concern.

At the face of all this huge mass of overwhelming evidence of
the prevalence of tuberculosis in childhood, we think it is
germane to the question to ask, how should we account for the
discordant absence or smallness of our figures of deaths from
tuberculosis in children, when it is an open secret that we hold
the shameful record of having one of the highest rates of infant
mortality and the hugest number of deaths from tuberculosis?
We would not like to appear too hypercritical, but the question
demands an answer. And there can be only one answer. We
are not lacking of cases of infants succumbing to some form
of tuberculosis. What we lack are good diagnosticians of early
tuberculosis, and the necessary equipments for a correct diag-
nosis, such as laboratory facilities. This is especially true in
our provinces. Were we so fortunate as to possess these two
instruments, we would be surprised at the number of gastro-
enteritis, athrepsia, marasmus, meningitis, infantile convulsions,
etc., that will be rightly classified as tuberculous enteritis, tuber-
culous arthritis, pulmonary tuberculosis, tuberculous meningi-
tis, milliary tuberculosis, etc. Had we the means and facilities
to carry out a thorough Von Pirquet test among the one million
children in our schools, we would be stunned by the disclosure
that almost 25 per cent of them show the trademark of tuber-
culous infection, and that the Government is expending 200,000
pesos in educating children who are doomed to die of tuber-
culosis before they reach their twentieth year of age.

185611 7

With the foregoing, we hope to have been able to demonstrate
that the doctrine of tuberculosis infection in childhood has a defi-
nite place in the child welfare program and has likewise made a
knowledge of tuberculosis essential in the training of the child
welfare worker.

The next question that should come in order, is : What are the
manifestations of tuberculosis in childhood? Inasmuch as the
description of them will require the use of many technical words
and details and the Conference, we are sure, is not interested in
them, we will take up the description of the factors and means
that help in the infection and spread of tuberculosis in children.

There is a point in connection with the different avenues of
entrance of tuberculous infection in children which needs a
thorough consideration, should we desire to come to a close and
perfect understanding of the latter. We are referring to the
influence of age in tuberculous infection.

By tabulating all the figures reported in this connection by
Hamburger, Wollstein, Morse, Krause, Harbitz, Griffith, Fish-
berg, Sison and others, and the tuberculin test results performed
by Fishberg among 600 children in New York City, we will
have a diagram as shown in Plate I which gives the dis-
tribution of tuberculous infection at various age periods be-
tween 0 and 14 years of age.

By looking at the diagram we can instantly say that tubercu-
losis is very rarely found in the first six months (5%) . In fact,
the new born infant is invariably free from tuberculosis, in-
dicating that infection, if it occurs at all, always takes place
after birth. The infection increases rapidly in frequency dur-
ing the rest of the first year, and steadily up to the fifth year,
after which the increase is gradual, reaching its maximum at
the age of 14 years (83 per cent).

CAUSES OF TUBERCULOSIS IN CHILDREN

In reaching this point the first question that might be put
to us is this: Is it not true that tuberculosis can be inherited
by the child from a tuberculous patient?

Virchow, whose autopsy experience was as immense as that
of any physician, stated that he never encountered a case of
fetal tuberculosis. This is on one hand. On the other hand,
that there may be occasionally a direct bacillary transmission
from the tuberculous parent to the child has been demonstrated
sufficiently to permit of no further dispute. Yet the number
of such cases is so insignificant that we are justified in stating
that the child is born free from tuberculosis, and that infec-
tion, if it takes place at all, occurs postpartum.

PLATE 1. FREQUENCY OF TUBERCULOSIS INFECTION IN CHILDREN

5
a £

°s

I *

D *"

)

O u

2 *

a «

2 I
a £

2 ~
_a §

2 c
0 1

gJl^ggSSSSSS"

. Tuberculosis in infancy is indirectly due to either a hereditary
or acquired predisposition on the one hand, and it may be traced
directly to postnatal infection on the other.

When either of the two parents is tuberculous, the child in-
herits a predisposition, or a physiological poverty as Dr. Knopf
happily calls it.

The tuberculous mother contributes a stronger predisposition
than the tuberculous father.

The more advanced the disease is in the mother, the less
chances for life and health the child has.

When both parents are tuberculous at the time of conception
of the child, the offspring is naturally more strongly predis-
posed to contracting tuberculosis than otherwise.

This inherited predisposition is frequently increa'sed or is very
easily acquired as a result of improper food, bad hygienic sur-
roundings, and lack of air and sunlight.

'The modus vivendi of the lower class/' is pronounced by Dr.
Sison, "as a favorable and predisposing condition for the spread
of infection." "The poor people live crowded in dingy, dirty
small houses in which they are packed like sardines in a tin
can, in many instances with 3 or 4, or even the whole family
affected with tuberculosis. Living as they do in such close
relationship, using the same utensils for drinking and eating,
and breathing the same vitiated air, saturated with tubercle
bacilli emanating from dried-up sputum in every nook and
corner of the house, makes the abode a deadly place. This con-
dition is worse at night on account of their habit of sleeping
with the windows almost hermetically closed."

Besides these sources, there are certain predisposing diseases
that make the organism of the child an easy prey for the rav-
ages of tuberculosis. Diseases of the mouth and throat, hyper-
trophy of the tonsils and adenoids, especially if accompanied by
cervical adenitis, all open the door for the entrance of the tuber-
cle bacillus. Bronchitis, measles, pertussis, and influenza are
often followed by tuberculosis.

So far, we have described only those conditions that pre-
dispose or make the organism of the child susceptible to the
implantation of the germ of tuberculosis. In the following
lines, we will try to study and demonstrate the different means
through which the tubercle bacilli gain entrance into the body of
the child after it has left its uterine habitation.

First of all, we think it is important to repeat here that the
particles or droplets of the sputum of a consumptive, contain
in great numbers the germs of tuberculosis. The sputum is

100

the usual agent of contagion. Sputum is as dangerous indoor
as outdoor. In fact the sputum in the streets becomes in part
the sputum of the home as you and I drag it across our thres-
holds when it clings to our shoes and clothes. The tubercle
bacillus is distinctively characterized by its ubiquity. It may
be found anywhere — in our mouths, on our hands, in our gar-
ments, in our utensils. The streets, sidewalks and public places
of our cities are copiously bespattered with the sputum from
thousands of throats and lungs, among which a fair number
are surely tuberculous. Day after day, year after year, tubercle
bacilli fresh from the body with their essential vigor and vir-
ulence are being spat upon the ground of public places as well
as private homes. We need not, therefore, emphasize the fact
that almost every healthy child has numerous opportunities of
becoming infected.

Coming now to the most frequent sources of postnatal infec-
tion and describing them in the same chronological order as the
child grows older, we have to mention first the peril affecting
those who happen to attend the child at its birth. We mean
physicians and midwives, especially the latter. Dr. William
Charles White of Pittsburgh cites the following very illustrative
case. In a town of about 1,300 inhabitants, the obstetric prac-
tice was divided between two midwives. Within fourteen
months no less than ten of the infants who were delivered by
one of these women died of tuberculous meningitis. In none
of those families was there a history of tuberculosis. This
midwife was found to be suffering from pulmonary tuberculosis
and died from that disease. It was her custom to remove the
mucus from the mouth of the newly born infants by direct
mouth-to-mouth aspiration and then to establish respiration by
blowing into the nose. In the practice of the other midwife,
who was healthy, no case of tuberculosis occurred, although she
treated the newly born infants in the same fashion. The case
illustrates some of the dangers that lurk in the methods used
by duly trained and licensed midwives. Imagine for a moment
how much greater are the perils that surround the birth of our
children when almost 97 per cent of them are annually delivered
by untrained and dirty midwives commonly known as hilots.

The next serious source of infection is the unscrupulous selec-
tion of a wet-nurse or person to be entrusted with the care of
the child. In the ward of a large infant asylum in New York,
the utmost care was taken to control tuberculosis by segregating
the children after giving them all a tuberculin test, and feeding
them only on pure pasteurized milk free from tubercle bacilli.

101

But as it so often happens, the greatest carelessness crept in —
they failed to examine those who were to nurse and handle the
carefully protected children. A consumptive nurse was admitted
to the ward, and all the children she nursed became tuberculous".

We naturally all agree that no food like that furnished by the
mother has ever been obtained for the rearing of children, as
we all would like to raise the very best children possible. We
have always advocated breast-feeding for infants as the par ex-
cellent food. The mother's milk is always clean and always
ready. Mothers, if possible, should always give their breasts to
their children, except in certain instances as prescribed by the
physicians. One of these exceptions is when the nursing mother
is suffering from tuberculosis, for in this instance the mother
is liable to infect the child with tuberculosis although tubercle
bacillus is never found in human milk except in cases of mam-
mary invasion in tuberculosis. The dangers in this case are not,
we feel, so much that the child will become tuberculous from
the mother's milk as by her coughing over it.

When requirements of scientific child care would necessitate
the use of cow's milk, the parents should be cautioned against
another serious danger. Tuberculosis in cattle, especially cows,
easily invades the mammary glands of the animal, and the milk
coming from its udders is usually loaded with bovine tubercle
bacilli. And it is an undeniable fact that tuberculosis in the
cattle, or bovine tuberculosis, is pathogenic or is transferable to
human beings. By the time the dairy business develops here,
this danger of postnatal infection of the child will necessitate
more than a passing consideration.

Somebody might say, "Oh, well, to save that trouble, why
not give the baby condensed milk?" Well, the proposition is also
fraught with no small dangers. We have seen many tuberculous
mothers prepare the food for their children. They take care
to do it personally. They flavor it and they taste it to ascertain
its temperature through the same rubber nipple or with the same
spoon which the child uses. Thus unconsciously the mother
conveys the germs of her disease from her mouth to that of the
child. Dr. Sison has also seen mothers feed their children with
the best intention, from their own mouths after first masticat-
ing the food. And Dr. Sison was right to call this "one of the
direct and horrible ways of transmitting tuberculosis, or any
other disease, to infants and children — one that can be called
criminal due to ignorance on the part of those who are suffering
from the disease."

102

Later on, when the child is able to .be moving about, he will
play on the floor of the room, and should there be a consump-
tive in the family, who, from carelessness or ignorance, is not
careful in the disposal of his expectoration, the child is, indeed,
likely to be infected. The little one while playing on the floor
may with great facility inhale the bacilli floating with dust in
the air, or may touch everything it can take hold of — shoes, slip-
pers, etc., infecting its fingers thoroughly and putting them
later in its mouth. (Plate II.)

As the child grows older, the dangers of infection do not
desert him. The child at play, with marbles, ball, hoop-rolling,,
top-spinning, rope-skipping, and in scores of other ways, cannot
help gather into its hands, repeatedly, the sputum in our streets
and sidewalks. And knowing children's habit as we all do, we
can assert with perfect confidence that frequently those hands
find their way to the child's mouth, thus introducing the bacilli
into the body.

Even in the school, the child cannot feel free from the linger-
ing infection. At school, the child is exposed to infection from
partaking of half-eaten fruits with his tuberculous fellow-pupils,
or by the exchange of toys, musical mouth-instruments, pencils,
or chewing-gum. Dr. W. E. Musgrave, one of our former di-
rectors of the present Philippine General Hospital, has said that
"even in our public schools patients are often found mingling with
students too closely for safety." "The dormitories of many of
the schools contain tuberculous patients to a starting degree."

The source of infection in school is not only in the contact
between pupils. Teachers are also a non-negligible factor of
infection. In Europe as well as in America teachers are said to
suffer heavily from tuberculosis. There is no reason to dis-
prove that the same thing is happening in the Philippines.

To finish this incomplete description of the postnatal sources
of infection in tuberculosis there still remain for us to mention
some bad common practices of a great majority of our people.
They are so common and of such every-day occurrence that we
wouldn't attempt to describe them in detail. They are shown
in actual pictures, in Plate III, hoping that they will illustrate
the latter better than words.

The picture shows a mother caressing and kissing her child
in the mouth. Now, imagine the woman to be suffering from
advanced tuberculosis; the picture will naturally give an idea
of the dangers hovering constantly over the innocent child.

The woman shown in Plate IV is doing what every health-
loving person should do. She is using her handkerchief in

PLATE III. SPREADING INFECTION BY KISSING ON THE MOUTH

PLATE IV. USING A HANDKERCHIEF IN SNEEZING

103

sneezing. Nothing can be said against that practice. It is per-
fectly within hygienic principles.

But now, the same woman is shown in Plate V. She can not
be considered a type of health-loving person. Why? Because
she is wiping the mouth of the baby with the very same hand-
kerchief she used when she sneezed a while ago.

We do not preach ir religion. We do not want to fight any
religion. We do not preach that one religion is better than
another. But who has not seen the picture in Plate VI ? Every-
body has seen it. Now, supposing — if a iscene that happens
99 times out of 100 can be called supposition — that before the
child is made to kiss the image, something about 300 mouths,
of which almost one third are tuberculous, went before him and
soiled the hands or the feet of the saint with their deleterious
sputum, would you have your child take the place of the baby
shown in the picture and do the same practice?

Plate VII pictures a very familiar scene in our amusement
centers called cinematographs. Because of the almost continu-
ous darkness in these places, the antispitting ordinance amounts
to a mockery. Breathing the offensive human emanation and
inhaling the germ-laden dust that is being blown around by
electric fans, would it be unnatural for a baby to catch a tuber-
culous infection?

To close this description of sources of postnatal infection, let
us look at Plate VIII that graphically depicts the term ap-
plied by Dr. Sison, "like sardines in a tin can." Overcrowding
and incidentally the loathsome habit of having the children
mixed up with non-too-healthy adults in sleeping quarters, are
not only a condition that favors susceptibility of the human
organism to disease but also actually become the instrument
for imparting infection.

HOW TO PREVENT TUBERCULOSIS

After having demonstrated the most serious sources of in-
fection for the child, the questions we shall take up next is a
short description of the measures to be observed in order to
prevent the ravages of tuberculosis in children.

Remembering the types and character of the sources of in-
fection in describing the measures for the prevention of tuber-
culosis in childhood, we shall separate them into three classes:
Prenatal measures, measures to diminish or prevent the inhe-
rited susceptibility, and measures to prevent contagion.

Before going into the description of each one of the above
mentioned classes, let us bring forth a point that will facilitate

104

immensely the carrying out of any campaign that tends to di-
minish the dangers of infection with tuberculosis. We have
demonstrated somewhere else in this paper that sputum is the
usual and the most dangerous agent of contagion. Without tu-
berculous sputum, or better still, without the bacilliferous spu-
tum, there can not be any danger of infection with tuberculosis.
So, the main measure of prevention should be to prohibit all
expectoration in public places. How? With laws and regula-
tions to that effect. Will those be effective? We doubt it.
There is an ordinance in our municipal laws prohibiting and im-
posing a fine for spitting in our streets. But does it prevent
spitting? No. If it does, our streets will look less bespattered
than they are, and incidentally, our municipal funds would be
increased to such an extent that any campaign against tuber-
culosis could be carried on without bothering the Government
and the charitable public for funds.

No ; the force of the law will never be enough to prevent the
dirty vice of spitting. That can be accomplished only through
education of the public. We believe with Dr. Krause when he
says: "When men and women instinctively turn gentlemen and
ladies, sputum will disappear from our streets." "It would be in-
decent, disgusting and bad were any of us to play the animal
and publicly attend to what we designate as the 'calls of nature'
in our streets. Yet, an enormous number of us go brazenly
through the world, scattering aimlessly and broadcast, sputum
which, considered in the bulk, can bring about more misery and
sickness and death by its transference to other individuals than
all the urine and feces in the world in these days when Asiatic
cholera is almost but a memory and typhoid fever can be made
one. But let us play the animal a little bit. Horses and dogs
are not given to spitting. Let us likewise refrain from it and
thereby help not only to make our streets clean but also — which
is more important still — to prevent giving tuberculosis to our
fellow-beings."

Now, let us describe the first class of preventive measures, the
prenatal measures. Whenever possible, let us follow that wise
dictum of the French clinicians when they speak of tuberculosis:
If a girl, no marriage ; if a wife, no pregnancy ; if a mother, no
suckling. But whoever may the tuberculous parent be father,
or mother; or whether the progenitors have been in the earlier
or later stages of tuberculosis, the overcoming of the predisposi-
tion to the disease in infancy and childhood must begin with the
child in utero. The mother who fears the transmission of a
tuberculous predisposition to her child must, throughout the

PLATE V. WIPING THE MOUTH OF BABY WITH THE SAME HANDKERCHIEF USED IN

SNEEZING

PLATE VI. SPREADING INFECTION BY KISSING IMAGES OR OBJECTS OF WORSHIP

PLATE VII. THE BAD HABIT OF TAKING SMALL CHILDREN TO CINEMATOGRAPHS

105

child-bearing period, live in the best possible hygienic environ-
ment and in the purest air obtainable.

In these days of the industrial advancement of women, an-
other environmental condition outside the household should be
taken into consideration, and that is, the factory or the workshop.
How can the pregnant woman, obliged to earn a living in in-
dustries often until the last few hours before her confinement,
carry out the hygienic instructions necessary for her to have
a child vigorous, strong and with sufficient natural resisting
power so as not to contract tuberculosis? What should we do
when, as it usually happens, employers are not alive to their
duty to their employees? In this case the law should step in.
There should be a law prohibiting the employers. from conduct-
ing work in insanitary, dusty and badly ventilated workshops
for all people, particularly for women and children. There
should be a law obliging the pregnant woman to stop working
in a factory or workshop two months before her confinement,
and not permitting readmission until one month after her con-
finement and complete restoration to health.

Once the child is born, what shall we do to prevent parents
from giving or augmenting the predisposition or the physiolo-
gical poverty as called by Dr. Knopf to the baby? First of all,
let parents and children have the most nutritious food and the
most hygienic condition of living. Everything that tends to
provide the poor with proper food and everything which gives
the children a greater supply of fresh air and sunlight are im-
portant in that they tend to prevent the development of any
acquired susceptibility. Every new park, every new playground,
every improvement in housing, aids in the fight against tuber-
culosis.

When adequate food and suitable hygienic living conditions
have been attended to, the next things to prevent are certain
predisposing diseases. Diseases of the mouth and throat, hy-
pertrophy of the tonsils and adenoids, especially if accompanied
by cervical adenitis, all open the door for the entrance of the
tubercle bacillus and should, therefore, receive early and active
treatment. The public must be taught to appreciate the dan-
gers of measles and whooping-cough; such diseases should be
reported to the boards of health ; and patients afflicted with them
should be isolated.

By following the foregoing instructions, the susceptibility to
infection is greatly lessened. But that is not enough. We must
also exercise all efforts to prevent the postnatal infection of the
child.

106

Most of the measures that are described in this connection, can
be attained only through constant, intensive and painstaking edu-
cation of the public. Take, for instance, one of the serious dan-
gers that menaces the child by the time it leaves the uterine
habitation — the danger of the ignorant, dirty and irresponsible
midwife, commonly known as manghihilot. Thousands and
thousands of pesos, and years after years of valuable time have
been spent to banish this scourge. Can we say that we are
better off than formerly in this regard? You can answer this
for us. The danger of the unscrupulous midwife will be solved
and the problem of infant mortality will be near to solution only
when every Filipino and every Filipina has had, through educa-
tion, the eyes opened to the real dangers of these intruders, and
when a maternity house could be built in every province, nay in
every town of the Philippines.

But let us suppose that the child has been able to evade the
first gulf in its extrauterine life. What will be the next thing
to be borne in mind to insure its safety against tuberculosis?
The next thing is the contagion through the milk, human or
animal. We have said before that tubercle bacillus has been
found but once in the milk of a tuberculous woman. In spite
of this, and in spite of our ardent campaign in favor of breast-
feeding, a tuberculous woman, mother or wetnurse, should never
nurse a child even if she is able to do so, both because it debil-
itates her and because the infant not only suffers from an in-
sufficient or abnormal supply of milk but also runs the risk of
direct infection through the secretions of the respiratory tract.
When cow's milk is used, then there must be both a close super-
vision of milch-herds and a careful pasteurization of the milk.

When the mother is stubbornly ignorant, the preceding advice
is of no avail. Then it becomes extremely difficult to guard the
child against contagion. The only treatment for these cases
is to get the tuberculous member out of the house if possible.
A tuberculous servant or a nurse, should be discharged. A
parent or any other immediate member of the family should
leave, if possible. If, as is usual in most cases, the patient can
not be made or does not want to leave the home, then the
children should, if possible, be sent away, preferably to the
country or to some institution built for the purpose.

In France, Professor Grancher has an establishment called
the "League for the Preservation of Children from Tuberculo-
sis," the main object of which is to remove children of tuber-
culous parents from their homes where they are daily exposed
to infection, and to send them into the country. In his appeal,

107

Professor Grancher says that he had for a long time been
haunted by the leading idea of Pasteur's book on "Diseases of
Silk-worms" which implies that in order to save a race that is
threatened with an infectious disease, the best plan is to save
the cocoon. Children taken from tuberculous homes are boarded
in the country with the farmers or rural families ; in addition to
these, there are rural colonies where poor and ill-developed
children from tuberculous homes are afforded a long stay.

In Germany there are also many vacation colonies for delicate
children located either among the extensive forests which sur-
round many of the large German cities, or in the open country,
or on the sea-coast. In Sweden, healthy children from consump-
tive families are being removed and boarded ont. They have
established also "children's homes" where they are kept until
suitable families are found with whom they can be housed. In
Denmark, Switzerland and, indeed, in almost all countries at
the present time, vacation or holiday colonies exist for weak or
sickly children. Is there any reason why the work of Grancher
could not be imitated by many of our kind-hearted and philan-
thropic near-millionaires or millionaires?

When the child starts to walk and play, infection from tuber-
culosis can be prevented by observing the following instructions :
Not only should consumptives be religiously careful with
their expectoration, but they should associate as little as possible
with young children and should stay away from playrooms and
playgrounds. Kissing of children in the mouth should never be
allowed and the little ones should be taught never to kiss nor
be kissed by strangers. They can be kissed by their own friends
and relatives as little as possible, and then only on the cheeks.
The floor on which the child plays should be kept scrupulously
clean. The hands and nails of little children should be kept as
clean as possible.

The dangers that surround the child in the school may be
partly avoided by instituting periodical and careful examina-
tion not only of the pupils but also of the teachers. Periodic
examination of teachers should be required particularly at the
beginning of their work, as is done in Denmark, where every-
teacher, receiving an appointment in a public school, is obliged
to present a medical certificate, stating that he or she, is not
affected by any contagious form of tuberculosis.

In reaching this point and in mentioning the role of the
school in the prevention of tuberculous infection, may we be
allowed to call the attention of this Conference to the importance
of that role, which appears to be completely disregarded if not

108

totally ignored by the social forces that are striving toward
our national betterment and happiness?

The very same idea that prompted Professor Grancher to
establish his' famous League for the Preservation of Children
from Tuberculosis has been haunting us ever since the time
we started our tuberculosis crusade. We would not like to
appear too hypercritical in our utterances, but still we firmly
believe that if all the money and energies that we have spent
and continue spending in our fight against tuberculosis could
have been 'directed toward the boys and girls in the schools,
by this time we would be nearer if not at the end of our struggle.
The field in which the decisive battle of our tuberculosis cam-
paign should be fought is the school. The gospel of health
should be preached in our schools. We have passed the best
part of our childhood in the schools, and every one of us per-
fectly knows that whatever is learned in those temples of knowl-
edge cannot be forgotten and will always be preserved through
the coming years until the boy of today is transformed into the
man of to-morrow.

It is a fact that we have had the pleasure of observing per-
sonally that those children in our schools who have been taught
that water must be boiled first before drinking it, always show
reluctance in drinking unboiled water. Why, therefore, should
we not take advantage of this plasticity in our children to im-
press upon their mind and consciousness the future citizenship
and the sound principles of hygienic living? Why, therefore,
should we show satisfaction because our children in the schools
can read "Tropical Hygiene" in which tuberculosis is only pass-
ingly touched upon? The instruction on tuberculosis in the
schools should receive nearly if not quite as much time, space,
and preparation as is given to American history. We do
not mean to criticize Americanization in the schools. We do not
wish to teach American history less, but we wish to emphasize
more the prevalence and preventability of tuberculosis ; not less
of the importance of the knowledge of American Constitution,
but more about the dangers of foul air, dirt and darkness; and
last, not least, to discourage nationalism in our school, but also
to encourage the prevention and eradication of the spitting habit.

Here we have given to the best of our knowledge, the most
appropriate measures for reducing the ravages of tuberculosis
among our children. The above may appear to be a program
for perfection and may seem too extensive and too expensive
for any community to undertake, but no labor or expense is too
great in the protection of the child from tuberculosis. What

PLATE IX. OUR CITIZENS OF TOMORROW

109

can appeal more strongly to the sympathy and interest of anyone
than the protection of the innocent, helpless child? Moreover,
it is an economic gain to the community to save the child for
future usefulness and it is a better contribution to the com-
munity, than the expenditure of large sums of money in
building sanatoria and hospitals to house them after active
tuberculosis has developed. The time is ripe for an offensive
instead of a defensive battle, "to save the cocoon in order to
save the race." "The fight against tuberculosis," says professor
Pannwitz of Berlin, "is in the last analysis an education of the
people in social hygiene, and every kind of education should
begin in childhood." "Whatever we do for our children is for
the good of our future generations," for, as the poet Words-
worth has so well expressed it: "The child is the father of the
man." The farmer does not expect to reap in the autumn unless
he cultivates and plants in the spring. Neither can the nation
look to its adult population for a full harvest of men and women
physically fit to meet the world's needs, unless it has given it
intelligent attention and effort in the spring time. The main
chance lies in childhood — if we would give right bent and
stature to the national tree of life.

// we don't give them our best in their childhaod, they will
give us their worst in their manhood.

DISCUSSION

Dr. E. P. SANCHEZ (Tokyo Imperial University). — I suggest that the
Philippine Government send at least two bacteriologists to Switzerland to
study the latest discovery in the treatment of tuberculosis. This discovery
was made by a Swiss bacteriologist. England has sent two of her bacte-
riologists and Japan one, and I hope that our Government shall do likewise.

Miss JOSEFA MORALES (Numancia, Capiz). — Everyone of us is aware
that tuberculosis is one of the causes of infant mortality and that in the
majority of cases the disease is inherited. In order to stop the untimely
death of our children, I suggest that provisions be made whereby couples
contemplating on marriage must present a clean bill of health or a doctor's
certificate.

Miss GRACIA B. QUERUBIN (San Esteban, Ilocos Sur). — As tuberculosis
attacks people of all ages, and does more harm than any other disease, and
as this disease is hereditary, and as there are many in my town suffering1
from it, I suggest that financial aid be given them.

Mrs. CANDIDA BELO (Capiz, Capiz). — Does the child of tubercular mother
get the infection before or after birth?

DR. PENAFLOR'S ANSWERS

The suggestion of Dr. E. P. Sanchez to have the Philippine Government
send at least two bacteriologists to Switzerland to study the latest discovery
in the treatment of tuberculosis is a very good one. The Philippine Govern-

110

ment is sending a certain number of pensionados abroad to study and
specialize in different scientific lines. In 1919 I was commissioned both
by the Philippine Government and the Philippine Islands Antituberculosis
Society to study in America the tuberculosis problem in all its different
aspects, but in my schedule, there had not been included a trip to Europe
for the same purpose. I think that Dr. Sanchez' idea of sending physicians
to Europe to study tuberculosis treatment should be carried on in the near
future. To this effect, .the Council of State is the only one that has the
privilege and the right to decide.

The idea of Miss Josef a Morales that tuberculosis is inherited in the
majority of cases should be rectified. Tuberculosis, as I have strongly
stated in my paper, is usually acquired after birth and the very rare cases
in which the tubercle bacilli have been found in the human milk cannot be
considered as sufficient ground to accept the inheritance in tuberculosis.
Her suggestion that there should be made necessary provisions whereby
couples contemplating marriage must present a clean bill of health or a
doctor's certificate, altho a very important one, cannot be enforced unless
the Philippine Legislature enact the necessary laws to that effect. Our
experience in the United States has shown us that similar provisions are
established and carried out by but very few states of the Union. The
main argument put up against the making of such provisions is that it
borders on an attempt to curtail the individual liberty, and, as I have
said above, the only body that has the right to make such provisions is
the Philippine Legislature.

The idea of Miss Gracia B. Querubin must be rectified as in the case
of Miss Josef a Morales. Tuberculosis is not a hereditary disease; it is
acquired after birth. About her suggestion of providing financial help to
the people who are attacked by the disease, I think the only way of carry-
ing it out is the establishment of more and better hospitals and sanatoria
for tuberculous patients in all the main localities of the Philippine Islands.
This I have tried to demonstrate as being a very pressing need in our
actual fight against tuberculosis.

The question of Mrs. Candida Belo is sufficiently covered by the answers
to Misses Josefa Morales and Gracia B. Querubin. The child of a tuber-
cular mother gets the infection after birth, not before.

B. HEALTH AND SANITATION

COMMUNITY COOPERATION AS AN ESSENTIAL FACTOR TO
DISEASE PREVENTION

VICENTE DE JESUS. M.D., Director of the Philippine Health Service

— -

In one of the chats which I frequently hold wi'th friends in
the Service, a comrade of the "Old Guard" told me, not so very
long ago, a story, savoring of the tragic and comic both.

It was either in the year 1909 or 1910. Two or three cases
of diphtheria had occurred in one of the well-to-do homes of
the Trozo District. The parents of the little patients, one of
whom had died of the diesase, refused to have the survivors
isolated and treated at San Lazaro. The Health Service, ful-
filling its duties, placed the house under quarantine. City
patrolmen were detailed as guards for the enforcement of an
effective quarantine. The lady of the house, however, found
the situation not only irksome, because of the difficulty of ob-
taining provisions, but also because the period of one week,
more or less, (required for securing two negative examinations
for throat swabs of contacts) was more than sufficient to keep
the costly touring car lying in all its glory under the house, in
forced inaction.

In the meanwhile, the telephone had been set to work asking
the Director of Health for a prompt and immediate relief of
the unhappy event. The Director, moved to pity, dispatched
forthwith a committee of one in the person of an American
Inspector, who, on account of an established fame for a gibble
tongue and a generous avoirdupois was thought all sufficient
to calm the anxiety of the exasperated lady.

The good inspector went forth to tackle his mission, but as
luck would have it, he took up the matter not with the lord but
with the lady of the house. As he stood beneath the front
balcony hollering "; Senorita, senorita!" in as hushed a tone as
he was capable of, the senorita promptly came out, with an old
blunderbuss aimed disrespectfully at the venerable pate of the
improvised truce-conductor. Here, the tragic portion of the

ill

112

incident ended, for the poor envoy, thinking that discretion was
better than valor, took to instant and dignified retreat, albeit
a bit hurried. The investigation that followed was rigid,
severe and uncompromising. Results: An inoffensive blunder-
buss, hammerless and uncharged.

Ladies and Gentlemen: You may interpret this anecdote as
best as you please, but were the Philippine Health Service to
tell you that, during the last three years, 60 per cent of typhoid
and paratyphoid cases — which are not strictly quarantinable
diseases, and 100 per cent of diphtheria cases — the disease that
gave way to the incident narrated above, come voluntarily to
San Lazaro for isolation, you may wonder what magic had
wrought this miracle. I shall be only too pleased to tell you how
this came to pass.

We may insure the success of a cause or collective enterprise
through cooperation, not through mere aid, or help. Aid or
help is a spontaneous act designed to meet an urgent need,
whereas, cooperation is a well-laid, deeply thought assistance,
designed to secure an end, to insure individual or public welfare,
or to prevent the loss, or amelioration of benefits or advantages
already at hand. If the public health guardians — physicians
and nurses, fail to do their duties, they should be discharged so
that others may guard the health and welfare of the community
the better. It is not a drastic act: the national wealth as ex-
pressed by community health has to be protected in the same
way as private property or wealth is held secure from a robbers'
gang.

However, conscientious cooperation should presuppose prac-
tical education of the popular mind with regard to hygiene
and sanitation if it is to play its proper role in health con-
servation. Such an education campaign is sought, through this
Conference, intensified to a point where comprehension and con-
viction is brought home to those present.

All things considered, the problems of public health are simple
enough. We should only bear three things in mind: firstly, to
prevent the spread of dangerously communicable diseases; sec-
ondly, to imbue in the individual, in an increasing emphatic
manner, the necessity for right living; and thirdly, to be always
on guard against the insidious inroads of all diseases with ob-
scure causation, prompt recognition of which might result in
cure. If the public will only have these three points impressed
in their minds, and shape their conduct accordingly, they would
be rendering the necessary cooperation not to the interests of
public health alone, but also to the welfare and health of children.

113

On the other hand, nothing can be gained, no benefit can accrue
from the many agencies and means which the Government has
created for the conservation of public health and for child wel-
fare, were the people to give no attention toward the acquisition
of the elementary principles of health conservation. Such
knowledge may be gained through the reading of pamphlets
regarding the origin of diseases, or of posters exhibited in
public places bearing instructions on protection against disease.
A more practical and efficacious manner of imparting health
instruction is to be found in lectures with cine demonstration,
whereby the public is given instruction and recreation at the
same time. The ideas gained there are readily transmitted to
those of the family or friends who did not have the chance to
attend the Conference.

There is still another scheme. I would suggest that every
other Sunday be set aside as a day for health instruction. On
such days, after the religious services are over, and while the
congregation is still in church or chapel, the local health officer
should take the place of the priest or preacher for imparting
such instruction as may have bearing upon hygiene and sanita-
tion. The idea is not new by any means. It has been practiced
in olden times by the priests themselves, with lasting results
upon the welfare and health of their flock. I shall see to it that
once the permission of the church authorities is obtained, the
holding of "dominical or Sunday health conference" be made a
permanent institution in our land. The Service has taken an
interest in this subject, and it is contemplating to take the
preliminary steps for the prompt realization of same.

In closing, I desire to state publicly, and with no small amount
of pride, that the Filipino people, progressive as they are and
open to all modern advances, have forgotten to use the un-
charged, hammerless blunderbusses and unhesitatingly accept
all measures imposed by our Health Service. And their con-
fidence goes even further than that, for they readily respond
to every call made upon them in the interests of public health
and national welfare.

DISCUSSION

Dr. SUMBITO (Occidental Negros). — In regard to sanitation, I think we
need the help and cooperation of the town. In the Province of Occidental
Negros, I have seen plenty of markets in or around which people live. I
believe this condition can be remedied by passing a law prohibiting people
to live in or around market places.

Mrs. SEVERA PAREDES (Santa Cruz, Ilocos Sur). — To reduce infant mor-
tality, I suggest a change in the health personnel in the provinces, for it

185611 8

114

happens that inspectors do not understand the nature of their work.
They do not need to be physicians but they ought to have at least some
notion of the work.

Mr. ENCARNACION (Ilocos Sur). — I suggest that in the conference to be
held in the provinces, the topics should be selected by a physician so that
the procedures of the campaign may be uniform and systematic.

Mrs. EUGENIA ARCILLA (Delegate, Virac Woman's Club, Catanduanes,
Albay). — I propose that a physician and a nurse.be stationed in Catan-
duanes exclusively at the expense of the Office of the Public Welfare Com-
missioner and the Red Cross. This physician and nurse should help the
woman's clubs. The Philippine General Hospital should also provide wards
for children in its branch hospitals, as well as other necessary articles and
medicines for young infants.

Mrs. DOLORES V. DE LUNA (President, Bontoc Woman's Club, Mt. Prov-
ince).— Inasmuch as the natives of the Mountain Province are too poor
to buy clothing, I suggest that donations for clothing them be given.
The Public Welfare Commissioner has already donated two boxes full of
clothes. We need more.

Miss JACINTA ANGELES (Consolacion College, Manila). — On my occa-
sional visits to the restaurants in Manila, I have observed that such places
are not sanitary. Therefore, I suggest that the Public Wefare Commis-
sioner recommend the passage of an ordinance subjecting such places to
fines if they fail to observe the sanitary regulations.

MR. F. POBLADOR (Cadiz, Occidental Negro's). — It has been found by
many physicians that municipal death records of infants are inaccurate.
If no laws are passed compelling parents to report births, I suggest that
the Office of the Public Welfare Commissioner induce municipal councils
to pass ordinances compelling parents to report births within the first
24 or 48 hours, so that municipal doctors and nurses may have accurate
information concerning deaths among infants.

Miss ANATOLIA P. GALANO (Batac, Ilocos Norte). — I suggest the recom-
mendation to the proper authorities of the prohibition of the kissing of
sacred images to prevent the spread of diseases, especially during Lent.

Mrs. CANDIDA BELO (Capiz Woman's Club, Capiz). — To cooperate with
the woman's club, the Public Welfare Commissioner should create in every
municipality a board of public welfare composed of the district health
officer, the municipal president, and a member of a local woman's club ap-
pointed by the board of directors of the woman's club.

Miss AURELIA CUANANG (Badoc, Ilocos Norte). — In view of the fact
that in our municipality there is a man, suffering from leprosy and is
not isolated, I suggest that the attention of the Office of the Public Welfare
Commissioner be called to look after such cases in the Philippine Islands.

Miss APOLONIA TANGHAL (Paombong, Bulacan) . — To arouse and keep
up the interest in a community in woman's clubs, I suggest that the district
nurse call a meeting once a week under the auspices of the woman's club,
and that the Public Welfare Commissioner be given the privilege of bring-
ing up the matter before the provincial doctor and nurse.

Mr. MANUEL M. AVELINO (Delegate, Provincial Board, Leyte). — I sug-
gest that all the delegates to this National Conference on returning to their

115

own respective provinces, hold conferences on infant mortality in all the
municipalities under the auspices of the Provincial Board.

Mrs. JULIANA P. PATRIARCA (Guinobatan, Albay). — In order to stop the
bad practice of midwives who do not follow the instructions of nurses
and others in authority, I suggest that the municipal physicians be em-
powered to deprive such midwives of their right to assist women at child-
birth.

Miss GENEROSA SUMICAO (Bayombong, Nueva Vizcaya). — According to
personal observation and that of the woman's clubs, patients are charged
for medicines at the Provincial Hospital of Nueva Vizcaya. I suggest that
if there is a regulation requiring payments, such payments should not be
required from those who have no means for support. I further suggest
that the time for emergencies in the hospital should not be limited.

Miss PAZ1 N. DE GUZMAN (Saw Isidro, Nueva Ecija).-^! suggest that
besides her ordinary duties, a provincial nurse should visit the different
woman's clubs of the province, inspecting their work once a month, and
giving them instructions. At present, her duties are confined to the pro-
vincial capital.

Miss ENCARNACION SAULO (Sta. Rosa, Nueva Ecija). — The high infant
mortality in our town is due to improper feeding and lack of proper care.
For this reason, I suggest that our municipality support a nurse to give
advices and instructions to mothers, under the auspices of the Woman's
Club.

Miss PERPETUA V. QUEVEDO (Philippine General Hospital). — I suggest
that every province should have one provincial doctor and two nurses.

Mrs. MARIA V. ALMOJUELA (Pandan, Catanduanes, Albay). — I suggest
that an up-to-date physician and a nurse be stationed in our town to in-
struct the ignorant midwives and parents. Due to poverty, I suggest that
the Public Welfare Commissioner inform us of the best way to acquire
the services of a doctor and a nurse.

In reference to allotments, I suggest that medicines be given to the
remotest backward places, for they are not able to secure any medical
help.

Mrs. NATIVIDAD G. FELIN (San Jose, Antique). — I suggest that author-
ities concerned authorize our provincial treasurer to send in requisitions
for medicines and other supplies needed by our puericulture centers at
the expense of the Woman's Club. This suggestion is based on the fact
that there is not one single drug store in Antique, and sea traffic is very
limited.

Miss SOCORRO CASTRONUEVO (Calinog, Iloilo). — I suggest that the estab-
lishment of barrios in regions covered by bamboo trees be prohibited;
that all superstitious persons pretending to be physicians be done away
with; and that remote towns be provided with physicians and nurses, and
I further suggest that in order to keep up our dispensary, a certain amount
of money be given to our club.

Mr. MANUEL M. AVELINO (Delegate, Provincial Board, Leyte). — It is
suggested that the Legislature pass a law providing each municipality
with a midwife at the expense of the municipal government, under the
direction of the local sanitary president; and that this midwife and the

116

president of the health division hold practical conferences in the barrios
under their jurisdiction.

Miss CARMEN ANCHETA (Ilocos Sur). — I suggest that all municipal-
ities be provided with a sufficient number of physicians and nurses to
check infant mortality.

Miss MAURA SALAZAR (President, Woman's Club, Piddig, Ilocos Nor-
te) . — Our town is in great need of a physician, for although there are a
provincial doctor and a district doctor in other places, they are too far
away to help us. As there are many children in our town who die because
mothers do not know how to take care of them, I suggest that either a
doctor or a nurse be stationed there to give instructions to the mothers.
I also suggest that all school children be given a physical examination
once a week, free of charge.

Mr. LORENZO MALLILIN (Cauayan, Isabela). — As the people of Cauayan
desire to have a dispensary, I suggest that the municipal government be
requested to appropriate 10% of its funds for the establishment of a dis-
pensary under the management of a physician or one or more nurses.

Miss ANATOLIA P. GALANO (Batac Woman's Club, Ilocos Norte.) — Since
the greatest problem confronting the Filipino people is the appalling high
infant mortality, and since the present scope of sanitation is limited and
funds appropriated and force at its disposal are inadequate to carry on an
effective work, and since the Filipino women as a rule understand the
home problems and needs better than the men, and since more work can
be accomplished if the various woman's clubs cooperate in solving this
vital problem, it is recommended that the Director of Health appoint one
competent woman in each province to help the provincial doctor and to
systematize the work of sanitation undertaken by clubs and to give lectures
on health and sanitation.

Mrs. MARIA T. MADALANG (Dupax, Nueva Vizcaya). — Since many towns
are too poor to buy medicines, I suggest that Insular fund or funds from
the Federated Woman's Club be set aside for the purchase of such medi-
cines as are needed in emergencies, on condition that such medicines be
sold to the public, the money received from the sale to be turned over into
the funds from which the money for the purchase was taken; and the
medicines and the money received thereof be placed in the hands of the
woman's club who will in turn make periodical reports to the National
Federation of Woman's Clubs. Since our municipality is far from the
provincial capital, I suggest that the District Health Officer be instructed
to answer emergencies.

DR. DE JESUS' ANSWERS
Dr. SUMBITO:

With regard to the sanitation of market places, the ordinance regarding
their establishment and maintenance for the City of Manila, should be
adopted as a model, modifying its scope only to suit local conditions. This
is a matter of the incumbency of municipal councils. An ordinance of a
like nature may be passed and its provisions observed by and with the
cooperation of the local police force. In this way, the sanitary mainte-
nance of such places can be regulated and enforced.

117

Mrs. SEVERA PAREDES:

Changes in the health personnel in the provinces may be made at any
time, provided, that, all charges preferred against any of the officers and
men of the Health Service be made in writing. Commissioned as well as
non-commissioned officers in the Service, do not receive permanent appoint-
ment unless they have passed the required examination for the grade or
position to which they have been assigned. Until the contrary is proven,
the officers and men of the Philippine Health Service are presumed to be
capable of discharging the duties of the position to which they have been
appointed.

MR. ENCARNACION:

The suggestion of having a uniform basis for public health talks is
a very good one, and the Philippine Health Service in conformity with
this suggestion, has prepared an outline for weekly conferences by district
inspectors, district health officers, presidents of sanitary divisions, district
nurses, and sanitary inspectors. The outline provides weekly material for
the remainder of the year, commencing April 1st, and covers the following
points :

1. Philippine Health Service

2. How to maintain health

3. Domestic sanitation

4. Personal hygiene

5. Isolation and quarantine

6. Disinfection

7. Medical attendance

8. Significance of public cooperation

9. Food sanitation

10. Milk

11. Milk-borne diseases, in general

12. Beriberi, infantile and adult

13. Infant feeding and care

14. Disease producing germs

15. Infection by direct and indirect contact with contagious cases

16. Peculiar habits and customs in each locality

17. Care of patients with communicable diseases

18. Water supply

19. Water pollution, animal or human

20. Soil pollution

21. Sanitary conveniences

22. Disease transmission

23. Domestic animals

24. The role of flies, mosquitoes, and other insects in the transmission

of diseases

25. Malaria

26. Rabies

27. Cholera

28. Typhoid fever

29. Dysenteries, amoebic and bacillary

30. Diphtheria

31. Tuberculosis

118

32. Whooping cough

33. Influenza

34. Plague

35. Leprosy

36. Smallpox, ehickenpox, and measles

37. Vaccination

38. Parasites

39. Carriers as potential dangers to community

40. Mental hygiene

Mrs. EUGENIA ARCILLA:

I heartily indorse the proposition of Mrs. Arcilla to the Commissioner
of Public Welfare.

Mrs. DOLORES V. DE LUNA:

The matter brought up by Mrs. Luna should be given due publicity, and
charitable organizations of the city should be appealed to for the benefit
of the mountain people.

Mr. JUAN GAERLAN:

I heartily indorse his appeal to the charitable organizations of the city.
With reference to the diseases the children in the Mountain Province are
subject to, they should be referred to the health officer in charge of the
district. This officer will order a sanitary survey made of the towns and
settlements in the Mountain Province in the near future, for the purpose of
ameliorating the conditions of those people and prevent the prolongation
of unnecessary suffering among them.

Miss JACINTA ANGELES:

The sanitary maintenance of restaurants, carinderias, refreshment par-
lors and other establishments of like nature, are regulated by the Revised
Ordinances of the City of Manila.

Mr. F. POBLADOR:

Sec. 2214 of the Revised Administrative Code provides that births should
be reported promptly after occurrence at the Office of the Municipal
Secretary in case the birth occurs in the provinces or at the corresponding
Health Station when the birth occurs in the City of Manila.

Miss ANATOLIA P. GALANO:

The suggestion of Miss Galano with regard to the prohibition of kissing
sacred images, while commendable in every respect, cannot legally be
established without infringing the provisions of the Jones Act. Sec. 3, par.
15, among other things provides, "That no law shall be made respecting an
establishment of religion or prohibiting the free exercise thereof, and that
the free exercise and enjoyment of religious profession and worship, with-
out discrimination or preference, shall forever be allowed."

Mrs. CANDIDA BELO:

The suggestion of Mrs. Belo should be taken up by the Public Welfare
Commissioner, and on our part we promise to do everything possible to
put it into practice. While it is realized that District Health Officers are
over-burdened with work, this Office is willing to make sacrifices for the
public good.

119

iss AURELIA CUANANG:
Our existing laws provide that all lepers should be segregated in the
Island of Culion. All that have to be done in case a person suspected of
having the disease is to apprise the nearest health officer of the fact so that
he might take the necessary steps for his capture and isolation.

Miss APOLONIA TANGHAL:

The matter brought up by Miss Tanghal has been sufficiently discussed
in the answer to Mr. Encarnacion's, relative to the topics for public health
talks.

Mr. MANUEL M. AVELINO:

I heartily indorse Mr. Avelino's suggestion to the Public Welfare Com-
missioner who, under existing laws, is especially chargedj with the cam-
paign against infant mortality.

Mrs. JULIANA P. PATRIARCA:

With regard to the faulty practices of midwives, municipal physicians
have sufficient power to call her into account. What should be done,
however, is to establish a sort of special school for them where they may
receive instructions on the management of normal labor, and the chief
danger-signals in pregnancy, labor and puerperium, so that the assistance
of a qualified physician may be called at once in case of necessity.

Miss GENEROSA SUMICAO:

Sec. 1006 paragraph (i) of the Administrative Code provides, "That
whenever practicable, furnish free medicines to indigent patients, and
when requested he shall render, free of charge, medical services to all
Government officers, and employees, to all persons in custody, and to other
persons entitled to such service."

Miss PAZ N. DE GUZMAN :

Woman's Clubs receiving Insular aid come under the supervision of the
Office of the Public Welfare Commissioner, and a provincial nurse is a
subordinate employee of the Office of the District Health Officer. Unless an
understanding, therefore, is had with the organizations concerned the sug-
gestion of Miss de Guzman is rather impracticable.

Miss ENCARNACION SAULO:

It is recommended that the suggestion of Miss Saulo be taken into
account by the Public Welfare Commissioner. It may be possible to em-
ploy a nurse on a cooperative basis.

Miss PERPETUA V. QUEVEDO:

The suggestion of Miss Quevedo has long been carried out into effect in
those provinces where adequate appropriation has been provided. As now
constituted, the Philippine Health Service maintains a doctor in each
health and sub-health district, which usually corresponds to a province or
sub-province, and one municipal physician in each sanitary division into
several of which a province has been divided. The policy of the Health
Service is to maintain a nurse in each sanitary division, and this has been
carried out wherever the resources of the province allow her employment.

Mrs. MARIA V. ALMOJUELA:

In our campaign for health education, it is intended to reach every nook
and corner of the Islands and according to present plans, each town and

120

important barrio will be provided with a well-stocked dispensary, and
physicians and other personnel will be detailed regularly to duty at stated
intervals at such places.

Mrs. NATIVIDAD G. FELIN:

The Public Welfare Commissioner having supervisory powers over the
Woman's Clubs is, I believe, the proper official that should take up the
suggestion of Miss Felin with the authorities concerned.

Miss SOCORRO CASTRONUEVO:

I don't know of any motive, sanitary or otherwise, which would prohibit
the establishment of barrios in regions covered with bamboo trees. On the
contrary, bamboo trees serve as excellent protection from the noonday
beat, especially during the dry season, and there is, moreover, the advan-
tage of having at hand, within the reach of the poor, material for cons-
truction.

The practice of medicine other than by qualified and licensed physicians
is prohibited by law, and any person who passes as a doctor or healer,
especially when prescribing any ailment for pay is liable to prosecution
under existing laws. Under existing economic conditions of the Govern-
ment, it is not always practicable to provide remote towns with physicians.
This deficiency can be remedied in part by the proposed establishment of
dispensaries in every municipality and important barrio of each province.

Insular financial aid may be had by any regularly established Woman's
Club which had been duly incorporated thru the Office of the Public
Welfare Commissioner.

Mr. MANUEL AVELINO:

Under existing laws, it is within the province of municipal councils to
employ midwives or nurses payable from the local funds. The suggestion,
however, is impracticable on account of the fact that there are not enough
licensed midwives to serve the needs of each municipality. The policy of
the Philippine Health Service has always been to encourage the employ-
ment of nurses, rather than midwives, because the training of nurses has
a wider scope than that ever received by any midwife.

Miss CONCORDIA ANCHETA:

I heartily, indorse the suggestion of Miss Ancheta to the Public Welfare
Commissioner who, by law, is entrusted with the campaign against infant
mortality.

Miss MAURA SALAZAR:

The town of Piddig, Ilocos Norte, is included in the 5th Sanitary Divi-
sion, and, under existing organization, this is about all that can be done
by the Philippine Health Service. The president of a sanitary division is
required to make periodical visits in the towns under his jurisdiction, not
only for the inspection of the sanitary conditions thereof, but also to give
medical consultations, especially to the poor. The physical examination
of school children is done by the president of the division at least once a
year and due to his multitudinous duties, the suggestion of giving physical
examination once a week, is rather impracticable. Any sickness, however,
which may develop among school children, especially those which have
been classified as dangerous such as — anterior poliomyelitis, anthrax,
beriberi, cerebrospinal meningtis, cholera, conjunctivitis (purulent), den-
gue, diphtheria, dysentery, glanders, influenza, leprosy, malaria, measles,

121 *

pertussis, plague, rabies, smallpox, trachoma, tuberculosis, typhoid, and
paratyphoid fever, and venereal diseases should be reported to that official,
so that he may treat the first cases and adopt the necessary measures to
prevent the further spread of such diseases.

Mr. LORENZO MALLILLIN:

Sec. 1012 of the Revised Administrative Code provides the creation of
a health fund, which in no case shall amount to not less than 5 per cent
nor more than 10 per cent of the general funds of a municipality, and each
provincial board is required to set aside a like amount from its general
funds. Section 1013 of the same Code provides how the health fund should
be used, and among other things, it provides for the purchase of medicines,
medical supplies and disinfectants to be distributed among the munic-
ipalities concerned for sanitary and other medical purposes. The estab-
lishment of a chain of dispensary system throughout the Islands is one of
the future activities of the Philippine Health Service.

Miss ANATOLIA P. GALANO:

Public health work in Manila, as well as in the provinces is conducted
upon a cooperative basis, and any suggestion of a constructive nature will
be most welcomed to the health officers, Lectures on public health will
henceforth be systematized, so that the public may be informed of those
elements of sanitation which make up for sound health.

Mrs. MARIA T. MADALANG:

The suggestion of Mrs. Madalang dealing as it does with the operation
of Woman's Clubs, should be taken up by the Public Welfare Commissioner.

District Health Officers shall, according to Section 980 of the Adminis-
trative Code, have the power to remove the cause of any special disease
or mortality. One of his duties, therefore, is to answer emergencies. In
cases, however, where the services of the President of a Sanitary Division
are more readily available than those of the District Health Officer, these
should be secured because among his other duties are to give free consul-
tation to the indigent poor, attend dystocial labor among them, visit any
house or place where any person is suffering from or died of a dangerous
communicable disease, and afford when requested free treatment at the
person's own house or elsewhere in case of accident or serious injury
received by an indigent person.

THE FUNCTIONS AND DUTIES OF A HEALTH OFFICER

GABRIEL INTENGAN, M.D., Acting Chief, Provincial Division,
Philippine Health Service

In connection with the campaign against infant mortality,
the chief of the division of provincial sanitation was requested
to read a paper before this Conference on the functions and
duties of the health officer, but unfortunately the one who could
speak with better authority on the subject has left the city
some two weeks ago to take up his new duties in the division
of Mindanao and Sulu.

As a result of this transfer, and following perhaps the laws
of gravitation, the subject had to be entrusted to one of a lower
rank. Ready to contribute my mite that this movement of per-
manent importance to the country may be a success, I hurriedly
made every effort to fulfill the task as assigned, and this with
luck indeed, inasmuch as the functions and duties of health
officers are already laid down in a clear-cut and concise form
in the Revised Administrative Code, and by the rules and regula-
tions as well as in various circulars of the Director of Health.

I thought at first that there was nothing left for me to do
but to read to you the existing statutory provisions, and the
service circulars.

On second thought, however, I realized that I was expected
to talk not on the official duties, but of the civic and social
obligations of health officers, of the humanitarian mission with
which such officers should be inspired upon accepting commis-
sion or appointment in the Health Service.

Above the laws and ordinances emanating from superior
authority, there are rules and regulations of self-respect and
duty-sense, with which a health officer, freighted as he is with
moral obligations, should be conversant on assuming his allotted
duties in any given locality. Oftentimes, a health officer is well
liked and respected because the community is aware that his
services may be urgently needed sooner or later. Under such
circumstances, it is the moral duty of the health officer to keep
his habits and demeanor beyond reproach, so that they may

122

123

serve as a perennial source of inspiration for the sanitary con-
sciousness of the people.

The health officer should take advantage of every conceivable
occasion, whether in misfortune, or in joy, for conveying to
the minds and hearts of the people helpful advice with regard
to the conservation of health. It is likewise his manifest duty
to get in contact with the lower classes, who, because of ignor-
ance and lack of opportunity to enjoy modern improvements
in public health, are almost always the first to suffer with their
lives and tears during outbreaks of dangerous communicable
diseases.

The health officer should be the principal factor in the up-
building of our nation, and, with his example in self-sacrifice
and initiative, should encourage all collective movements aimed
at the suppression of unnecessary deaths amongst the new born
and older children. It is, thus, his social duty to create opinion
and to coordinate the different agencies interested in checking
the ravages of our national misfortune, our high infant mor-
tality rate.

The presence of health officers is not evidenced in tangible
social reform in some of our remote provinces, simply as a
consequence of their lack of decision and faulty interpretation
of their civic duties, and failure to expose with a strong will
and in a virile manner such defects in living as have become
rooted among the masses, and with which he perforce comes
in daily contact.

We have here, in neat and bright array, the eloquent expres-
sion of the decided help of our fair sex, a sort of lever of an
indefinite length. In contemplating the united efforts of the
community that has been spurred to fight together the nation's
greatest sorrow, some consideration arises in my mind as to the
many hardships to be met and obstacles to be overcome. In
the face of such hardships and difficulties, a health officer,
however, cannot be indifferent, for he would be a disgrace to
the service and a shirker of his civic duties. Our mission does
not end here, though. We must not forget that, as physicians,
all our efforts, our" health and comfort, nay, even our lives are
committed neither to ourselves nor to those who are dear to
us, but to the task of relieving the moral and physical suffer-
ing of the people as it finds expression in our high infant
mortality records.

The laws and authority that stand back of a health officer
are not a sure guarantee of success. The application of health

124

measures which as you all know, are coercive in nature, is one
of the hardest duties of a health officer, and were he not pos-
sessed with a true spirit of abnegation and conscientiousness
of duty, the work is sure to prove replete with embarrassments.
These measures, especially those relating to the protection of
the health of children, require extreme care, prevision and
tact, inasmuch as we are brought face to face with century-
old traditions underlying the foundations of thought, and sani-
tary conceptions of our ancestors, and which will have to be
dealt with in a gentle and judicious, although, persistent man-
ner. Furthermore, aside of the different social strata and
organizations with whose workings, customs and manner of
living a health officer should be familiar to insure success of
his undertakings with them, the utmost harmony should be
maintained with local representative authorities in all dealings
in which a health officer happens to have with them, provided
that original purposes and the fulfillment of our obligations are
not placed in jeopardy.

The health officer is an indispensable element in public wel-
fare work, and with regard to infant mortality. He should
scrutinize each locality to ascertain why, when and under what
conditions and causes such mortality occurs. By so doing, he
renders invaluable aid through his knowledge and experience,
and would, thus, be instrumental in helping to solve a problem
hitherto unsolved. The task is arduous indeed, but there can-
not be any excuse for evading the responsibility to direct and
encourage the movement, which is thrust upon us.

It is not necessary for the service to make an appeal to its
officers with regard to this subject. It pins its faith in their
spirit of service, in their love and sense of loyalty to the people
who employ them as health officers.

DISCUSSION

Mr. M. AGUINALDO (Bataan) . — Mr. Chairman, I request that the duties
of a chief health officer be explained fully, for in some municipalities,
he simply goes to the municipal building, and does no other work.

The CHAIRMAN (Dr. de Jesus, Director, Philippine Health Service). —
In order not to lose time, since there are other papers to be read yet,
the suggestion which has just been made will be noted down and will
be answered later.

Mr. EMILIO DE GALA (Candelaria, Tayabas). — If we wish to protect
the public health, I suggest that the Bureau of Health adopt a rule
whereby employees who neglect their duties are punished, for it is known
that any neglect means danger to public health.

125

Mr. MELECIO BALON (Moron, Bataan). — I have observed that some local-
ities are not even visited by the District Officer of the province. I sug-
gest that district officers be instructed to visit the municipalities under
their jurisdiction at least once a week. In this way, they can determine
whether sanitary inspectors perform their duties or not.

Mr. ONOFRE SISON ABALOS (Calasiao, Pangasinan). — In view of the
fact that in the remote barrios of Pangasinan, the personnel in charge
of public health are interested more in money-making than anything else,
I suggest that each town be provided with nurses who will give mothers
maternity instructions.

Dr. HERNANDEZ; (Sorsogon). — I believe time is uselessly lost talking
of things not pertaining to the lecture read. Somebody has argued that
the duties of the health officer have not been mentioned in it. I believe
they are in the Administrative Code and I ask the chairman to discon-
tinue all discussion.

Dr. DE JESUS. — In accordance with this, I second the motion of the
colleague. We can treat of the matter after all the papers have been
read. We are here precisely to know the defects and the faults, and
all that there is to be done to remedy them. I know that not much is
done and that some complaints presented have reasons for being made,
and so I want to hear what is being complained of, and thus to know
best the disease that we have to fight. I acknowledge that there are
some who do not fulfill their duties and for this reason I have it said
that those who do not teach how to prevent the diseases of children and
to take care of them, as will be object of complaints, should be discharged
because it is our duty to see to it that they perform their duties, and
that they should be in contact with the mass of the people and not among
the official elements or the higher-ups. The physician should be with the
people, with those below, not with those above. Gentlemen, let us finish
with these remarks, because time flies and the other papers have to be
read yet.

Dr. SIMPAO (Philippine Health Service). — In connection with what has
just been said of health officers, I propose that all complaints be made
against them, and I hope we shall all be manly enough to admit who is,
and who is not to blame.

Dr. DE JESUS. — So it should be done.

Miss MORALES (llocos Nortc). — In connection with the duties of a dis-
trict health officer, I suggest that the authorities require said officer to
have at least once a year a diagnosis of the people in every municipality
in his district. If this is done, I am sure it will minimize the number
of untimely deaths of our people.

Mr. M. CARAGAY (Bataan). — I have observed that in some localities,
in an epidemic, a constabulary officer is stationed to guard a house when
any inmate is taken ill with disease. This is a great injustice, for the
other members of the family are kept from earning their daily livelihood.
I wish to know whether it is the duty of the Bureau of Health to shut
in the people when a member of the family is taken down with the
disease in an epidemic.

126

Mr. FAUSTO FUHAY (Cavite). — We know that each province is divided
into sanitary divisions, each division, having a physician for its president.
Each sanitary division is composed of several towns, sometimes four.
The president of the sanitary division visits the towns once a week,
and for the rest of the time, he employs a sanitary inspector to do the
work. Oftentimes, the inspectors are ignorant of the work entrusted
to them. Therefore, I suggest that men must pass a Civil Service
examination before they can be appointed as sanitary inspectors.

Mrs. S. B. LONDRES (Oton, Iloilo). — I suggest that the president of
the sanitary division hold classes on sanitation under his charge.

Mr. SEVERING HERNANDEZ (Sorsogon). — I believe that one of the causes
of infant mortality are intestinal parasites. As these parasites cause
physical weakness, I suggest that the District Health Officer should
examine children both in private and public schools at least twice a year
for intestinal parasites.

Miss FIDELA ROBERTO (Orani, Bataan). — Since it is the aim of the
Health Officer to have the town under his supervision clean, I suggest
that he take active part with the school children in the "clean-up-week."
It would be of great help if the children, health officer, and townsmen
cooperate in this work.

Mr. JOSE KATINDIG (Delegate, Provincial Board, Bulacan). — In view
of the fact that the success of our campaigns depends largely upon the
interest and activity of the health officers, and in view of the fact that
the paper of Dr. Intengan contains wise suggestions, instructive advices,
and patriotic principles, I suggest that the paper above referred be
issued in circular form, with the director's instructions to the effect
that it be studied and put into practice by all health officers.

Mrs. LABAO (Mogpoc, Marinduque) . — I request that the high author-
ities instruct municipal officers in my municipality to inspect market
places and closets.

Miss ANATOLIA P. GALANO (Batac Woman's Chib, Ilocos Norte). — As
sanitary inspectors accomplish very little due perhaps to incompetence
and lack of training; to lack of cooperation on the part of the people,
or due to the too extensive area they have to cover; and as nurses
graduated from reputable nursing schools are more competent and more
efficient, be it resolved that the work of sanitary inspectors be turned
over to such nurses.

Miss PAZ SEMILLIANO (Valladolid, Occidental Negros). — Valladolid, my
home, is in the Bago Health District, separated from Bago by a wide
river which often delays medical attention in our place. I therefore sug-
gest that Pulupandan, Valladolid and San Enrique be put in one health
district, making Valladolid the center for the convenience of the other
two towns.

Mr. F. POBLADOR (Cadiz, Occidental Negros). — Since the most serious
problems relating to infant mortality and infant welfare are met with-
in the thickly populated localities, especially in the barrios, I suggest
that the Bureau of Health make it clear to the municipal health officers
to visit each barrio, inspect and examine the homes thoroughly, especially

127

those of the lower class, and to make a concise and comprehensive report
of the actual existing conditions.

In the course of these visits, they should give instructions (verbal or
written) to parents, particularly the mothers, regarding the promotion
of sanitary modes of living.

Mr. HONORIO LOPEZ (Delegate, Provincial Board, Leyte). — I suggest
to the Bureau of Health that sanitary inspectors be given instructions
and be made to pass an examination before they can fill the position
as such ; and that sanitary inspectors be prohibited to perform any surgical
operation.

Miss BERSABE BASADA (Guiuan, Samar). — Due to lack of physicians
and nurses in the provinces, I suggest that sanitary inspectors in the
different towns be given six months training under the Provincial Health
Officer before they are allowed to perform their duties jas such.

Miss JOSEFA TITONG (Borongan, Samar). — Our club so far does not
have sufficient funds to support a doctor or a nurse. Inasmuch as there
is a district health officer in our town, I suggest that this health officer
be instructed by proper authority to give monthly lectures to the mothers
regarding care of children, and the essential elements in the reduction
of infant mortality.

Mrs. MARIA V. »ALMOJUELA (President, Woman's Club, Pandan, Al-
bay). — I suggest that a physician be made the president of the sanitary
division in my home town.

Mr. FEDERICO RODRIGUEZ (Balincaguin, Pangasinan). — Permit me to
call the attention of proper authorities to the fact that most of the
sanitary inspectors stationed in the different municipalities are not fitted
to hold such offices, for some of them can scarcely read and write; and
do not understand either English or Spanish. As a result, such inspectors
are unable to comply with the circulars and regulations issued by the
Bureau of Health. Most of the district health officers, thru the influence
of municipal politicians, appoint ignorant men as inspectors — such prac-
tices result in inadequate performance of official duties.

Miss G. LOPEZ (Lingayen). — I wish to suggest, thru the Public Welfare
Commissioner, that sanitary inspectors, sent by the Health Officer, must
see to it that they not only give instructions in hygiene and sanitation,
but must also see to it that such instructions are strictly carried out.
I say this, because in my own town, the inspectors go around and give
verbal instructions, but do not go around to check them up.

Mr. FEDERICO RODRIGUEZ (Balincaguin, Pangasinan). — Due to lack of
sanitary supervision of the different municipalities of the Philippine Is-
lands, and especially those of western Pangasinan,- I suggest that the
proper authority be informed, so that he may give strict instructions to
the district health officers for the proper performance of their official
duties.

Mr. M. AGUINALDO (Bataan). — I suggest to the Director of Health
that a thorough investigation be made in each province as to whether the
health officers (sanitary doctors) and especially the sanitary inspectors
perform their duties as such, or not.

128

The object of this suggestion is to find out whether these agents in
charge of the public health comply or not with the regulations and duties
allotted to them by the Director of Health, for there are many complaints
here against the inefficiency of the sanitary inspectors.

DR. INTENGAN'S ANSWERS
Mr. M. AGUINALDO:

Sec. 1006 of the Administrative Code explains fully the duties of a
chief health officer.

Mr. EMILIO DE GALA:

Yes, we are severely punishing any employee who neglects his duty.
Mr. MELECIO BALON:

The District Health Officer visits the municipalities under his juris-
diction whenever it is necessary to do so.

Mr. ONOFRE SISON ABALOS:

The presidents of sanitary divisions legally practice medicine at large,
but other employees cannot. The suggestion requesting maternity nurses
for each town is referred to Dr. Fabella.

Miss MORALES:

We are making the diagnosis you referred to, but not all the people.
The sick is advised to go to the public dispensary. %

Mr. M. CARAGAY:

Yes, it is the duty of the Health Service to quarantine a house with
a case of disease necessitating that measure, for the good of the com-
munity.

Mr. FAUSTO FUHAY:

The idea you suggest is the rule now in force.

Mrs. S. B. LONDRES:

We are making an educational campaign thru lectures, not thru a
school of sanitation.

Dr. SEVERING HERNANDEZ:

The idea you suggested is being put into practice by us now, as you
will see in the annual report of the Bureau of Health.

Miss FIDELA ROBERTO:

The health officer is doing "clean-up-day," and he must lead the move-
ment you referred to.

Mrs. LABAO:

The officers you mentioned are already instructed.

Miss ANATOLIA P. GALANO:

There is no objection to the suggestion, provided that the positions of
sanitary inspectors be maintained as heretofore.

Miss PAZ SEMILLANO:

We shall take up with the provincial board the matter you brought
up, and we hope you will help us in it.

Mr. F. POBLADOR:

We are doing the things you suggested with the help of nurses and
sanitary inspectors.

Mr. HONORK

129

[r. HONORIO LOPEZ:

Sanitary inspectors are prohibited from performing any surgical opera-
tion. Instruction is given them thru the Sanitary Inspector's Handbook.

Miss BERSABE BASADA:

Your suggestion is good, so we are planning a sanitary training school
for doctors and sanitary inspectors.

Miss JOSEFA TITONG:

We are giving weekly lectures now on the subjects you suggested.

Mrs. MARIA V. ALMOJUELA:

Your suggestion can be carried out if the physician is available.

Mr. FEDERICO RODRIGUEZ:

There is none eligible in the Civil Service list.

Miss G. LOPEZ:

The strict observance of instructions on hygiene and sanitation depends
upon the public spirit of the community and upon sanitary convenience,
too.

Mr. FEDERICO RODRIGUEZ:

We would like to be informed always of any health officer who is not
performing his duty.

Mr. M. AGUINALDO:

We are making the investigation you suggested.

185611 9

REFUSE DISPOSAL

ANDRES CATANJAL, M.D., Chief, Division of Manila Sanitation,
Philippine Health Service

DEFINITION AND CLASSIFICATION

Refuse disposal constitutes a chapter in the study of preven-
tive medicine and hygiene. It is not a science, but it is an
important part of a science, the science of preventing diseases.
For this reason, refuse disposal has influence on the morbidity
and mortality of infants and on the welfare of the population.

But let us first define the word "refuse" considered in its
relation with private and public welfare and sanitation.

In the popular book of Professor Rosenau, "PREVENTIVE MEDI-
CINE AND HYGIENE," refuse is defined as "solid waste material
not carried by sewers.' ' This definition excludes from refuse,
the human waste carried by sewers, as excreta and liquid waste
from the household.

The Philippine Health Service, in its "MANUAL FOR THE
BUREAU OF HEALTH" classifies refuse into two principal groups,
under the names of "garbage" and "rubbish," and it gives separ-
ately for each group the following definitions : "Garbage," that
Manual says, "is the refuse of such animal or vegetable matter
or food supplies >as were intended for human food but have
been rejected for such use, and also dead animals weighing ap-
proximately less than thirty pounds, and the refuse of slaughter-
houses." "Rubbish," according to said Manual, "comprises the
following refuse: (a) all waste or used paper, pasteboard,
woven materials, matting, wood, straw, husk, tin cans, or
other metallic vessels and broken glass or porcelain; (b) loose
or decayed materials and dirt-like substances which may ac-
cumulate from repairing operation or from storing or cleaning
of properties and goods; (c) the dung of cattle, horses, mules;
and other animals, also stable litter, refuse and sweeping."
130

131

In the already quoted book of Doctor Rosenau, "PREVENTIVE
MEDICINE AND HYGIENE," and, in the book of Dr. MacNutt,
named "MANUAL FOR HEALTH OFFICERS/' refuse is classified into •
the following six groups: ashes, dead animals, garbage^
manure, rubbish, and street sweepings.

However, the classification made by the Philippine Health
Service, seems to be the best one, as the same is founded on
the ordinary natural wet or dry condition of refuse, provided
that the dung of cattle, horses, mules, and other animals be in-
cluded in the garbage group, and not (as it is in the actual
classification) in the group of rubbish.

DIFFERENT REFUSE DISPOSALS

Refuse disposal can not be similar in different countries, be-
cause it depends entirely on the conditions prevailing in each
locality; the size and density of the population; material and
disposition of the buildings; activities of the inhabitants; geo-
graphical situation, altitude, climate, and topography of the
town; the civilization and progress of the people, and, above
all, it depends on the wealth and financial power of the cor-
responding local government.

Certainly, the municipal ordinances referring to the refuse
disposal of a big city like New York, with its millions of pop-
ulation, immensely dense populated area, the enormous size
of its commerce and industry, the uninterrupted superactivities
of its highly civilized people, its many-storied buildings, and
never failing municipal funds, cannot successfully be applied
to a city of the actual size and conditions of Manila; nor can
the revised ordinances of this city in regard to refuse disposal
be enforced in an ordinary fourth-class municipality in the
poorer provinces of the Philippines.

Ill

DIVISION OF WORK

But if refuse disposal cannot be uniform in each locality,
the work to be accomplished for the disposition of refuse can
be divided in any town into the following three different parts or
periods, namely: collection, transportation, and final disposition
of the refuse. In fact, said division of work is the one actually
required by the revised ordinances of the City of Manila, and
it is the one that is described in the following paragraphs.

132

COLLECTION OF REFUSE

The work of collecting refuse in this city is being accom-
plished by the private citizen and by the municipal government.

The work of the private citizen is being carried on partly by
the owners and partly by the occupants of the houses, build-
ings or places of business.

The owner or owners, agents or administrators of every build-
ing, premises, or place of business shall provide and maintain
at all times in said buildings, premises or places of business,
for the use of the occupants thereof, suitable and sufficient
number of garbage receptacles, to contain without leakage, all
the garbage that may accumulate for each period of 24 hours,
in or around such building, premises or places of business.

Every garbage receptacle to be provided by the owners of
houses, or by their representatives, shall be water-tight, fitted
with tight covers, and shall not be less than 25 centimeters in
depth by 20 centimeters in diameter, and not more than 81
centimeters in depth by 47 centimeters in diameter, fitted with
handles, and of such construction as will permit handling
readily.

It is unlawful, for any person or persons to place or to keep
garbage in any place or vessel other than the proper garbage
receptacles provided therefor. No receptacle for garbage shall
be filled to more than approximately ten centimeters from top
thereof. It is also unlawful for any person to lease, sublease
or turn over to another for occupancy any building, premises,
or place of business, or any part or portion thereof, without
providing such garbage receptacles in sufficient number to con-
tain the corresponding refuse.

The occupants of the buildings or place of business have the
duty to provide for their own use, rubbish receptacles, suitable
and appropriate to contain rubbish only, with safety, without
leakage or spilling. Said occupants or tenants of buildings or
places of business, shall at all times maintain in said buildings,
rubbish receptacles, sufficient to contain all the rubbish that
may accumulate for each period of 24 hours, in or upon said
buildings.

It is also the duty of said occupants or tenants to place
the receptacles for garbage and the receptacles for rubbish on
the outer edge of the sidewalk each day, or at the outer edge of
the street, if there be no sidewalk, at such time not earlier than

133

eight o'clock, and not later than eleven o'clock postmeridian,
and to remove them from there after their contents, garbage
and rubbish, have been taken away by the city transportation
employees.

The collection of refuse by the municipal government is ac-
complished by municipal employees who perform their duties
during the labor hours of the day time, by sweeping from the
streets, markets and other public places, every refuse dropped
by passers-by, or by the inhabitants of the adjoining places.

Refuse collected by the municipal street sweepers is placed
into the street receptacles provided for by the city, which re-
ceptacles are conveniently distributed and permanently installed
in the different sections of the streets, and in the public markets.

No separation is made of garbage from rubbish. All refuse
collected in the streets and markets is mixed and deposited
together into said receptacles.

The total number of refuse receptacles in use by the City
of Manila at the end of 1920 was 11,393. Receptacles newly
installed during the year were 1,227, and the receptacles re-
moved were 1,334. The total of receptacles exchanged were
1,893.

TRANSPORTATION OF REFUSE

The transportation of refuse from the house, street and mar-
ket receptacles to the places of the final disposition, is made by
employees of the transportation and sanitation department of
the city. To carry out this work, suitable carts, wagons, and
other vehicles drawn by horses are used.

The work usually commences at night after 9 p. m., continues
until the morning of the next day, and generally ends at the
early hours of the afternoon.

In cages where there are large or unusual quantities of rubbish
or trade refuse to be removed from any building, premises, or
places of business, it is the duty of the occupants thereof to
notify previously the transportation department of the city, at
least 24 hours before the removal is necessary, in order that
proper transportation may be furnished for same.

Nevertheless, not all the city refuse is being transported to
the places of its ultimate disposal at the expense of the city
funds. When the quantity of garbage or of rubbish, con-
demned goods, building or trade refuse to be transported from
any buiding, premises or place of business, is so large that

134

it exceeds one five-ton truck load, the occupants of the build-
ings, premises, or places of business, shall provide the neces-
sary transportation to the place for its final disposition.

Also in case the daily removal or replacement of receptacles
for refuse at hotels, hospitals, boarding houses, and any other
private place, is required as a necessity by the health service,
the expenses caused by said removal and replacement shall be
defrayed by the occupant of the premises, though the charge
shall not exceed in any case the actual cost of the service.

The transportation of the garbage and rubbish from the mili-
tary hospitals and quarters within the city limits is being per-
formed daily in garbage carts and rubbish truck pulled by
horses, under the management and supervision of employees
of the army, who convey the refuse from the hospitals to the
places fixed by the city authorities for final disposal there.

After the cart, wagon or other vehicle is entirely loaded
with refuse, it must be driven without delay to the specified
place of disposal, and it shall not be allowed to stand in the
vicinity of any human habitation, market, schoolhouse or places
wherein people are assembled.

All refuse shall be disposed of definitely within 12 hours after
its transportation is over, and it is unlawful for any person
or persons to remove from it and sell, or cause the removal
and sale of any decayed vegetables, fruits, unwholesome or de-
cayed meat, found in the transported garbage.

FINAL DISPOSAL OF REFUSE

The permissible methods of final disposal of refuse are the
following, viz.: incineration; reduction; burial or plowing into
ground; dumping, filling in lowlands, and animal feeding.

From the sanitary viewpoint, incineration is the best method
for the final disposition of refuse, because it destroys quickly
and entirely all disease bacteria that may exist therein, and
removes at the same time all possible breeding places for flies,
and every substance that might attract and feed rats. But the
selection of method, or methods to be adopted in any community,
involves necessarily the consideration of local conditions, and
specially the financial capacity of the local government.

Our City of Manila, for the final disposal of its refuse uses
at the present time two methods : incineration and filling in low-
lands.

Incineration is used for the final disposition of garbage com-
posed of organic matter, animals and vegetables intended for

135

food, which on inspection were found unfit for human con-
sumption. The Palomar crematory is the one wherein crema-
tion is being daily accomplished. During 1920 there were
incinerated 6,313 tons of garbage, 491 tons of which are oJ
different kinds of organic matter, 2,185 cattle and miscellaneous
animals, and 164 tons of condemned merchandise. From the
1st to the 26th of November last there were cremated 48 dogs,
23 Filipino horses, 8 cows, 19 hogs, 1 deer, 15 carabaos, 4 Am-
erican horses, 2 mules, 1 goat, and 160 cans of miscellaneous
organic matter.

By previous permission granted by the Director of Health,
and subject to the conditions required by said authority, the
rubbish part of the city refuse has been and is -being used by
the city officials, as final disposition thereof, in filling in low-
lands that were in bad sanitary conditions, belonging either
to the city itself, or to private corporations, or individuals.
During the year 1920, 65,811 metric tons of refuse were finally
disposed of in this way to .accomplish the permanent sanitary
improvement of public places and of private lots.

Among the improvements permanently accomplished in the
few years after 1917 are the extensive area of Harrison Park,
several isolated lots of lands on Taft Avenue, Calle Espafia,
and the lowlands behind La Salle College.

The following table shows the final disposal made of the Ma-
nila refuse during ten months of the present year 1921, from
January 1 to October 31, inclusive. The detailed amounts and
classification of refuse made in this table were obtained from
the city file, through the kindness of Mr. Santiago Artiaga, the
engineer of the City of Manila.

VII

Manila refuse disposed of from January 1 to October 3.1, 1921

Total ref-
Month. • use dis-
posed of .

Total used
in filling
lowlands.

Cremated.

Refuse.

Organic
matter.

Animals.
Miscella-
neous.

Cows'
heads.

Merchan-
dise.

Metric ton.
January 6 069 190

Metric ton.

5, 500. 120
5,465.714
5,629.274
5, 221. 284
5,756.201
5, 755. 465
6, 123. 051
5, 879. 722
6, 210. 596
6,179.676

57, 721. 103

Metric ton.

569. 074
551. 670
559. 994
605. 744
402.053
171.567
0.000
360. 314
450. 300
430. 359

4, 101. 075

Cans. «

31
30
31
133
150
207
206
222
209
259

Number.

52
118
152
116
161
328
177
204
150
208

1,666

timber.

0
0
0
0
0
0
0
0
0
0

Metric
tort..
15. 469
13. 123
47. 895
17.164
12.122
0.000
0.000
32.500
19.606
19. 778

177. 657

February i 6,017.380

March ___ 6 189 270

April 5 827 030

May_ 6158250

June.. 5 927 030

July 6 123 051

August.. 6*240030

September 6 660 890

October i 6 610 040

Total 61 822 161

1,478

136

VIII
REFUSE DISPOSAL IN PROVINCES

No uniformity exists as to refuse disposal in the Philippines-
provincial and municipal. In towns where this service is estab-
lished and regulated by the municipal council, the transporta-
tion of refuse from the private houses and premises to the
places of its final disposition is generally made in carts rented
or owned by the municipalities. Garbage and rubbish is carried
to some distant places out of the town, where it is, sometimes,
burned. In large cities like Iloilo, refuse is also used, when
permitted by the local health service, to fill in low and insanitary
lots of land.

In the towns where refuse is not disposed of by the municipal
government, householders must dispose of it by burning it
without any risk of causing fire; otherwise it should be buried
at least 20 centimeters deep.

REFUSE AND INFANT MORTALITY

Since this series of lectures is intended to discuss and to find
a remedy for the excessive infant mortality, and to promote
public welfare in the Philippines, we must examine now what
relation has refuse disposal with the mortality of infants and
the welfare of the people of our country. In other words, we
must determine whether or not an effective or defective dis-
posal of refuse may decrease or increase the morbidity and
mortality rate of infants, or improve or deteriorate the pros-
perity and happiness of our communities.

Refuse is undesirable and obnoxious for the following reasons :
First, because it contains numbers of microscopic animals in-
visible to the naked eye, which produce in man serious and
frequently fatal sickness ; second, because it gives breeding places
and food to flies ; third, because it furnishes shelter and nourish-
ment to the rats ; fourth, because it emits offensive and distress-
ing odor which is intolerable for nervous persons; and fifth,
because it is unsightly.

Among the microbes or disease germs that may be found in
refuse, those of tuberculosis, typhoid fever, dysentery and
cholera are the more dangerous. They are incidentally de-
posited in refuse, either by persons suffering from said diseases,
or by the persons who carry them without suffering from any
sickness, and who for this reason, are named carriers of diseases.

137

Any part of refuse (pieces of waste paper, cotton, skin of
fruits, etc.), touched by said persons before being placed into
the refuse receptacles, or before being carelessly thrown into
the streets, markets or other public places, may actually con-
tain bacillus of any of the above-mentioned sicknesses, and so
become a source of danger to the community, and subsequently
to our little infants.

As to the fly, Oh !, the fly is the worst and the greatest enemy
of mankind. The fly is worse than the mad dog and the poison-
ous snake together, for it caused and it is causing more deaths,
more sorrow, and more misfortune to mankind than all the
venomous reptiles and all the rabid dogs in the world. It is not,
however, the fly that produces directly the sickness in man and in
our infants, but the bacillus transported by it from the refuse to
the food of the healthy person. The fly is simply the carrier
of the germs producing diseases. Without flies many cases of,
and many deaths by cholera, dysentery, typhoid fever, and
tuberculosis could have been avoided in the past. Many lives
of infants could have been saved, and much welfare in the home
could have been promoted, if there were no flies at home; and
there would have been no flies at home, if no refuse were allowed
to remain on the premises, or on the surrounding places.

Rats are attracted and fed by refuse. For this reason refuse
should be removed from our houses, and must not be allowed
to be spread there because the rats, besides being very destruc-
tive animals, might bring bubonic plague and death to us, or
to some members of our families, or to our dear little infants,
through the bite of fleas that bubonic infected rats may harbor
on their bodies.

The offensive and distressing odor that emanates from refuse,
and the unsightly and repulsive aspect that it offers to view, are
more than sufficient motives for everybody to detest and hate
•its accumulation in his premises and surroundings. Offensive
odor spoils happiness in the home and isolates the family
from its friends and acquaintances. Bad emanations alone, or
combined with the dirty and unattractive view of refuse, make
of any high-priced and beautiful residence a useless and unpro-
ductive investment, by driving from there the actual and the
prospective tenants.

SOCIAL AND PERSONAL DUTIES

Since from a sanitary viewpoint as well as from social and
personal considerations, refuse must be and should be disposed of

138

effectively, to safeguard from danger our health, prosperity and
happiness, and subsequently the lives of our dear little infants,
which constitute the purpose of these conferences, it appears
to be the duty of every person concerned to do his or her best
for the accomplishment of an effective disposal and removal of
refuse, not only from each private individual's dwelling, but
from the public places of each community.

It must always be borne in mind that it is our unavoidable
social duty to contribute with our efforts and right conduct to
the welfare of the community where we are living: and with
this consideration in mind, let every one concerned try to dis-
continue the objectionable practice of throwing refuse into the
streets, markets, and other public places. Remnants of lighted
cigarettes, scraps of used wrapping papers, wrappers of sweet-
meats, peelings of fruits, etc., are being indiscriminately dropped
into said places, while one is walking, eating or acting otherwise.
Any of said refuse, if previously touched by a bacillus carrier,
might, through the agency of flies, convey cholera, typhoid fever,
or other diseases to a healthy person, adult or infant and cause
his or her death. It is our social sacred duty, ladies and gentle-
men, to prevent and to avoid said possibility.

Individually, we owe it as a duty to ourselves, to our families,
and to our dear little babies to dispose of our refuse effectively,
and to keep our homes always clean, not only when we are
preparing to receive high-ranked visitors or to organize a dance,
/ but even when we expect to receive nobody, and during the daily
performance of our ordinary business in life. Cleanliness is
the sign of decency, the mark of an orderly conduct, the symbol
of distinction, and, above all, it is the required condition for the
health, prosperity, and welfare, not only of our little infants
but of all mankind as well. Viewed in this light, it is the in-
dividual duty of all right-minded persons to carry out in their
houses, premises and places under their control, constant and ef-
ficient refuse disposal, if we desire to contribute in the reduction
of the high infant mortality and the promotion of the welfare
and the greatness of our beloved and adored Fatherland.

DISCUSSION

Mrs. RAMONA R. BULLO (Nurse, Mariveles Puericulture Center, Ba-
taan) . — In Mariveles, the public toilet is built too far from the majority
of the houses which have no toilet facilities, and for this reason human
waste is not properly disposed of. Besides, the tubes of the public toilet
empty into the sea where fishes are caught for public consumption. I
suggest therefore that the Bureau of Health issue a circular requesting

139

the town of Mariveles to establish the Antipole system for the disposal
of human waste in each house.

Mr. ATANASIO GODAY, — Looking over the prescription

books of pharmacists in our towns, I find that many prescriptions are
for intestinal diseases. We see refuse thrown out on the streets every-
where. I suggest therefore that the Antipolo sewerage system be intro-
duced in every town in these Islands.

Miss MELCHORA A. BERNABE (Delegate, Piddig Woman's Club, Ilocos
Norte). — I know very well that intestinal diseases so common among
children are caused by wrong disposal of waste matter and refuse; there-
fore I suggest that the Public Welfare Commissioner help bring about
the establishment of the Antipolo Sewerage system in every locality.
The pail system is very expensive.

Mrs. MARIA V. ALMOJUELA (Pandan, Catanduanes, Albay). — I suggest
that a proper drainage system be constructed in our place, since there
are many swamps.

Mr. F. POBLADOR (Cadiz, Occidental Negros). — Refuse from market
places, streets and other places are thrown out on the seashore; and the
odor is blown back to the homes. I suggest that this refuse be deposited
in a low place in that part of the town where it may be burned, to pre-
vent the spread of bacteria thriving on refuse.

Mr. FLORENTINO PACQUING (Santiago, Ilocos Sur). — I suggest that each
municipality be given a definite and suitable place for the disposal of its
refuse. In all the towns of our province outside of the provincial capital,
there is no systematic way of getting rid of the refuse; and we are not
instructed in the best ways of disposing of waste matters. In my own
home town, some of the people just throw all waste products in one
corner of the yard; others just dump their garbage out on the streets,
for they do not know what to do with it.

DR. CATANJAL'S ANSWERS

It is evident that the suggestion of Mrs. Ramona R. Bullo is not within
the scope of the paper just read. Refuse Disposal is an entirely different
service from that of Human Waste Disposal.

Her recommendation, however, can be realized after an investigation
has been made showing and proving that the continuation of the toilet
system referred to in Mariveles is producing diseases, or nuisance to
that population or to the transient residents in that town.

In this connection, the attention of all concerned is emphatically invited
to the fact that Human Waste Disposal and Refuse Disposal are two
different services, but directly established, managed and paid for by the
municipal governments with municipal funds entirely independent of the
Health Service funds.

The part taken by the Philippine Health Service in the two above
mentioned services, consists only in the preparation of ordinances for
said services, in the recommendation for their approval by the corre-
sponding councils or boards, and in the inspection and care that said
ordinances be duly complied with.

140

Without sufficient funds, or without the cooperation of the municipal
executive authorities, and, above all, without the cooperation of the com-
munities concerned, proper and efficient disposal of refuse and human
waste cannot be duly accomplished in any municipality, all the combined
efforts of the Philippine Health Service notwithstanding.

The above answers are also given to Mr. Goday, and to Miss Bernabe
(Delegate, Piddig, Ilocos Norte). It must be stated further that the
establishment of the Antipole system for the sanitary disposal of human
waste in every municipality of the Philippines, where no better system
exists, is and has been for years included in the sanitary program of the
Philippine Health Service. And, as an officer of said institution, I con-
gratulate Mr. Goday for the interest he shows in behalf of the advance-
ment of sanitation in this country.

The suggestion of Mrs. Maria V. Almojuela of Pandan, Catanduanes,
should be referred to the municipal council of her town so that said
body may pass ordinances, in accordance with paragraphs (v) and (w)
of Section 2625 of the Administrative Code, for the construction of the
above suggested drainage.

Mr. F. Poblador's suggestion should be referred through official chan-
nels to the corresponding municipal councils in order that refuse disposal
may be regulated and provided for, in accordance with paragraph (o)
Section 2625 of the Administrative Code, to the satisfaction of every
one concerned and the benefit of the public health.

As to Mr. Florentine Pacquing's suggestion, the same answer for Mr.
Poblador is given him, for his suggestion deals with the same subject
of refuse disposal. Of course, the efficiency of the disposal of refuse
will entirely depend on the funds of the municipality. Where short or
no funds exist for the collection of refuse by employees paid from the
public treasury, the voluntary cooperation of the inhabitants of the com-
munity in the disposal of their refuse in a sanitary way is the only
available means to keep the town in a clean and sanitary condition.

'ATER SUPPLY IN RELATION TO INFANT MORTALITY

J. P. BANTUG, M.D., Senior Medical Inspector, Philippine Health Service

Upon the quality of its water supply depends in great measure
the health of a community. When the Manila water system was
drawing its supply from the Mariquina River, the mortality in
the city from what has been properly classified as water-borne
diseases (typhoid fever, Asiatic cholera, the dysenteries, intes-
tinal parasites), was very much more then than it is at present.
Exclusive of cholera, the mortality from the above diseases has
fallen from an annual average of 3,558 to 1,195 after the com-
pletion of the new waterworks in November, 1908. Prior to
this time the safeguarding of the Manila water system from
contamination at its intake from human sources was a problem
of such magnitude that the military had been called upon more
than once whenever an epidemic of cholera threatened to de-
cimate the city. During the cholera epidemic of June, 1906,
Major-General Wood, was requested to furnish a detachment of
troops to protect the water shed. Thru an act of the Commis-
sion, army officers were invested with the prerogatives of peace
officers with power to arrest and to try anyone who violated
sanitary rules and regulations. No such drastic measures are
now necessary because the present supply comes from a water-
shed protected from all possible contamination from human
sources.

A few instances will possibly bring out the role of pure water
in the prevention of these diseases. Cholera used to make its
appearance, at certain season of the year, but it is now shorn
of its former terrors, thanks to a better knowledge of its causa-
tion, the perfection of anticholera vaccine and improved methods
of treatment. The experience of Dr. De Jesus in the town of
Pasig is particularly instructive. In the cholera epidemic of
1913, he demonstrated to the satisfaction of all concerned, that
the mouth was the only portal of infection and that the causative
agent of the disease was chiefly conveyed by drinking water.
Thru the generous cooperation of the military authorities at
Fort McKinley, a liberal supply of artesian water was secured,

141

142

and this was distributed freely to the inhabitants of the town
in big army wagon tanks, and in conjunction with well estab-
lished sanitary procedures, brought the threatened epidemic
to an end. While the part played by those diseases due to the
intestinal parasitic worms of man in the high mortality of the
Islands may not be apparent in our mortality statistics, especially
among older persons, nevertheless, their pernicious influence in
those stricken with Asiatic cholera has been recognized by
Benoit as early as 1820. In an autopsy performed by A. Guzman
of the Sanitary Commission upon the body of a male child, about
10 years old, suspected of having died of Asiatic cholera in Na-
votas, Rizal, in 1916, it was ascertained that the primary cause
of death was acute appendicitis due to intestinal parasites. A
full grown ascaris was found with half its length stuck into the
lumen of the appendix. Another child, 6 years old, who died
with symptoms simulating those of cholera was autopsied a few
days later, and 227 ascaris and 285 thrichiuris were recovered
from the intestines. Several days before death, a number of
ascaris had already been expelled with the dejecta. Doctor
Heiser, in a paper entitled, "The Tuberculosis Problem in the
Philippines and the Elimination of Intestinal Parasites as the
First Step in its Solution/' has conclusively shown that with the
elimination of intestinal parasites, the death rate in Bilibid
Prison fell down from 261 per thousand prison population per
annum in 1905 to 15.65 per thousand in 1908. By the introduc-
tion of modern sanitary methods, the mortality was reduced to
75 per thousand, but it resisted further reduction until the pri-
soners were rid of intestinal parasites and measures adopted to
prevent their introduction. Many obscure medical problems in
our daily practice, especially in places where diagnostic labor-
atory facilities are not available, may safely be ascribed to their
lethal influence and their preponderance in infancy and childhood
is vividly brought out by the mortality statistics of the Census
of 1918. Of 2,677 deaths directly attributed to intestinal para-
sites, the largest number of deaths was registered in the age
period of from 2 to 4 years, with 1,431 deaths or 52.47 per cent
of the total from this cause. The second largest occurred in the
age period of from 5 to 9 years, it being 521 deaths or 19.83 per
cent; and the age period of 1 to 2 years came next with 353 deaths
or 13.44 per cent. In infants under 1 year of age, they claimed a
total of 206 deaths, or 0.76 of 1 per cent, a comparatively large
proportion, when it is considered that the child at this age is
still dependent upon its parents for everything and the opportun-
ities for self-infection is not yet so great. The morbidity and

143

mortality from the dysenteries was high particularly in the
provinces where these diseases are usually regarded as trivial
affections, the people ordinarily trusting to their home remedies,
oftentimes without beneficial effect, and when the physician is-
called upon to see the patient, he is usually beyond all human
help. It is not surprising therefore that in 1919, out of a total
of 60,169 cases reported as occurring in the Philippines the
deaths amounted to 18,191. Matters, however, have improved
since then, for in 1920, thru a better supply of drinking water
and its maintenance from contamination in public eating places,
the disease is gradually disappearing from the city. While the
disease is still endemic in many provinces, the figures for 1920
have shown a decided decrease, from 18,066 deaths in 1919 to
8,511 deaths in 1920. In Mindanao and Sulu a reduction in the
number of cases has been registered.

Infant Mortality

Year.

Total
infant
deaths.

Rate
per 1.000
births.

Total in-
fant
deaths
from wa-
ter-borne
diseases.

Percent
of deaths
from wa-
ter-borne
diseases
to total
infant
deaths.

1913.--

1,546

322. 46

170

11.00

1914.

3,325

345 34

326

9.80

1915 ...

3,511

396. 72

291

8.29

1916 ...

3,059

336. 82

309

10.10

1917

2 447

275 47

257

10 50

1918 ..

3,611

397. 56

401.

11.10

1919

2 256

224 95

242

10 73

1920

2,687

213. 02

276

10.27

The infant mortality rate in the city of Manila has shown a
decided reduction, especially since 1913. From a mortality of
322.46 per thousand births in 1913, it fell down to 213.02 show-
ing a net reduction of 109.44 per thousand births. The propor-
tion of infant deaths from water-borne diseases to total infant
deaths has, however, changed but little since 1913. Water-borne
diseases constituted 11 per cent in 1913 and in 1920, 10.27 per
cent. In spite of an improved water supply the mortality from
these diseases among infants has riot been materially affected.
When we consider that about 90 per cent of all infections enter
the body thru the mouth and that the causative agent, while
largerly conveyed thru the drinking water, may also be intro-
duced into the mouth with the food, with objects put into the
mouth or with the fingers as was usually the case among children,
the facts as presented to you should cause no surprise. The
problem here, therefore, is not so much as improving the present
water-supply but in guarding it against infection. Here, as in

144

the United States, "we find among rich and poor alike, the largest
number of deaths in the first year from disease of the gastro-
enteric tract." As Holt has pointed out, the extreme suscepti-
bility of infancy to this disease is due to several causes :

"1st. The digestive organs are severely taxed to provide for
the needs of the growing body;

2nd. The mucous membrane of the gastro-enteric tract is
very delicate in structure, and has not much resistance; it is
constantly exposed to injury by irritation, and to infection."1

Fecundity is one of the virtues of Filipino women, and yet the
increase of population due to births is not proportionately large.
Infant mortality is still high and the establishment of measures
for the protection, especially of nursing babies, is imperative.
However, in any effort to save them, their mothers must not be
neglected. The fact should not be lost sight of that run down
mothers can only beget sickly children. The ultimate solution,
therefore, of the infant mortality problem lies in raising the
standard of living, by promoting local industries, by the patient
education of the masses of the people and by realizing once and
for all that any measures for the prevention of the excessive
infant mortality without due regard to the mother will prove
expensive and of little and transient benefit in the end.

DISCUSSION

Mr. GALA (Delegate, Puericulture Center, Tayabas) . — I have observed
that in the provinces people get water from shallow wells dug in the
sand along river banks. I suggest that the Director of Health thru the
president of each sanitary district have the water of such districts
analyzed.

.Miss ROSARIO MANAHAN (Balanga, Bataan). — Since poor water supply
is one of the great causes of infant mortality, I suggest that the health
officers request the higher authorities to render necessary help to munic-
ipalities to enable them to obtain the proper water supply, as the con-
struction of artesian wells.

Mr. DIOSDADO VALENZUELA (Samal, Bataan) . — Abundant water supply is
no doubt the key to cleanliness. It is stated somewhere in the Adminis-
trative Code that a cemetery must be at least 50 meters away from the
river, and if it is less than 50 meters away, such a cemetery 'must be
moved away. In our municipality the cemetery is only 2i meters away
from the river. No one can deny that this condition exerts some effect
on infant mortality.

Dr. V. IBANEZ (Delegate, Provincial Board, Cebu). — According to Dr.
Bantug's paper, the water works system in Manila has a great deal to
do toward reducing infant mortality. Following such arguments, I sug-

1 HOLT, L. EMMET. The Diseases of Infancy and Childhood, fourth edi-
tion, 1908, p. 354.

145

gest that the Office of the Public Welfare Commissioner and the Philip-
pine Health Service cooperate in asking the Government to set aside
two-thirds from the Insular and one-third from the municipal funds of
the amount necessary for the installation of the waterworks system. In
this way the first and second class towns can at least be provided with
artesian wells.

Mrs. MARCELA VILLAPANDO (Lucena, Tayabas) . — I suggest that the
Bureau of Health issue an order that all water for drinking purposes
t be boiled so as to kill all germs.

Mr. MELECIO S. BATOL (President, Moron Puericulture Center, Ba-
taan). — I have discovered that some municipalities have already appro-
priated certain amount of money for drilling of artesian wells, but the
Bureau of Public Works does not have sufficient number of drilling
machines. I suggest therefore that the Legislature be requested to appro-
priate the necessary amount of money for the purchase *of more drilling
machines.

Mrs. RICARDA DE LABAO (Delegate, Mogpog Woman's Club, Marindu-
que). — According to the report of the Bureau of Science, the water supply
of our municipality contains amoeba. I suggest that the president of the
sanitary division inspect the water reservoir and report any defect to the
district engineer for repair. During the rainy season, the water becomes
polluted and I fear that it will give rise to a cholera epidemic.

Miss AURELIA CUANANG (Delegate, Badoc Woman's Club, Ilocos
Norte). — According to what has been stated by Dr. Bantug, I believe that
infant mortality may be reduced by raising the standard of living. I
therefore suggest that a law be passed by both houses compelling idle
people to work.

Mrs. MARIA ALMOJUELA (Delegate, Woman's Club, Catanduanes,
Albay). — I request that an artesian well be constructed in my municipality.

Mr. MARIANO CARAGAY (Delegate, Abucay Puericulture Center, Ba-
taan). — I have discovered that in some municipalities much money has
been spent for artesian wells which have not been drilled in proper places,
yielding little water, or none at all. I suggest that the Public Welfare
Commissioner request the Bureau of Public Works to have a special survey
of every municipality for the purpose of determining the proper point
for an artesian well.

Mrs. FELISA RAMORAN (Delegate, Sual Woman's Club, Pangasinan). —
I have observed many deaths of children due to faulty water supply. In
the name of our Woman's Club, I reqaest that financial help be given
us so that we may have an artesian well in our municipality.

I further suggest that the Welfare Committee help us in our efforts
to stop the evil practices of some mothers which lead to the death of many
children.

Mrs. MARIA ALMOJUELA (President, Pandan Woman's Club, Albay). —
Our town gets its drinking water supply from a near-by river. I request
the proper authority to have an artesian well constructed in our town.

Miss PRESENTACION OBADO (Delegate, Bacarra Woman's Club, Ilocos
Norte). — I suggest that every municipality in the Philippines be provided

185611 10

146

with a sufficient number of artesian wells in order to help reduce infant
mortality.

Mrs. CANDIDA BELO (President, Puericulture Center, Capiz). — Infant
mortality in Capiz is partly due to its improper water supply.

Mrs. NATIVIDAD G. FELIN (President, San Jose Puericulture Center,
Antique). — In view of the fact that the public faucets have been closed
in the municipality of San Jose, the poor people are forced to use water
from any source since they are not able to pay for installing water faucets
in their homes. I suggest that the Director of Health, thru the Antique
Health Officer and the Municipal Council, bring about the reopening of
public faucets.

Miss MAURA SALAZAR (President, Piddig Woman's Club, Ilocos Norte) . —
As most of the deaths in our town are due to intestinal diseases caused
by drinking impure water, I suggest that the remedy lies in the drilling
of artesian wells in the town. There is one artesian well but the water
is not very good, hence it is used by very few people only.

Mr. F. POBLADOR (Delegate, Puericulture Center, Cadiz, Occidental Ne-
gros). — I suggest that wells from which people get water for washing
and drinking purposes be inspected regularly; and if found insanitary
they should be covered and closed by the proper authority.

As there is water standing in practically all ditches in this "poblacion,"
I suggest that proper drainage be established by the officials concerned.

Miss MARIA ABELLA (Dasol, Pangasinan). — Since the people in our town
drink water from polluted wells, and since bad water supply is partly
responsible for the high infant mortality, I therefore suggest to the
Public Welfare Commissioner that an artesian well be drilled in our town.

Miss N. ABASTILLA (Baguio Woman's Club, Mt. Province) .—For the
sake of the mountain people and our little children who die of dysentery,
typhoid fever, and other intestinal diseases due to lack of proper water
supply, I appeal to the Director of Health to bring about the necessary
changes, as the drilling of artesian wells.

Mr. MELECIO S. BATOL (President, Moron Puericulture Center, Ba-
taan) . — Since it has been proved that one of the best means of combating
infant mortality is by supplying a community with good drinking water;
since it has been found that the artesian well is the best drinking water
container; and since the Government does not have enough artesian well
drilling machines to meet the de'mand, I suggest that a petition be sent
to the Philippine Legislature, asking for an appropriation of a certain
sum of money for the purchase of more drilling machines.

Mr. LORENZO MALLILIN (Cauayan, Isabela). — I recommend to the Leg-
islature thru the Public Welfare Commissioner, the passing of a law
authorizing the municipal council of Cauayan to take up contributions for
the construction of a pumping well in each barrio under the direction ol
the Bureau of Public Works.

Mrs. FLORENCIA E. BANEZ (Delegate, Tacloban Woman's Club, Leyte). —
In view of the fact that in most of our towns, the wells dug by our
people are infected with ascarides and amoebic dysentery, I suggest to
the proper authority that such wells be closed, and be replaced by pump-

147

ing or artesian wells if the residents desire it. To further safeguard
the public, I suggest that these pumping and artesian wells be examined
for infectious organisms once or twice a month.

DR. BANTUG'S ANSWERS
Mr. GALA:

The water obtained from shallow wells dug in the sand along river
banks, is never safe, although it may be potable. The water from such
wells is easily contaminated by seepage, it being generally known that
in many towns, the sewage empties directly into the river. The source
of pollution is close at hand, and the danger from it is always present.

Miss ROSARIO MANAHAN:

It has become the policy of the Philippine Health Service to provide
each town of the Philippines a good water supply together with a safe
system of sewage disposal. The construction of artesian wells has always
been encouraged by us and the number of wells drilled in any one year
in any given province is only limited by the funds available for the pur-
pose and the number of drilling machines in the field.

Mr. DIOSDADO VALENZUELA:

Section 1075 of the Revised Administrative Code provides in fact that
no cemetery or burial ground shall be authorized or established within
50 meters (of either side) of any river, spring, well or other source
of water supply; but the Director of Health is authorized in his discre-
tion to permit the continuance or reopening of any burial ground, ceme-
tery, or other place for the temporary or permanent disposal of the dead,
not meeting the requirements of this section, which may have been
established prior to February twenty-first, nineteen hundred and six.

Dr. V. IBANEZ:

With regard to Dr. Ibanez' suggestion, the Philippine Health Service
will be willing on its part to cooperate with the Office of the Public Wel-
fare Commissioner in asking the Government to appropriate ample funds
for the installation of water work systems, two-thirds of which to come
from the Insular Treasury and one-third from the municipality to be
benefited. The present practice, however, of raising funds for the pur-
pose of drilling artesian wells in the provinces is by means of a resolu-
tion of the municipality concerned, setting aside a certain amount for
the purpose and the province sets aside an equal amount by resolution
of the Provincial Board. Then the Bureau of Public Works, upon the
approval of the Secretary of the Department of Commerce and Com-
munications, grants one-third of the amount necessary to carry out the
project.

Mrs. MARCELA VILLAPANDO :

While boiling water for drinking purpose is a good sanitary procedure
worthy of support by the Philippine Health Service, still this is believed
to be in many cases impracticable. It cannot be carried out in individual
houses because this will entail the constant supervision of every house-
hold, and because people do not relish boiled drinking water, not to
mention the cost of fuel which to the poor people would mean a consider-
able outlay of money, especially in places where firewood is not readily
obtainable, except upon buying, as in the City of Manila and the capitals

148

of many provinces. It is a different thing, however, with regard to
itinerary vendors, carinderias, refreshment parlors, restaurants and hotels
where the management can be compelled to furnish safe drinking water
to the public, it being a health measure applicable to a large part of
the community and easily supervised.

Mr. MELECIO S. BATOL:

The suggestion of Mr. Batol will be referred to the Bureau of Public
Works, it being the office directly concerned in the purchase and opera-
tion of drilling machines.

Mrs. RICARDA DE LABAO :

XThe suggestion of Mrs. Labao will be referred to the President of the
Sanitary Division concerned for investigation and action.

Miss AURELIA CUANANG:

With regard to Miss Cuanang's suggestion, I beg to inform her that
we already have such a law in Act No. 519 of the Philippine Commission,
and re-enacted by the Municioal Board of the City of Manila, penalizing
all persons without visible means of support or lawful employment. What
is needed in this connection I believe is to denounce such persons publicly
and bring them to court.

Mrs,. MARIA ALMOJUELA:

The request of Mrs. Almojuela will be referred to the Director, Bureau
of Public Works.

Mr. MARIANO CARAGAY:

The suggestion of Mr. Caragay will be referred to the Director, Bureau
of Public Works, through the Commissioner of Public Welfare.

Mrs. FELISA RAMORAN:

In answer to Mrs. RAMORAN, I would recommend that she should in-
terest the municipal council of her town to appropriate part of the money
for sinking an artesian well. To this appropriation a like sum should
be appropriated by the Provincial Board and with the approval of the
Secretary of the Department of Commerce and Communications, the
Director of Public Works may set aside one-third of the amount required
for the project.

To overcome the evil practices, leading to the death of children, of
which Mrs. Ramoran made mention, education is the best remedy. In
this connection, it may be well to remember that every health officer is
always ready and willing to give instruction along health matters for
the benefit of the public.

Mrs. MARIA ALMOJUELA:

The answer to the request of Mrs. Almojuela has already been covered
above.
Miss PRESENTACION OBADO:

The policy of the Philippine Health Service has always been to en-
courage the sinking of artesian wells, not only to reduce infant mortality
but also to prevent the spread of water-borne diseases in epidemic form.

Mrs. CANDIDA BELO:

Woman's Clubs are an asset to the community. While their object
should primarily aim at the reduction of the present high infant mortal-

149

ity, they also should interest themselves in the general welfare of the
community in which they are established. The urbanization of rural
districts, the provision of safe water supply, safe disposal of garbage
and sewage, should not be neglected as they make up largely for the
general well-being of the community.

Mrs. NATIVIDAD G. FELIN:

The public faucets at San Jose, Antique should be opened for the
benefit of the poor. It is a poor policy to close public faucets because
the people cannot pay for them. .Pure water is an essential necessity
in the daily life of a people and any effort to curtail its supply is fraught
with danger to the public health. The measure is a short-sighted policy
and reflects upon the civic virtues of the municipal council concerned.

Miss MAURA SALAZAR:

It should be the endeavor of every woman's club to provide the town
in which it is established an adequate system of water supply. When
a spring is near at hand, it should be availed of in the establishment
of the water supply system. It can be done at a relatively low cost.

Mr. F. POBLADOR:

The matter brought up by Mr. Poblador is within the province of the
district health officers themselves to remedy. It being a public utility,
the municipal council concerned can be made to provide proper drainage.

Miss MARIA ABELLA:

The water supply of Dasol, Pangasinan, is obtained from shallow sur-
face wells. According to Miss Abella, these wells are polluted. They
can be made safe for drinking purposes, while the construction of an
artesian well is pending, by disinfecting those wells and protecting them
from contamination. The health officer of the division will largely lend
his cooperation towards endowing the town with a safe water supply.

Miss N. ABASTILLA:

Baguio is already provided with a safe water supply. With regard
to other water supplies in other part of the mountain province, it should
be easy for any given place to secure its water supply at only a small
cost. Springs are plentiful and the water from any of them can be
easily piped to the nearest settlement.

Mr. MELECIO S. BATOL:

The suggestion of Mr. Batol will be referred to the Bureau of Public
Works, it being the office directly concerned in the purchase and operation
of drilling machines.

Mr. LORENZO MALLILLN:

There is no need of any action of the Legislature* with regard to Mr.
Mallillin's proposition, and this point has been covered already in one
of the answers given in one of the preceding suggestions.

Mrs. FLORECIA BANEZ:

The suggestion of Miss Baiiez can be easily carried out if the munic-
ipality will appropriate a sum for the construction of an artesian well.
The rules for the proper protection of these wells from contamination
can be laid down by the health officers concerned and their observation
can be enforced by the local police department.

THE LABORERS' "BARRIO" AS A FACTOR IN REDUCING
INFANT MORTALITY

JOSE E. DEL ROSARIO, President of the Congreso Obrero de Filipinos

I consider it a high distinction and a beautiful opportunity to
speak before this distinguished assembly of ladies and gentlemen
from all parts of the Philippines, who have come to the capital
of the Archipelago, confronting many hardships and making
great sacrifices in order to support in an eloquent and decisive
manner the meritorious campaign undertaken by the Government
with the cooperation of the woman's clubs against the terrible
infant mortality that is causing great havoc in this country.

This undertaking is much more admirable for having enlisted
in it our women who are the basis in the character and intellectual
formation of our children, the men of the future, in whose hands
the destiny of a country will be intrusted. In the subject of
infant mortality which must deserve a detailed study of this
Conference, the cooperation of women will, undoubtedly, be of
beneficial results since the first infancy which furnishes Death
most of its victims is entirely committed to the mother's care.
For this reason it is but just that we reiterate on this occasion
our loving tribute of respect and admiration to woman who, in all
parts of the world, symbolizes virtue, faith, and love.

And I hope you will pardon me, ladies and gentlemen, for
feeling elated over the privilege of speaking on 'THE LABORERS'
BARRIO AS A FACTOR IN REDUCING INFANT MORTALITY," a sub-
ject which ought to deserve your sympathy because it involves
the destiny and the future of a good number of our people, those
who expect preferential attention and all sorts of aid from us,
because they are disinherited by fortune and depend upon health
alone for their capital in the great struggle for life.

I expect therefore to deserve the attention of the worthy rep-
resentatives to this Conference in the hope that the laborers in
this country, who are as deserving of better fortune as the labor-
ers in other countries, will get something practical and beneficial
from this event so memorable and highly important in the his-
tory of the Philippines.
150

151

Those who have had the luck or the misfortune of knowing
the great City of Manila must have observed with their own eyes
the undeniable fact which may be considered a valuable ally of
the terrible mower that reaps many precious lives of children.
I refer to the congestion of inhabitants in the lodgings located
in districts peopled by laborers. So as not to tax your attention,
I shall cite to you, as an example, one of the most congested
districts of Manila, that of San Nicolas, more than half of
whose area is occupied by the proletariat. Due to the high
rent of the lodgings on one hand and the scarcity of dwelling
houses on the other, our laborers whose wages can hardly
cover the immediate necessities of life are compelled to live
crowded together. Thus we have an apartment which can
only lodge with relative ease a family of six, occupied by
four or five families, without counting the children who, by
their nature and constitution, are more exposed to diseases
which originate from this sort of physical and spiritual
amalgam of those neglected by fortune. And, it generally
happens that someone in the house becomes ill. Then the
family of the patient, following the traditional custom of the
masses, intercepts the ventilation of the dwelling with curtains
to keep, as they say, the air from hurting the sick. Imagine now
how unhealthy and unhygienic a house in such a condition would
be and the risk which babies that live there would run. And
how many sick people who suffer from an infectious disease live
in that dangerous congestion without any one's realizing the
great risk that is run !

In order to fight the evil in its roots, the labor leaders have
been for years asking for the establishment of laborers' barrios
in this city with the object of reducing the congestion in those
crowded districts which are always fertile fields for all sorts of
diseases. We know and we have stated in various occasions that
each child that dies is a factor less in the economic and political
development of our country ; and in order to reduce in the utmost
possible this terrible scourge which for years has been causing
great damage in the Philippines, we have always asked the Gov-
ernment for the construction of houses for the laborers, since the
children of these are the ones most exposed to diseases, given
the condition of poverty in which they live.

According to the last report of the Bureau of Health infant
mortality has decreased in Manila. I can assure you that a
great part of this decrease is due to the fact that a large num-
ber of our laborers, owing to the prevailing crisis, emigrated

152

to different towns and provinces of the Archipelago, and with
this exodus there was a certain reduction of the congestion
of population in the most crowded districts, thus reducing the
field in which diseases develop.

This fact shows us that the laborers' barrios will contribute
in a decisive manner in the decrease of deaths among our babies ;
for our laborers will scatter themselves in such barrios, aban-
doning the unhealthy shacks which now serve them as home;
and the compact masses which live crowded together, transmit-
ing to each other perhaps the germs of a disease, will be dis-
persed in order to find a place exclusively theirs where they can
live a healthy, worthy, and happy life. While it is true that
the babies of the laborers will be born poor, protected only by
the modest means of their parents, they will, however, live there
a healthier life less exposed to dangers, and will grow healthy,
beyond the reach of the germs that swarm in insanitary shacks,
under the loving care of their mothers and the protection of
Nature, the greatest and most immortal of mothers.

On the other hand, the laborers' barrios are directly related
to public welfare. These barrios which, in all parts of the
Archipelago, will be the greatest portion of each province or
city, will be surrounded with all the guarantees of sanitation
and welfare. The Government which will establish them will
see to it that each dwelling has enough sanitation to insure the
health of those who will live there. And the laborer will find
in them a help to his economic situation, because each house
will cost him less than the rent of a house in bad condition ; he
will be free from the impositions of unscrupulous house owners ;
and, above all, if he is abstemious and industrious, he will become
in time absolute owner of his home, a property which he would
acquire thru slow payments to the Government. And thus,
when he dies, he will have the consolation of bequeathing to his
children a home which has sheltered them while struggling for
existence.

The campaign in behalf of public welfare, on the other hand,
will find facilities for its undertakings in the laborers* barrios,
because these will constitute centers inhabited by thousands of
people who are always ready to receive the advice of the disin-
terested apostles who work for the welfare of humanity. Then
the laboring mass, which at present forms a fertile field for
numberless diseases, will be converted into a wall impenetrable
to such diseases because it would be made of vigorous beings,
beaming with health.

153

You who come from distant towns to which the social prob-
lems have not had any access yet, ought to be interested in
this problem. With the progressive development of our country,
in a day not far distant the social problem will invade even the
last corner of the Philippines, and then when that day comes,
you who in this Conference have shown great interest in the
problems of humanity will be compelled by your own feelings
to take up in your account the defense of the unfortunate labor-
ers who, in search of subsistence or of better luck, alight in your
towns like wandering swallows that fly away from the winter
of life. Then will you have fulfilled one more duty in the name
of humanity.

Ladies and gentlemen, many thanks for the kind attention
that you have given to my humble lecture; and I hope that this
great Conference devoted to the preservation of the babies' lives
a"nd the public welfare, will favor with interest, and will demand
from the respective authorities the immediate establishment of
laborers' barrios, as an important factor in reducing infant
mortality.

DISCUSSION

Miss ROSARIO P. SALAS (Law School, National University). — I suggest
that Mr. del Rosario include in the by-laws of the constitution of the
"Congreso Obrero" of which he is chief, a statement to the effect that
members must turn over to their wives, part of their salaries for the
support of the family. If such a statement is not adhered to by such
members, they should be deprived of the protection and privileges of the
association.

C. ORGANIZATION OF SOCIAL FORCES

THE KNOWLEDGE A CLUB WOMAN SHOULD ACQUIRE TO
MAKE HER AN EFFECTIVE LEADER IN HER COMMUNITY

TRINIDAD FERNANDEZ, Secretary of the National Federation of Woman'
Clubs and Provincial Club Extension of the Woman's Club of Manila

Before attempting to write a dissertation on the knowledge
a club woman should acquire to make her an effective leader
in her community, I will first make clear the meaning of the
term "club woman." In this country, where club work is still
in its early stage of development, the term club woman is not
yet widely known. It is to propagate the accepted meaning of
this phrase that a definition of what it implies and what it
represents will be necessary before it is mentioned any further
in this paper. A club woman is one who belongs and is affiliated
to, or works for, an organization, the aims of which are for
civic, charitable, or humanitarian purposes. She must be dis-
tinguished from the woman who belongs to an organization
which is purely of a social nature. In other words, a club woman
is a worker and a hustler, whose interests are not for herself
alone, but also for the good of her whole club, and, consequently,
for the community to which her club owes valuable service.

The club woman who becomes a really effective leader usually
assumes that responsible and enviable position, because of some
striking qualities which she possesses — qualities which are in-
herent in her, and which she can not gain by observation and
experience alone.

Personality comes first among these inherent qualities. A
club woman who has a pleasant, charming personality — one that
is neither too assuming nor too pliable — will sooner or later be
pronounced the leader of her sex in her locality. She need not
necessarily be good-looking or elegant, altho she would be neat
and tidy, both in her dress and in her habits.

Not less important than a charming personality — in fact,
commensurate with it — is the power to execute things quickly
and rightly. Personality without executive ability will not make

155

156

a successful club woman, nor will executive ability alone per-
form such a miracle for that matter. One is inter-dependent
upon the other.

A leader must also possess tact and diplomacy. To do and
say the right thing at the right time, and to execute it in such
a way that it will not create any discord among her followers
is not all a difficult task for the tactful and diplomatic woman.
Many misunderstandings and petty troubles can be avoided and
overcome if the right step is taken soon. Nor should we limit
ourselves to these qualifications alone, for broadmindedness
ranks as one of the essential units in making up a successful
leader. By broadmindedness is meant the ability to see a wider
view of things, and to grasp new ideas which will be for the
benefit of the club and the community, even tho the adoption
of these ideas is a complete divergence from the usual way of
doing things in that particular community.

With these five qualifications — personality, executive ability,
tact, diplomacy, and broadmindedness — inherent in her, the club
woman has the basic grounds of a leader. She can accomplish
much, if she will only try. That is why her associates, her
people, and her community, expect much of her. They look up
to her as a ministering angel, who can do everything and never
know failure. Yet such is not always the case, for there are
other things which she ought to know so as to insure the stab-
ility of her leadership and retain the faith of her associates.
This does not necessarily mean that she must be a college woman
nor a high-school graduate. Academic degrees may be possessed
by a successful club leader, but she does not need to have them.

A knowledge of the local conditions in her community is far
more essential to her than a startling memory of dates in
history and rules of rhetoric. First of all, the earnest club
woman must find out what her community really needs, and
having found it, must decide to have her club undertake to do
it. This will give the club something permanent to do, for
usually these needs are expressed in concrete forms, such as
puericulture centers, nurseries, and hospitals.

In time of epidemics, such as cholera, influenza, dysentery,
and the like, she must step in at once, and survey the condition
of her community, so that she may call for outside assistance
if necessary. If she is first to appear on the scene and succor
the victims of a fire or a flood disaster, she metes out that much
ability, thoughtfulness, and kindliness in her favor.

Then, too, the club leader ought to know something about the
schools and school children, the hospital and library in her

157

town, if there are any, the markets and wells, and other public
conveniences which pertain to her particular nook and corner
in the archipelago. She should take a keen interest in all of
these, find out their needs, and the means of securing these
needs. When this means is available, she should induce her
followers in the same cause, so that they may jointly proffer
their service and cooperation whenever and wherever necessary.

Most of these activities, of course, involve money, but as I
have said, the club leader who knows what she is about, will
know where to direct her inquiries for help, and to whom to
direct them.

In Manila, she can address any of the following for sugges-
tions, information, and help :

First. The central office of the National Federation of Wo-
man's Clubs for all inquiries concerning club organizations,
activities or any other incidental matters, which the provincial
clubs desire to be taken up and indorsed to the proper agencies
or authorities. In this way, the office of the National Federa-
tion of Woman's Club will serve as a medium for the coursing
of club inquiries, appeals for help and general correspondence.
In this way also, the federation can keep track of each and
every club in the Islands, so that should any request for infor-
mation or data about these clubs be made at any time, the
federation will be doubly able to give accurate, interesting in-
formation that will reflect favorably on club work and club
women in the Philippines.

Second. The Office of the Public Welfare Commissioner, which
is demonstrating a kindly sympathy to the work of woman's
clubs, is but too willing to help in the establishment of pueri-
culture centers, maternity hospitals, and dispensaries. Any club
that desires financial aid can address the Public Welfare Com-
missioner, expressing this desire, accompanied with a well for-
mulated plan of work to justify the request.

Third. The Red Cross and the Bureau of Health never refuse
their help to those deserving clubs that apply to them. The
Red Cross distributes supplies to the clubs, and offers nurses
to work in those places where the services of one are much in
demand. The Bureau of Health, which is one of the pioneer
supporters of club work in the Islands, can be appealed to in
times of epidemics and casual outbreaks of other maladies.

Fourth. The Bureau of Agriculture can be called on for as-
sistance in everything pertaining to the campaign in food pro-
duction— such as home-gardening, poultry, and hog raising;
and the Bureau of Education, on matters related to the schools.

158

In her own province, the club leader must not hesitate to call
on the Provincial Board or the local Red Cross branch for help.
If the need is local, and the municipality is in a position to
extend help, by all means, she should direct her appeal to the
municipal council first.

Some clubs fail because the members do not know how to win
the sympathy of the people of the community. People want
to know what their money is for whenever they give contribu-
tions. Knowing what it is for, they naturally expect to see the
fulfillment of the promises made by the club. An effective club
leader, before soliciting contributions, must plan out the purpose
of the contributions, and having told the people what it is, she
must live up to her promises. In many towns, people are
willing to give their money for any good cause, and they only
become miserly and indifferent when club members fail to ful-
fill their promises.

Another way of winning the sympathy of the people is to do
one thing well, which will stand out prominently as the achieve-
ment of the club, and which will demonstrate to the people a
material proof of what the club can do. In this attempt to do
one thing well, the aim must be at constructive work — some-
thing that will be lasting and beneficial not only to a handful
of citizens, but also to the whole community as well. If this
practice is carried out, it is impossible for the people to be in-
different and adamant to that which is only for their own good.

Again, much diplomacy has to be exerted in dealing with the
various types of people which are invariably the same in every
community. There are the political leaders, the Government of-
ficials, the religious sect, the misers, the indifferent and the en-
vious, the intolerant and conservative group, the tactless and
domineering sort, and countless others who have to be called up
on once in a while for help. To be on good terms with each and
every one of these is, indeed, a puzzling problem, yet that is
exactly what every 'club woman should strive to do, for even
the most generous person in the world will be tired of giving
contribution, if called upon to do so at frequent intervals. And,
if the benefit is to be for the whole community, it is unjust, not
to say absurd, to tax the pocketbooks of only a few. Therefore,
club women in order to reap success from their work, must be
friendly, democratic, and diplomatic to the people of the com-
munity. If every club leader will only remember not to meddle
in politics or religion, and to keep away from any outside in-
fluence which tends to disunite rather than perfect a union
among the members, no troubles will arise, either among the

159

members themselves or with the people of their community.
This does not mean that she must not be friendly with any one
of them. By all means, she should cultivate their sympathy,
but she should guard herself from being too friendly with only-
one group, else she will surely breed nothing but trouble and
discontent.

A club, to be successful, must have team-work and cooperation.
One lone woman cannot form a club, nor can she exercise all
the function of a club officer for that matter. It is the club,
whose members know the ins and outs of its activities, and
who take an active part and interest in them, that will grow
in spite of unfavorable conditions. Give every single member
a chance to work on a committee, and do not let the burden of
work rest solely on the shoulders of a few. Above 'all, make the
work interesting to the members so that they will be proud
to claim that they are the members of the woman's club.

To keep the integrity of a club, the leader must have a full
knowledge of the functions and duties of each officer as
provided for in the by-laws, and she must abide by those
by-laws. The minute she tries to ignore them and begins to
confuse and shift the duties of one officer with another, that
minute she spells the downfall of her organization. She must
be reserved in all her actions, for if she becomes too "bossy"
or too domineering, she is apt to arouse the enmity of her
followers. Consequently, discord will follow, and when there
is discord, no real work can be accomplished. True club women
have no time to stoop to petty trifles which should be avoided
and overlooked. It is the serene club woman, able to add a dash
of pleasantry at the end of her remarks, who has the least
chances of creating animosity among her associates.

Last, but not least, a club leader must have some knowledge
of world conditions along her line of activity, for club work
is universal ; therefore, it were well that the woman of this
country know something of what other women in other countries
are doing. We have much to learn yet before we can claim
that we are on the level with the women of other countries like
England, France, and the United States. The fact that we are
less experienced and are new to the movement, stands as our
excuse for the present, yet that must not discourage us, for the
average Filipino woman is very keen to learn new ideas and is
willing to follow good examples when she sees them.

Club women in this country must stand for concerted action
along certain definite lines. Only by doing so will they realize
any material results from their work. This concerted action

160

naturally necessitates on the part of club workers a knowledge
of what the women in their own country are working and
striving for. At present, our interest is centered in the infant
mortality problem. It is a rightly chosen problem, and one
which each and every club can take up.

In direct conjunction with the infant mortality problem, the
Filipino women must cooperate with the health officials in
working for better health conditions. Then, too, as house-
keepers, wives and prospective wives, the Filipino women must
stand together and strive for more beautiful home surroundings,
with emphasis laid not so much on the architecture of the
house, as on the little natural touches that will enhance and
transform even a barren bamboo house into one of comfort and
beauty.

By their present interest in social problems, the Filipino wo-
men are helping to make history. But history must not be
permitted to record in its pages anything else but success and
actual results from our achievements. I say, must not, because
I believe it is within every Filipino woman's reach to prevent
this. If each and every single woman in this country will come
to the fore and set her shoulders to the wheel, all else is possible,
and the infant mortality bugbear and most of these transcen-
dental problems affecting our public welfare will become a
history of the past.

In conclusion, I wish to express my admiration for the splen-
did way in which the club women in the provinces are con-
ducting their organizations. What they have accomplished is
not even a fractional part of what they still have to do. It is
only thru union and cooperation that we can see quick results
from our work. Every body should foster the establishment
of woman's clubs and similar organizations whenever possible.

DISCUSSION

Mrs. MARIA F. MADALANG (President, Dupax Woman's Club, Nueva Viz-
caya) : I request that a central office for the woman's club be established in
the provincial capital where municipalities may take their local problems
for solution, and where they may receive instructions.

Mrs. CANDIDA BELO (President, Capiz Puericulture Center, Capiz). — I
suggest that all money collected in every town be set aside to help the work
of woman's clubs in reducing infant mortality.

Mr. PAUL* VERZOSA (Orion Puericulture Center, Bataan) . — I propose that
all employees in the welfare work in Manila and elsewhere receive syste-
matic instructions in social work so that they may perform their duties
more efficiently.

Miss ANGELES ARIZOBAL (Cantilan Woman's Club, Surigao) . — I believe
that the high infant mortality in these Islands is due to the ignorance
of our people. I suggest that the Office of the Public Welfare Commissioner
employ women organizers, one for each province.

The organization of a club requires intellect, spirit, willingness and
knowledge, and I do not believe there are many towns and barrios where
there are women capable of taking the lead in organizing clubs in their
own communities.

I therefore recommend that one woman organizer be appointed to stay
in each town at least two months to carry on the organization work, re-
porting same to the Secretary of the Provincial Club Extension.

185611 11

GIRLS' ASSOCIATIONS: THEIR OPPORTUNITY, ORGANIZATION,
AND MANAGEMENT

JOSEFA JARA MARTINEZ, Social Worker in the Office of the Public Welfare
Commissioner and Secretary of the Associated Charities of Manila

I am thankful for the privilege of speaking before you on a
topic which is quite in keeping with the purposes of this Con-
ference. Our efforts toward public welfare will not be complete
unless we take up the welfare of girls and champion its cause.
And so I invite you to consider with me this morning the
opportunity afforded by girls' associations, and the methods
by which we may take advantage of this opportunity.

Eleven years ago, the Woman's Club of Manila was organized
for a great and noble purpose. Soon after its organization,
similar ones sprang up in the provinces thru its initiative, until
finally the club idea spread throughout the Islands. Those who
conceived the plan of organizing the women of the Philippines,
recognized the good which they can do when working together.
And the women have lived up to their expectation. They and
their leaders truly deserve high commendation for their accom-
plishments.

The same spirit that prompted and guided the initiators of
woman's clubs should inspire and encourage us to work for the
cause of the girls between ten and eighteen years of age. Their
health, happiness, and prosperity have been unintentionally
overlooked to some extent. In my judgment, there is no gain-
saying it that before we can have women who are able to
think independently, women who have initiative, women who
are conscious of their community's needs and ready for service,
we must train the girls and prepare them to take their places
as leaders in community welfare.

And we have splendid materials to work with. All we need
to do is to go into the homes, schools, colleges, business, and
industrial houses, and there we shall find girls of every de-
scription. We should take an interest in them, study their prob-
lems, and get them to join hands for service to themselves, to
other girls, and to their community and country. The Filipino
162

163

girl, nowadays, dislikes to sit down and fold her hands. She
does not want everything done for her. She wants to help
others, and be ever ready to serve her country. Instead of
having an easy time, she prefers to tackle difficulties so that
she may feel happy and triumphant over her success. Normal
girls in the adolescence are susceptible to suggestions, very im-
itative and are unusually active. Therefore, let us take advan-
tage of girls' nature at this age, and direct it into useful channels.

An association is the best means of utilizing the girls' activ-
ities, as it affords a great opportunity for doing good. In the
first place, it is of great value to the individual girl for it fills
her hands and minds with wholesome, inspiring, and healthful
activities. It teaches her to serve other girls an.d prepares her
for citizenship. Then, too, an organized group of young people
can accomplish much in preventing infant mortality and in
promoting general welfare. Human beings work together bet-
ter in groups. Girls in their teens are no exceptions to this
rule. They naturally enjoy doing things together and find the
hardest kind of work light when they do it in the spirit of fun
and service.

The opportunity offered by girls' associations is not confined
to the girls alone. Every organized club, in order to accomplish
its work, must have a competent leader who understands girls
and can direct their energies wisely. Here is a splendid op-
portunity for the well-educated woman. To be a club leader
is a privilege that she should welcome, for in this position,
she has a chance to inculcate good habits into the girls, and to
train them so that they can be depended upon to finish whatever
they undertake. The woman who can do these is rendering
just as much service to our country, as a school teacher, a
doctor, a nurse, or a lawyer.

So great is the opportunity that associations offer to thes
girls and educated women, that we should spare no efforts in
pushing the movement along. Girls thruout the world have
nature and traits that are common to all of them, even tho each
nationality may have special needs and problems. Girls' asso-
ciations have done wonders for the girls of America; I am
convinced that they, too, will do wonders for the girls of the
Philippines. ^

When you return to your respective communities, you will
undoubtedly be instrumental in guiding the girls there. Before
you leave, permit me to give you a few practical suggestions
on organization and management, hoping that you will find
them useful in your work.

164

An organization, in order to be efficient, should have a com-
petent leader. Miss Fernandez has already enumerated a num-
ber of things necessary to good leadership. I might add to
them a few special qualifications which a successful leader of
girls should possess. There is no disputing that the adviser
should be a woman, not that I question the ability of men because
I do not, but because women understand the problems which
the girls constantly meet. But, being a woman alone, does not
qualify a person for leadership. She must be neat and attractive
in appearance — not necessarily good looking. She should pre-
ferably be a college woman, a normal or high school graduate
or one with wide experience and must enjoy the things that
most girls enjoy, such as music, dramatics, reading, athletics,
dancing, cooking, needle-work, and other handicraft.

The next consideration in organizing, is membership. Who
shall belong in a group? Some organizations in the Philippines
have failed miserably because they were composed of girls Who
were of different ages and had very little in common. The
secret of club success depends upon the joy that the members
find in each other's company and the harmony with which
they can work and play together. Girls that are of nearly the
same age, from the same neighborhood, of the same grade, of
the same occupation, or of the same religion are more closely
attached to each other than those who have different nature
and emotional preference. Girls in their teens can be conve-
niently grouped into two for club work purposes: first group,
ten to fourteen; second group, fifteen to eighteen.

The number of girls in one group is very important to suc-
cess. Experience has shown that the fewer the girls there are
in one association, the more efficient they can do their work and
the more helpful the leader can be to the individual girl. There-
fore, it is suggested by many experienced club leaders that each
group under one adviser should have not less than six nor more
than twenty girls. In a small town, however, it is often a great
advantage to have one large organization to which any girl
may belong. This large organization may in turn be divided
into various smaller groups, each having a leader of its own
but all under the supervision of one director.

The tactful club leader must be keen enough to watch for an
opportunity to organize girls. In the Philippines, it is very
seldom that a group of chummy girls will approach a leader
and ask to be organized. It therefore remains for the organizer
to take the initiative, and go after them. One successful method

165

of getting the girls together is to invite them to a party or
a picnic. The invitation should be so worded as to attract the
girls to come. The following has been found very effective in
getting the girls to respond :

Talk about good times ! Here's one :
Short and snappy speeches, delicious eats,

spicy music — all to be had by coming

To 807 Wright Street at 4 p. m., Saturday, December 17.

Coming? Of course, you are!

When the girls are together, tell them something about the
value of the girl's association and what the girls of other
countries are doing. If presented in an interesting way, they
will take to the idea and will immediately proceed to organize
themselves. One warning to the leader: You should not im-
pose an organization upon the girls, but you should impart your
ideas to them individually or in groups, get them sufficiently
interested in your proposition and you will find that they will
want to be organized.

Once an association is formed, the tactful leader will permit
her girls to exercise initiative. She should give them consi-
derable power to decide policies of membership and other things
that pertain to the club, in order that the girls may regard
the organization as their very own. They should elect their
own officers, submit all the decisions to the will of the majority
and learn to cooperate. The leader's work should be to suggest
and guide without seeming to impose.

A club should have a constitution, of course, and the shorter
it is, the better. Its provisions should vary according to the
purpose of the association, but they should cover at least the
following points: name and purpose, colors, motto or slogan,
membership, officers, committees, meetings, finance, amendments
and by-laws.

The name, colors and motto or slogan should be carefully
considered, because they will be used frequently. "Maria Clara"
for instance, may be selected for a club name because it is that
of a great woman whose character is what the girls' wish to live
up to. Names that suggest the purpose and work of the asso-
ciation are sometimes used. Among these are: "Aim Well,"
"Little Mothers' League," "Service Club," "Ever Ready," "Help-
ing Hands," "Jolly Friends," and the like. You should select
colors that can be bought in popular and. cheap materials, so that
you will meet with no difficulty later when buying things for de-
coration. Mottoes should be short, catchy, and expressive of

166

the association's aims. To illustrate, I am quoting herewith
those used by popular organizations in the United States :

GIRLS SCOUTS, Motto : Be prepared.

Slogan: Do a good turn daily.
THE GIRLS RESERVE Slogan: To face life squarely

Purpose: To find and give the best.
CAMP FIRE GIRLS, Slogan: Give service.

The hardest problem met by the inexperienced club leader
is how to hold £he interest of her girls, once she has secured
it. The reason why so many of the associations in the Philip-
pines have failed is because the leaders relied too much upon
the inspiration of the moment. The activities should be well-
planned out for the week, month or year. At first, the leader
will do most of the planning and suggesting, but as the girls
become more and more familiar with the ideals of their associa-
tion, they will be more desirous to give their opinions and
suggestions.

Another method of engaging the attention of girls is by
introducing new ideas and by varying the method of carrying
out the activities. Successful club leaders have found parties
and picnics of intense interest to girls. Clever invitations like
the following may be sent out or posted in order to get the girls

to come:

Saturday next

One P. M.

the

Front Door

with
Ten Centavos

in
Hand

Another one (adapted from Nebraska Girls' Club) :

Come on, girls, hit the pike!

Be ready at five (a. m.) for a mountain hike,

Wear a middy and bring a stick

Meet at Central School, and come double quick.

July 22, next Saturday, heed!

Bring twenty-centavos for a good old feed.

An association like the Camp Fire Girls of America stimulates
interest by awarding honors for good work, health, and service.
What adolescent girl does not feel proud and happy when,

167

in recognition of her achievement, she is given a prize before
admiring relatives and friends!

Other clubs have found suspense a good means of keeping
up interest. Every one enjoys a "surprise," and the "leader
who announces a surprise for her girls and gives them a real
one at the next meeting is bound to be popular.

Keep the girls well posted of the club's doings thru posters
and reports. Create in them a sense of belonging to something
by having them cheer for their organization, or sing their
club songs at each meeting. The following cheer of the Girls
Reserves, a Y. W. C. A. organization, is typical of the many
catchy and snappy cheers that the American girls use. The
Filipino girls will enjoy it too:

We are girl§ of world-wide fame,

Girls Reserves is our name;

Tall girls, short girls, fat girls, thin,

Girls Reserves takes them all in.

You don't need money and

You don't need pearls,
Anybody, everybody, just so you're girls.

I have now given you some idea of the opportunity offered
by girls' associations and a few suggestions on how to organize
and manage one. To conclude, I entreat the women of this
Conference to take the girls' welfare at heart and start associa-
tions that will train them for efficient citizenship. High school
girls, student nurses, normal school girls, college girls — yours
will be the task of leading those with less advantages than you
have had. To you all I say: get ready, keep steady and fill the
position ably.

DISCUSSION

Mr. M. AGUINALDO (Bataan). — I suggest that copies of Mrs. Martinez'
speech be furnished all delegates of the Conference.

Miss FORONDA (Ilocos Norte). — With reference to Mrs. Martinez' paper,
I suggest that a Junior Woman's Club of all girls between 15 and 18 years
of age be formed in every municipality on recommendation of the National
Federation of Woman's Clubs.

THE PUBLIC WELFARE NURSE AND HER SPHERE OF ACTION

SOCORRO SALAMANCA, Superintendent of Nurses of the Office of the Public

Welfare Commissioner

When I was asked to read a paper in connection with infant
mortality and public welfare, I did not hesitate to accept the
distinction offered to me for one strong reason, and that is,
to contribute what little I can for the solution of our foremost
national problem, namely: infant mortality and public welfare.
I wish to emphasize, however, that in accepting the invitation,
I did not mean to admit that I am well versed on the subject
I will try to discuss today. It takes long years of constant
observation and practice before one can speak with authority
on this subject, which experience I do not have.

My subject is the Public Welfare Nurse and Her Sphere of
Action in the campaign for public welfare and the reduction of
infant mortality. For the sake of a clear interpretation, I have
divided her aims as follows:

1. To keep well babies, well.

2. To reduce death rate among babies.

3. To reduce maternal mortality.

4. To teach mothers, motherhood.

A graduate nurse with many years of hospital work behind
her is not sufficiently equipped to tackle the work. Oftentimes
we hear the remark that a nurse that has done some visiting
work may easily carry the responsibilities of a public welfare
nurse without any practical or theoretical preparation. This
is an erroneous assumption. She needs an appreciable length
of time for post-graduate instruction just as any other branch
of the nursing profession.

Altho at a glance all the branches of the nursing profession
strive toward a common aim, that is*, physical welfare in
general, yet the methods employed by each group, the scope
of the work and the results, differ a great deal. And this is
not all. Let us take as a comparison a general practitioner and
a specialist. The specialist attains definite successful results
168

169

of his cases and in a larger scale, because he has enough
time to spend in the study of his cases. His sphere of re-
search, his attention and, his interest are drawn toward a
particular phase of his work.

The same simile is applicable to the nursing service. We
all know that public health nursing has nine branches, namely :
visiting nursing, industrial nursing, mental hygiene nursing,
first aid and home nursing, emergency nursing, hospital social
service and maternity and infant welfare nursing. Each branch
takes charge of fields already large enough to keep their hands
full and to embrace some more will only make their principal
function an utter failure and will find it a difficult task to
determine how far has been its influence in improving public
health.

Nurses from the different branches of the nursing profession
now in operation in the islands, who tried to undertake the
work of maternity, infant and public welfare, needed a great
deal of theoretical and practical training. Many phases of the
work are utterly new for them and the methods of training
are original.

Let us now see the methods the public welfare nurse employs
in order to make her efforts produce the desired effects. I
will limit myself to describing how it differs from the other
branches.

Survey work. — Before starting any kind of an enterprise be
it commercial, social, charitable or religious, we should find out
what place would best suit our purpose. Without this preli-
minary step, we might be led to a considerable expense of
effort, time and money without any material result.

Survey work covers location and topography, soil and climate,
population, literacy and intelligence of the people and means
of communication; whether the community is industrial, agri-
cultural or commercial; its vital statistics and causes of infant
deaths; also whether there are charitable organizations and
public health activities. We also inquire into the religious be-
liefs and political opinions. However, we pay more emphasis
on the general living conditions, work done by mothers during
pregnancy and at the time of childbirth, the care she receives
during pregnancy and confinement and the cost of such care.
Also the care and health of babies and children up to pre-
school age.

Our methods of survey of infants and children's health
vary from the simplest procedure of weighing and measuring

170

with the use of our standard table charts, to that of a thorough
physical examination.

Preparation for survey work. — The need of accurate weighing
and measuring should be well emphasized. Records should be
complete -and properly filed as the results of the work depend
mostly upon this item. The above, however, are phases of the
nursing work often met with in the other branches of the
profession. But to know how to put up, repair and standardize
scales, the use of standard table charts and taking physical
examination are infrequently expected. For these reasons great
care should be taken in the selection of the nurse, to ascertain
her aptitude for the service. She should have had ample and
thorough professional education ; a variety of experience would
best prepare her for the requirements of maternity, infant and
public welfare work. Survey work requires a great deal of
visiting and this requires a nurse with the ability to gain
cooperation and to be indefatigable in responding to the calls
of those that need her care.

The technic of the survey:

1. Make a preliminary survey of the whole town.

2. Get acquainted with the officers of the town to insure co-
operation.

3. Prepare materials necessary such as scale, meter stick,
tape measure, office supplies, tables, chairs and benches, records,
charts, tongue depressors, dressing and some disinfectant.

4. Make house-to-house visits. This phase of the work in
general has many objects, but in survey work its objects are:

(a) To get acquainted with the people.

(b) To arouse their interest.

(d) To announce the survey.

(e) To invite mothers to go to the station with 'their
children.

5. Attend to the station work.

6. Give conferences and demonstrations with graphic pres-
entations, individually and collectively.

7. Answer calls.

8. Collect such other data as should be covered by the survey.

9. Fill report blanks.

As long as it can be afforded, two nurses are needed for the
station work. One to do the recording while the other to do
the weighing, measuring, and examining. From experience,
it has been found out that station work for survey purposes can
not be permanent. It should be an ambulant one to go to

171

every nook and corner of the town or province to make the
results accurate.

Organization. — When the finding's of the survey have estab-
lished the necessity of carrying out a campaign for maternity,
infant and public welfare, someone or somebody should back
the enterprise.

Such institutions must be mostly supported by public con-
tribution and aided, if necessary, by the Insular Government.
This policy has several advantages and I will try to enumerate
some:

1. It being a community fund that is used in the campaign,
the community itself see to it that the money is not used
extravagantly and that their efforts, time spent and expenses
incurred, give material results.

2. The enterprise being by the community and for the good
of the community, the local people take a personal interest in
seeing to it that it lives a long and progressive life, and that it
really diminishes infant mortality and other social defects.

3. A program inclusive of every individual and group and
every legitimate interest within the individual or group life,
must be the basis of all social effort. It is evident that a
program that holds the interest of any considerable group must
have some merit.

Very seldom does it fall on a nurse's province to take up
organization work, especially community organization. How-
ever, the public welfare nurse has /often been called upon to
do it. Whether she has been successful or not will be determined
by future results.

The part of the nurse in organization work is the following :

1. To approach the most influential persons of the community,
to advertise her purpose just as a salesman does with his goods.
Like a salesman, the nurse should be capable of giving the
most convincing facts of the good qualities of her goods and
the advantages it will afford if made use of. She should ap-
proach at least a representative of a religious or political or any
other party in existence in the community, whose cooperation
she will need.

2. To conduct public meetings in order to acquaint the people
about the advantages of the enterprise and the imperative need
of their cooperation.

3. To speak in schools, to make a propaganda thru the school
children and teachers.

The above details point out the necessity of a higher edu-
cation and thorough training that public welfare nurses should

172

have as a background. Further research work and a more
intensive habit of reading are imperative. She should be ac-
quainted not only with matters pertaining to her line of work
but also with a good knowledge of all other sciences and arts.

4. To conduct or help conduct meetings preliminary to or-
ganization. Here again the public welfare nurse should be
familiar with parliamentary rules and with the requisites of
the Bureau of Commerce and Industry previous to preparation
of the articles of incorporation.

5. Once the association is constituted the nurse helps the
directors in raising and collecting funds. They either go from
house to house or hold benefits. Oftentimes the nurses have
to be the leaders of the affair to be an incentive both to the
officers of the town, the directors of the association, and the
community in general.

6. While the nurse is working for the organization of the
association she has to perform such other duties as are inherent
to her mission. This will insure the community's confidence
on the necessity of the institution and will stimulate their ready
response and cooperation.

7. As soon as the association has enough money to start the
work, and the services of a physician and a nurse, or a nurse
alone, have been secured, an estimate of the expenses for the
operation of the puericulture center should be made. In this
detail the nurse is an indispensable factor. She should be
the source of very valuable information as to the equipment,
utensils, medicines and other supplies necessary, with their
approximate cost. She should also be able to give opinion or
advise when selecting the site for the center.

8. Very often, a nurse is called upon to perform the duties
of a secretary. She is the one that should prepare a system of
blank forms, reports and filing.

9. Lastly, she helps in putting up the puericulture center.

A few more words about organization. Any organizer be-
fore going to the field should know that our people have certain
peculiarities which should not be overlooked to make the organi-
zation a success. The procedure should be from below rather
than from above. The necessity of the organization should not
be forced into their minds. It will have to be by suggestion.
Avoid appearing to them as being very much above their level
and boasting as an intellectual man. Remember that the meek-
ness and patience of Christ gained for Him his universal faithful
followers.

173

Demonstration work. — As soon as the center is ready for
operation, the nurse conducts demonstration work; that is, she
shows the permanent nurse how to do things. She works out
a plan of procedure which will make sure that no well-intentioned
effort should be thwarted thru badly-directed methods.

The work of the public welfare nurse in a puericulture center
should be:

1. To receive mothers.

2. To take data.

3. To undress infants.

4. To weigh, measure and record same.

5. To prepare for examination.

6. To attend physician during examination.

7. To give further instructions to mothers in the ways of
carrying out the physician's advice.

8. To demonstrate, if necessary, how to give treatment.

9. To give treatment when ordered.

10. To file records.

11. To fill report blanks.

12. To give lectures on maternity and child care with de-
monstration, encouraging always breast feeding.

13. To do follow-up work.

14. To do relief work.

Prenatal work in connection with the puericulture center:

1. Attract girls and prospective mothers by house-to-house
visits, conferences, and clubs. Mother's and little mother's
leagues will help a great deal.

2. Teach as early as possible sex hygiene.

3. Inculcate the principles of hygiene in pregnancy and see
that the mother-to-be follows all advice given.

4. Convince expectant mothers to be under the care of a
puericulture center, a physician or a nurse, from the time of
conception. Advice them to attend the center or to see the
physician or the nurse regularly.

5. Help the expectant mother prepare the necessary things
for confinement.

6. Urge confinement in hospital.

7. Attend delivery in hospital or at home.

8. Give care during puerperium.

9. Instruct mothers to make regular visits to the center after
puerperium.

10. Visit them in their home to ascertain if all instructions
given are faithfully carried out.

174

Follow up work. — This is done for the following purposes :

1. To ascertain whether what has been shown and instructed
is being followed or not.

2. To determine the degree of influence of the campaign.

3. To find out the living conditions of the family under care.

4. To be acquainted with the family and to gain their con-
fidence.

5. To give such other assistance as may be necessary, such as
food, money, and clothing; shelter, etc.

6. To convince mothers of the necessity of regularly calling
at the center.

Relief work. — The public welfare nurse is often called to do
social case work. She goes to make investigations. She ap-
proaches employers, priests, physicians, and teachers, and the
relatives and friends of the persons concerned. She diagnoses
the defects and makes recommendation for relief. She is often
the messenger of the relief agencies, or gets the relief from
her personal pocket.

In cases of disasters such as fire, flood, famine, etc., she
has been always ready to relieve not only physical injuries but
also to secure shelter for the homeless and food for the hungry.

Aside from what has been mentioned it would be advisable
to say here that the public welfare nurse in her daily rounds
has been able to refer many, many cases for hospital care,
asylum, settlement house, orphanage and other special insti-
tutional care, not to speak of the cases for which she has been
able to secure employment.

Provincial work. — There is a prevalent inclination among
some of the graduate nurses to prefer to work in the city
rather than serve in the provinces. It is true that provincial
work is a trying ordeal and often undermines the health. But,
is it not more blessed to serve where we are most needed? Is
it not a great satisfaction to feel that we have been important
tools in saving a life just as when the missionary man saves a
soul? The city is crowded with hospitals and dispensaries,
there are numerous medical practioners, drug stores in every
nook and corner, and many nurses and charitable organizations.
Think of our countrymen yonder in isolated towns and barrios
where besides the absence of the facilities encountered in the
city, distance is a very serious obstacle to securing medical aid
and medicines. Imagine a town where they have to travel
nineteen kilometers before a physician could be summoned and
medicine bought. Add to this the poor condition of the roads,

absence of transportation facilities, in times of floods and storms
and a very ill patient at that.

No doubt you have all witnessed the anxiety of a family
where one member is ill and all attempts to secure facultative
aid have failed. No wonder that the sick as well as his relatives
would just sit and wait for the end.

When a nurse reaches a town to start a work, she often
meets with indifference, superstition, opposition and rebuke.
These are but passing clouds. It does not take long before,
instead or your going to the people, you will see them flocking
around you, eager to receive a kind word or a caressing touch
at least. However, this will depend upon the personality, tact,
sympathy, and skill of the nurse.

One important detail must not be forgotten. I refer to re-
ligious tolerance. The time has passed when nursing was
closely attached to religion. Today we minister unto the needy
irrespective of religious creed. We can save their lives with-
out catechizing. When you are in a town where there is a
predominant creed do not attempt conversion as this will call
for unpopularity and render the campaign unsuccessful.

Difficulties. — The most common difficulties met with in pro-
vincial work are the absence of medical aid. This throws
the nurse into a greater responsibility. She is forced. to go
beyond her limitations.

The absence of drug stores is another great handicap.

The efforts of a provincial nurse in improving health, pre-
venting disease, and diminishing mortality is thwarted when
there are no facilities for hygienic living. Most common
among these are improper disposal of refuse, very poor drainage,
and the use of the surface wells.

The appeal to improve these things should go hand in hand
with the campaign for maternal, child and public welfare.
Otherwise one-half of the efforts of the health workers will be
in vain.

In closing, permit me, ladies and gentlemen, to say a few
words about the campaign that the Office of the Public Welfare
Commissioner is now undertaking in the provinces. Your pre-
sence in this Conference has a great significance to us and we
pray that the hope we put on you for the success of our campaign
will not be deferred. From the first days of our struggles to the
present we have always been the recipient of the kind hospitality
and unfaltering cooperation of the people in the provinces
and wre must say that we appreciate them in a most genuine way.

176

May brighter days dawn to our suffering infants thru your
indefatigable assistance.

DISCUSSION

Mrs. DOLORES VDA. DE LUNA (President, Bontoc Woman's Club). — For the
welfare of the children in the Mt. Province, I suggest that a female nurse,
to be paid by the Office of the Public Welfare Commissioner, be appointed
to work in the town or capital of Bontoc.

Mrs. CANDIDA BELO (Capiz Woman's Club, Capiz). — The Woman's Club
requests that the Office of the Public Welfare Commissioner support a
nurse to work exclusively for the club in this municipality and that every
municipality be provided with a nurse instead of a "sanitario" if the town
cannot afford to have both, because nurses can do better work and have
more interest in public welfare. Su.ch a nurse must be under the control
of the woman's club. It further requests that the municipal nurse hold
a conference for mothers once a week under the auspices of the club; and
that private midwives be instructed by nurses before they are allowed to
practice.

Mr. A. P. ANUNCIACION (San lldefonso, Ilocos Sur). — I suggest that
the Office of the Public Welfare Commissioner furnish every municipality
with one nurse at its expense with the provision that such nurses charge
for their services; and funds so acquired be turned over to the government.

Miss PRESENTACION OBADO (Bacarra, Ilocos Norle). — In view of the fact
that the northern provinces of Luzon suffer from epidemic diseases every
year, I suggest that the Office of the Public Welfare Commissioner ap-
propriate a sum of money to pay district nurses, for only a very few of
the municipalities at present can afford to pay nurses.

Mrs. RAMONA R. BULLO (Mariveles Puericulture Center, Bataan). — In
connection with our puericulture center, I suggest that the nurse be given
the privileges of having Sundays and official holidays off, for as it is, she
works during the entire week.

Miss CONSOLACION B. MORA (Iba Woman's Club, Zambales). — I suggest
that a female district nurse be stationed in Zambales to cooperate with
the provincial physician in helping mothers solve the problems of infant
mortality and public welfare. I feel that a female nurse understands the
urgent needs of our girls and women better.

Mrs. JULIANA P. PATRIARCA (Guinobatan, Albay) . — I suggest that all
municipalities without puericulture centers, be provided with a nurse who
should make house-to-house visits instructing mothers in hygiene and
sanitation.

Miss RAMONA BELLO (Bangui, Ilocos Norte). — I suggest that towns far
from the provincial capitals be provided with one graduate nurse. I fur-
ther suggest that the president of health must be at least a graduate from
the nurses' school.

Miss CRISTINA ORDONA (Delegate, Woman's Club, Bauang, La Union). —
I suggest that there should be at least one nurse for every municipality in
the provinces to look after the people. The nurse should visit the whole
town and the remotest barrios.

177

Miss FLORENTINA PACQUING (Santiago, Ilocos Sur) . — Ini as much as the
services of a nurse are indispensable in the fight against infant mortality,
I suggest that every provincial town be provided with a nurse and a free
clinic where mothers and children can secure proper aid.

Miss MARIA PASTOR (Delegate, Woman's Club, San Felipe, Zambales). —
I suggest that every club in Zambales should have a nurse to be paid and
supported by their respective municipalities.

Mrs. ENRIQUETA DE PERALTA (Ilocos Norte). — As it has been explained to
us, the public welfare nurse should work for the masses. Comparatively
speaking only a few enjoy the help of these visiting nurses since there
are not enough of them to do the work. Isi it possible for the Bureau of
Health and the Office of the Public Welfare Commissioner to solve this
problem, by furnishing each town with a nurse to cooperate with the
Woman's Club or any local club in the observance of the sanitary regula-
tions?

MISS SALAMANCA'S ANSWERS

There is a shortage of nurses just now.

As to the suggestions that the Office of the Public Welfare Commis-
sioner furnish at its own expense a nurse to each town, I must say that
the policy of the Office is to make the woman's club pay for the salary of
their nurse.

As to having nurses instead of "sanitarios," this is a matter that should
be referred to the Public Health Service. I doubt whether nurses working
in place of "sanitarios" may ever be placed under the control of the
woman's club.

It is part of a nurse's work to give conferences to mothers as often
as possible, if she has had the proper preparation. There should be a law
regulating the practice of private midwives. When a nurse has not antag-
onized the private midwives, she will do a great deal in improving their
methods by having them under her supervision.

The question of appropriating money for district nurses during epidemics
should be referred to the Philippine Health Service whose function is to
support district nurses to combat epidemics. The suggestion that a female
district nurse should be stationed in Zambales should also be referred to
the Philippine Health Service. The same may be said with the other sug-
gestions asking for nurses in municipalities having no puericulture centers.

A nurse should have such amount of rest that would compensate for her
hard work. Otherwise she will ruin her health. I am of the opinion that
on Sundays and official holidays a nurse of a puericulture center should
be left free for recreation and rest, provided that she may be called upon
to attend emergency cases.

185611 12

PREPARATION AND DUTIES OF THE VISITING NURSE

ANASTACIA GIRON, Superintendent, Nurses Training School, University

of the Philippines

The qualifications of the visiting nurse are not only practical
and professional, but in a large measure spiritual. Purity, inte-
grity, and broad social conceptions of duty to mankind must
constitute her ideals and must manifest themselves in her daily
routine work.

An institutional or a hospital nurse works in most cases under
favorable conditions. There is a set of rules for 'her and the
patient under her care must follow the regulations prescribed
by hospital authorities'. In the hospital, there are the director,
the superintendent and other officials at her elbow. In times of
difficulty, they are there to help her in anything which may arise
in connection with her work. There is an adequate supply of
linen, appliances and other equipment at her command, and
above all there is just one patient as a unit to care for.

A district or a visiting nurse does not have these facilities.
Every home is her hospital. Her work takes her to factories
for industrial workers, into the school rooms to look after the
children's health, and into the remotest parts of the district.
There is no set of rules for her and the patient to follow; she
has none of the supplies, appliances and equipment which she
is accustomed to use in the hospital wards. She goes to the
patient and not the patient to her. Her work compels her to
take the whole family as a unit. She has to be interested not
only in the patient, but in every member of the family. She has
to win the love^and confidence of the patient, and the help and
sympathy of the father and mother, the brothers, sisters, grand-
parents and sometimes 'aunts and cousins and other relatives
who are zealously watching her in her work. Her sphere of
action is thus broader and larger than that of her sister nurse
in the hospital.

Here is where she finds her greatest field of usefulness, where
she can use (her ingenuity, intuition and resourcefulness1, be-
cause at a short or no notice at all she must devise means to
substitute the rather luxurious things she was accustomed to

178

179

in the hospital. Her influence is far reaching in her task of
preaching the gospel of sanitation, the importance of raising
better babies, and the necessity of minimizing morbidity and
lessening death rate.

She is the connecting link between scientific knowledge and
results. She is called upon to solve many tangible and intricata
human problems and she must necessarily be a social worker.
Public health nursing is a most interesting and fascinating
branch of the profession. It is a national service. Much of the
progress of the Philippines depends upon the work of the army
of public health nurses.

In the Philippines a post graduate course in Public Health
Nursing from six months to two years to prepare nurses to join
public health work more effectively could be established. In
order to inspire and to give the best training to the nurses who
desire to take up public health nursing, visiting nursing, and
other specialized branches of public health nursing, the course
should be given under the University of the Philippines, the
highest institution of learning in the country. The course to
begin with should be six months' and later extended to one year.
The course should include lectures in psychology, sociology, case
work on social service, sanitation, statistics1, dietetics, and ad-
vanced subjects in nursing and other subjects in connection
with the course.

The course should include fifty per cent or less of lectures
and fifty per cent or more of field work in order to obtain the
best results.

One of the most important duties of the visiting nurse is to
help in the reduction of infant mortality. When a nurse is
sent to a district to work, she should first of all take a survey of
the place, she should know the population, its common occupation
and industry ; she should acquaint herself with the municipal or-
dinances, legal proceedings, water supply, laws governing hous-
ing and disposal of house waste, contagious disease, child labor
laws, philanthropic agencies of the city, and their functions and
office hours.

An effective means of reducing infant mortality is the organi-
zation of a Little Mother's League. Every school girl between
the ages of 10, 12, and 14 should become a member of this league.
The visitingliurse could make the membership run to hundreds.
Literature of the work, aims, and functions of the league should
be distributed. Members should be given lectures in simple
language on the care of their little brothers and sisters. Prac-

180

tical demonstrations in giving bath, dressing the babies and the
like should be touched in every meeting. Mothers1 should be
invited to attend the meetings. By-laws should be drafted,
badges distributed. Each member should be told to invite one
or two friends at each meeting.

A mother's club composing of mothers and expectant mothers
could also be organized. The aim of the club should be to
inculcate the importance of prenatal care, the importance of
hygiene, proper diet and sanitation, care of babies and the
home. These should be explained in lectures.

School teachers can greatly help the work of the nurses
through cooperation, and by helping organize this Little Mother's
League among the school children.

The work of the woman's club and that of the visiting nurse
is so closely allied that cooperation between the two is essential.
The work, of the woman's club aims at civic improvements. It
concerns itself among other things with the reduction of infant
mortality. The club could help the nurse in many ways in her
work. The raising of funds for the acquisition of proper sup-
plies and office for the nurse and to pay a salary commensurate
to the work of the nurse are among the duties of the club. The
nurse interprets the ideas and spirit of the woman's club, and
the woman's club in turn interprets the work of the nurse to the
public. The i woman's club can influence the right type of young
women to enter the training school for nurses.

DISCUSSION

Dr. SUMBITO (Occidental Negros). — In the provinces, nurses are very
scarce, therefore I suggest that the requirements for admission to the
nurses' school, be reduced so as to qualify intermediate graduates.

Mrs. S. B. LONDRES (Oton, lloilo). — Referring to what Miss Giron has
said that not all trained nurses are efficient public health nurses, I suggest
that a special school for nursing under the direction and control of the
Office of the Public Welfare Commissioner be opened, so that nurses who
are to operate puericulture centers in the provinces may receive training
before they are detailed to operate such centers.

Miss MANAHAN (Balanga, Bataan). — In order to make Miss Giron's
suggestion effective as regards the Little Mother's League among the school
girls, I suggest that the authorities concerned request the Bureau of
Education to issue regulations in accordance with the suggestion.

Miss JOSEFA SERRADO, „ — The Philippine General Hospital

being a Government institution for nurses, where hundreds have already
graduated, I suggest that the Legislature be requested to give the Philip-
pine General Hospital sufficient money, so that it can offer post graduate
courses in nursing.

181

Mr. D. J. SAMONTE (Laoag, Ilocos Norte). — As the requirements for
the nurses' course have been raised by the Board of Examiners, the number
of applicants is consequently limited. For this reason, it is suggested that
the requirements be the completion of the intermediate course of instruc-
tion only.

Dr. MANUEL M. AVELINO (Delegate, Provincial Board, Leyte). — I sug-
gest that the educational requirement for the nurses' course be limited
to the completion of the intermediate course. I suggest also that the
Legislature enact a law authorizing all municipal governments to appoint
three "pensionadas" to take up the nurses' course, one of whom must take
up a course in midwifery.

Miss. FELIZA BAUTISTA (Delegate, Woman's Club, Santa Barbara, Pan-
gasinan). — To reduce infant mortality, I suggest that each municipality
pension one person to take up the course in midwifery, since in most of our
towns there are no physicians.

Mrs. MARIA A. DE TALAVERA (San Fernando Woman's Club, La
Union) . — To interest and encourage those who wish to take up the nurses'
course, I suggest that each municipality aided by the Insular Treasury
pension one young lady to study nursing and to later return to that
municipality to work. I also suggest that the nurses' course be shortened
as was done during the last world-war, so as to enable them to take up
other studies if they so desire.

Mr. Pio Gozo (President, Mahay hay Puericidture Center, Laguna) . —
Due to the scarcity of nurses, I suggest that each municipality be requested
to give scholarships to some accredited school for nursing and midwifery.

TRAINING RED CROSS AID OR CHILD WELFARE VISITOR
ELIZABETH M. BORDMAN, Supervisor of Nurses, American Red Cross

Classes for Red Cross Aids, or child welfare workers, which-
ever you care to call them, were organized to fill a need which
it will take years to meet, if we wait until there are enough
nurses to fill these places. We are not trying to make trained
nurses of them; the time is too short to do that, and they
thoroughly understand this. But we can, and this is what we
have tried to do, give them a thorough training in practical
nursing.

Our subjects have been anatomy, physiology, obstetrics, sur-
gery, hygiene, and sanitation, and the care of the baby. All
of their work has been with the mothers and babies.

In the training of these women it must be remembered that
they have no hospital to work in, nor patients to work on,
except maternity cases. To make it easy for them to under-
stand we have worked out a course of lessons covering the three
months. During the first month we have anatomy, and phys-
iology, which they must know something about to enable them
to know and locate the different bones in case of fractures;
and arteries and veins to control hemorrhage. This is in con-
nection with first aid. During the second month we have ob-
stetrics, hygiene, and sanitation.

In the Home at headquarters we have six trained nurses and
six aids. In the district work in the morning, from 7 to 12
noon, each nurse takes an aid with her; to her work. In these
visits the nurses' teach v the aids how to take care of the baby
and mother.

Before the aid can teach the mother anything she must learn
Tagalog. The aids come from provinces where other dialects
are spoken, so before they could take the work alone they had
to learn this dialect. This they did in less than two months.
At the end of that time the work that they were doing with the
nurses was turned over to them, and the nurses took up new
work, supervising the aids every few days.
182

183

The nurses do district work in the afternoon. The aids
have class from 2 to 3. Practical work on the lesson is1 done
from 3 to ;4, and the recording of their visits from 4 to 5.

We have used for textbooks the "American Red Cross First
Aid" and the Philippine Health Bulletin No. 19, which Dr. de
Jesus, Director of Health, kindly gave us enough copies to
supply the first two classes.

Following the lesson we have practical work. If the lesson
is on fractures the assistant, one of the nurses, gets everything
that is needed to take care of any kind of a sprain or fracture
from a simple to a compound fracture. Two of the aids are
used as subjects; the others do the work. Everything that is
done in a hospital for these cases is done in the class. All
kinds of baths and sponges are given. Three of the aids are
put to bed, and three aids do the work. All treatment ordered
is given just as it would be to a patient in a hospital. Hot
water bags are filled with hot water. Ice bags are filled with
ice and applied.

In lessons in reducing a baby's temperature we use the foot
tub. The water is made the right temperature before the
baby, which is a doll, is put in. It is treated just as a live baby
would be treated and given the same care afterward. The as-
sistant in all the classes supplies the equipment for the prac-
tical work.

After all kinds of emergencies and sickness have been ex-
plained and demonstrated we take up review work. We have
the same lessons, but the aids must find the appliances for the
demonstration.

We have about eighteen obstetrical cases a month, delivered
by the nurses. Two aids always go with a nurse. In most
of these cases they are out all jiight.

At headquarters on Wednesday afternoons, from 4 to 5, we
have a "Little Mother's Class." Nurses and aids teach these
children, who are from 10 to 15 years old, how to bathe and take
care of the baby. They use a doll to demonstrate. In this
class we have from twenty to twenty-five children.

On Thursday afternoons we have a class of children which
number about 40. The little ones are taught kindergarten
work, and the older ones quilt pads to put under the babies in
the district work. They work one hour and play one hour.

It is through these children, if we can keep them interested
that we hope to put into practice our lessons in sanitation.

184

On Friday afternoons, with the exception of the dispensary
nurse, and one hour given to the aids' class, the time is given
to sewing for the poor and for the coming Christmas.

On Saturday morning in the dispensary, from 7 to 9:30, we
have baby bathing, and a talk on cleanliness and sanitation.
At this clinic the mothers who are willing and can give the baby
a bath correctly are given a prize. These mothers have been
taught in their homes by the nurses and aids how to bathe and
take care of the little ones.

We have a big dispensary work in Azcarraga, with clinics
every day from 2 to 5 p. m., except on Sundays and holidays. We
have from 900 to 1,000 patients a month. Here the aids get
good experience in taking care of simple surgical cases. They
also attend the maternity clinics on Tuesday and Friday morn-
ings.

These aids, a class of six young girls — one from Cagayan,
one from Laguna, one from La Union, and three from Ilocos
Norte — have done good work. I feel sure that with a little
supervision and encouragement from their branches and .clubs
they will continue to do good work. They are young, too
young some of them, so you who supervise will have to be
patient with them, until they are familiar with their work. It
is not easy for experienced people to go into new places and
new work, and it will not be for these aids.

We would like them to run their little health centers on the
same plan that we have at headquarters. I feel sure that these
aids will make an effort to make their centers, probably on a
smaller scale, what the Azcarraga Center is.

We are receiving many letters of commendation from regis-
tered nurses in regard to this work that is being done. We
would like to take this opportunity to assure them that this
expression of their appreciation is a great stimulant to us to
push on to higher and broader fields.

We will also take this opportunity to tell you how much we
owe to the Red Cross nurses at headquarters, and to our Red
Cross nurse at Navotas, Rizal, in training these aids. Together
they have been enthusiastic workers. We wish this first class
of Red Cross Aids every success in this pioneer work that they
are going into.

DISCUSSION

A DELEGATE. — Three months training in Red Cross Aid is not sufficient,
so I suggest that the course be lengthened to six months, one month of
which should be spent at the San Lazaro Hospital.

Miss ANATOLIA P. GALANO (Batac, Ilocos Norte). — Ilocos Norte is for-
tunate in having secured the services of a Red Cross nurse. At present
the office of this nurse is located in a private home where people are em-
barrassed and reluctant to go and ask for help constantly.

I therefore suggest that the Red Cross secure a room for an office in a
building that is easily accessible to the public, and preferably one with a
telephone connection.

MRS. BORDMAN'S ANSWERS

In regard to the training of the Red Cross Aid, I agree with the remark
made that three months training is a very short course. Six months, by
all means, should be given if the Red Cross branch and the clubs are willing
to bear the extra expense. I think, too, that great care should be taken
in selecting the candidates. They should be women who are interested in
the work, not too young, and with a seventh grade education if possible.
However, all these questions will have to be decided by the Manager of the
Philippines Chapter.

The Ilocos Norte nurse and her work has* never been under my super-
vision. So, that too will be decided by the Manager. I know that he
will make every effort to help in every way that is best.

THE ACTIVITIES OF THE CATHOLIC WOMEN'S CLUB OF

MANILA

Mrs. IRVING C. HARTIGAN, President of the Catholic Women's Chtb

The Catholic Women's Club of Manila highly appreciates
the honor of the invitation to speak before this wonderful con-
ference which is marking one more great step forward in the
rapid progress of the Philippines towards its merited place
among the nations of the earth.

We surely are with you in spirit and in person and in our
modest way we will endeavor to have you feel that we are — and
that we are of some assistance in the country's wide campaign
for public welfare and the saving of the country's little chil-
dren— two magnificent objects that are primary with every
woman's club in the whole world — no matter what may be its
professed scope or its, stated activities.

In these days when woman's clubs are being organized all
the time for every good purpose we are among the very newest
of them and whatever little success we are having is a proof
that doing good is not necessarily accompanied by long faces
and sad statistics, but can be accompanied with cheerfulness
and sociability.

We started out with the idea of organizing the Catholic
ladies of the large and growing English speaking congregation
of the cathedral of Manila of different races and nationalities,
so that there would be friendly relations established and so that
the more powerful influence of an organized body could be
used to further the welfare of the entire community.

We found that there was a very goodly amount of that won-
derful Oriental cordiality and friendliness, that is in the air
of this beautiful country, existing among our own members,
and there was but little difficulty in securing sufficient number
for a good start. After the usual fuss and feathers ever con-
sequent on launching a ladies' organization, we found ourselves
with a brand new club and brand new officers, many of whom
were without much experience in parliamentary organization,
but making up for want of knowledge of "Robert's Rules of

186

187

Order," by enthusiasm and interest. Also we found ourselves
with sixty live, active, members ready for any good work that
might come to hand. We first got well acquainted by holding
meetings in each other's houses, enjoying refreshments1, chat--
ting over situations and listening to talks on work done by
Catholic women in different countries but particularly by the
Catholic women's organizations in America, and other talks on
the truly wonderful growth and influence of the National Ca-
tholic Welfare Council of the United States which, in addition
to its religious progress, is recognized by thinking America
as one of the greatest movements for public welfare and civic
virtue and one that will valiantly help in keeping civilization
extant, militant, and away from the horrible chaos that threatens
the whole world.

These talks were made at our meetings by such esteemed citi-
zens as our great and good Archbishop O'Doherty and our Pastor
Father McErlain, both of whom have recently returned from
a long voyage to Rome and Europe and a comprehensive visit
to the United States.

One of the first functions of the club was a tea for the newly
arrived Jesuit fathers from the United States who have come
to the Ateneo de Manila to keep that great school in its proud
place in education of the Philippines. All of these gentlemen
have appreciated the splendid welcome the Islands gave them,
notably Father Byrne and Father Duffy, who have been giving
us up-to-date talks on public welfare and welfare organizations
and who are taking splendid personal interest and personal part
in the unequalled progress of our dear Philippines, of which
the speaker is a proud and enthusiastic daughter.

The question of what welfare work the club should do was
continually discussed and we found, and are finding, plenty of
it. While ever keeping up the entertainment side of the club
we formed committees for practical work and our committees
are real, working committees too. The variety of welfare work
crying to be done in Manila alone is simply wonderful and
it is not all confined to the people of the Islands.

For instance, a small but much appreciated work we did was
visiting the many sick and destitute sailors in St. Paul's hos-
pital, all of them many thousands of miles away from home
without friends and even without acquaintances. Reading mat-
ter, small gifts, pleasant talks, efforts to procure employment,
etc., cheered up the spirit of these poor sick men, many of
them still small boys and away from their homes for the first

188

time. Our efforts for these men called attention to the other
destitute Americans in the Islands, rendered destitute by the
economic "baguio" that has been sweeping the world, and now
the rich and powerful American Chamber of Commerce has
taken up their problem and will settle it satisfactorily.

However, we know that charity should begin at home, and
we find plenty to keep us busy in the Islands, and, while we
believe that welfare work and charity should include every race
and every creed, we find a vast field for work among our own
Catholic people here.

Very little has been said in this Conference of the welfare
work of the greatest private charitable institution in the
Islands, the Roman Catholic Church. I suppose it is because
its charity is universal and eternal and that people do not speak
about it because they are accustomed to it like they are to the
daylight and to the sun, but possibly a few of the details of
its work as it exists in Manila will be interesting.

In the remodeled and modernized hospital of San Juan de
Dios alone, one hundred absolutely free beds are in daily use
and occupancy.

In the great St. Paul's hospital, 15 per cent of its large
capacity, is kept and used for free patients.

One thing in which the Philippines leads the Christian world
is that there are no poorhouses in the Islands and while we
have the Hospicio de San Jose ready and open for unfortunate
poor, only sixteen poor old people are registered there, and
the principal work of the Hospicio, all of which is purely char-
itable, is in caring for the little ones.

For example, while the number of babies abandoned by their
mothers in the Philippines is infinitesimal in comparison with
other countries, still there are some and since American occupa-
tion the Hospicio de San Jose has received more than two hun-
dred of these poor waifs through its always open, revolving
basket which admits the little human contained in it without
card of identity nor appearance of the depositor. Of older
babies and destitute orphans the Hospicio at all times takes
care of a hundred of them and they are well kept and satisfied.

The Belgian sisters in Tondo care for and educate one hun-
dred poor little girls while Looban School does the same for an
equal number of the same class ranging between four and four-
teen years of age and Santa Isabel School makes a home where
everything is provided for.

In Santa Ana the archbishop has just opened a house of the
Good Shepherd which will take motherly care of wayward girls

189

and also contain a school for orphans and poor children. While
this is an old established institution in Europe and America
it is a new institution in the Orient. The nuns are un-
selfish American ladies who are ready to work for and with
unfortunate girls of the Philippines and their work will bring
contentment and virtue to these erring ones and at the same
time build up the morality and conscience of the Islands.

This is but a partial list of the charitable work of the Roman
Catholic Church in Manila alone, and you can see that the field
is a very wide one, too wide to be satisfactorily covered by
a small organization like our present Catholic Women's Club
which, even though it is rapidly increasing its membership and
hopes at sometime to have many thousand members, is yet,
necessarily, very limited in its numbers.

The field of our activities extends to individual cases as well
as to institutions and we have been successful in doing many
individual acts which are for the welfare of the community
and country, and we are ready and anxious at all times to aid
and assist in all cases brought to our notice by our very com-
petent visiting committee or otherwise.

I will not take up any more of your valuable time with our
club and its activities. We feel the honor you have done us by
inviting us and listening to our intentions and practices. We
believe our club in a modest way has solved the problem of
keeping up the interest of the club members in the public wel-
fare activities of the club by uniting with these activities a
never ceasing sociability and friendly intercourse.

DISCUSSION

A DELEGATE. — I wish to know if the institution is for penniless and de-
pendent children regardless of creed, — Catholic, Aglipayan, etc.

Mrs. HARTIGAN. — It is mostly for wayward girls. It makes no dif-
ference as to religion.

A DELEGATE. — I would like to know if this institution is for the children
of Manila only, or for the provinces as well.

Mrs. HARTIGAN. — I believe it is for all, — Manila and the provinces.

THE DEVELOPMENT AND CONSERVATION IF OUR NATURAL
RESOURCES AND THEIR BEARING ON PUBLIC WELFARE

MARIA R. VALDEZ, Director of Women, University of the Philippines, and
President, Philippine Conservation League.

The subject of the development and conservation of natural
resources seems to be far-fetched and yet upon deeper study,
we find that all doctrines' spiritual, ethical, physical, and edu-
cational have to have an economic background. The twofold
motive of the existence of an organism, that of self-preservation
and reproduction, the very alpha and omega of life, is the one
that controls the activities of human beings and their relation
with one another. For this reason, the economic foundation
is the essential, for how can we teach our people to have better
homes, to feed their babies properly and dress them decently,
to use disinfectants, to use mosquito nets and all those demands
of sanitation and hygiene, higher standard of living and educa-
tion, if they do not have enough means to do so? Hand in
hand with our sermons on sanitation, hygiene and education
must come our precept and example in the way of acquiring
the means of livelihood, for what we teach our people cannot
do much with an empty stomach, nor can they be put into prac-
tice with respect to children living under conditions of poverty
and distress.

Inasmuch as society thrives or languishes according as pro-
duction is abundant or scarce, then national prosperity must
be founded on our resources, human as well as natural. These
two resources are both indispensable as are the two blades of
a pair of scissors, one plays no larger role than the other. The
Filipino people are a good human material; our forefathers
have left us a heritage of strength, courage, and endurance;
their legacy of mines, forest, land and water are left for us
to develop and to take advantage of, that we may be healthy
and happy, but we are to use them wisely in order that we may
hand them down to our children and children's children in a
state more useful, more productive, and more lasting than when
we received them ourselves.

190

191

And what are these natural resources, how shall we take
advantage of them that they may minister unto our needs ?

Let us first take our land resources. The Philippines cover
an approximate land area of 29,629,600 hectares. Sixty-three
per cent of this is covered by forest and public lands, 21.5 by
cogon and open lands, mangrove swamps and unexplored lands
while there are only 15.4 of private lands almost one-half of
which is not cultivated. This means therefore that only about
8 per cent of the total area of the Archipelago is cultivated.
Even Ilocos Sur, the most thickly populated province of the
Archipelago has only 40 per cent of the land area under cul-
tivation while 47 per cent is covered with cogon. In Cotabato
alone the land area of which is 2,491,580 hectares about 20
times as big as the Province of Ilocos Sur, only 0.2 per cent
is under cultivation.

And yet in view of this condition we find that there are
regions which suffer from lack of food. Of the total area of
the Philippines more than one-half is considered suitable for
agriculture, but so far only about 567,000 hectares or about
2 per cent has been applied for as homesteads, lease, sale, and
free patent concessions. Lands in the Philippines can be had
for the asking and the Government gives 24 hectares to any
man or woman 18 years of age or the head of a family who does
not own more than 24 hectares for a fee of 1*20 payable in
annual installments. Public lands are also leased or sold at
any low price, this being done only to encourage the Filipino
to own and cultivate farms. These lands can be planted with
sugar, hemp, coconuts, rubber, and other staple and commer-
cial products. With proper methods of cultivation, the area
now cultivated would double its production, and if, with the
improvements in cultivation there would go hand in hand an
extension of the area cultivated, we could treble or even qua-
druple our output. If the 4,621 men Filipino laborers who
went to Hawaii had gone to Cotabato for homesteads, there
should be 100,904 hectares of land added to our agricultural
cultivated lands.

Calculations on rice production show that if 300,000 hectares
were put under proper cultivation there would be an increase
in the annual production of rice by at least 6,000,000 cavanes
and would surely remedy the annual shortage of rice which
has amounted to abut 3,500,000 cavanes for the past 20 years.

The extensive grass lands of Nueva Vizcaya, Mountain Prov-
ince, and Bukidnon could be utilized for pasture lands. At

192

present there are only 603,107 heads of cattle and 1,271,000
heads of carabaos in the Philippines and yet there is an annual
importation of cattle, carabaos and meat products amounting
to an average of 1*3,502,983 for the five-year period, 1915-1920.

With the development of these grass lands and the increase
of our pasture we would have enough meat for food, leather
for our shoes, milk for our babies and work animals for our
farms. In smaller farms poultry and hog raising could be well
encouraged. In 1918 eggs valued at f*966,346 were imported.
Why could not our farms supply this need and export as well?
For the proper development of the said industries, the Bureaus
of Science and Agriculture are always ready to lend their aid.

The Philippines is rich in mineral resources. Gold, silver,
and non-metals including chemicals and building materials are
abundant. Mining, however, is an industry where capital is
necessary, so that we shall consider only those which can be
developed with small capital and within the reach of most of
our people.

The building materials, such as lime, stone, rock, brick, and
clay could be well utilized for the making of stronger and more
comfortable homes. The making of clay pipes for the proper
disposal of waste, could be encouraged in small communities.
The salt industry needs nothing more than some effort, yet
salt figures as one of our imports. The encouragement and
development of this industry will foster the salted fish industry
and remove refined and crude salt in the list of our imports.

In water power, the Philippines has the advantage of a high
and young tophography and constant rainfall so that there is
surely a great blessing that awaits the development of this
inexhaustible source of energy. The generation of electric
power in our rivers and streams would 'bring about much
production at low cost so that in the end the poor will be able
to share the comforts now enjoyed only by the rich. Elec-
tric current will make work on the farm and in the home
cleaner and easier so that there will be an increase in health
and wealth and more time will be given for recreation ne-
cessary to the human body or study for the ignorant mind.
Light generated at low cost will result in the proper lighting
of the streets and thereby eliminating' the perpetration of
crimes in places which otherwise would be dark. There is
no province in the Islands but where there is some waterfall
or strong stream which can be harnessed to furnish motive
power for engines ranging from 10 to 1,000 horse power or over.

193

A rough calculation shows that more than 1,000,000 horse power
is available from streams and waterfalls, but up to 1918 only
237,000 horse power has been utilized. The Agno River dev-
elopes at the gorge where it emerges into the plains of
Pangasinan 60,000 horse power supposed to be able to supply
the whole of Luzon with electric power and light.

Water as a resource has various uses. The sprinkling of
streets would greatly lessen the spread of tuberculosis, influenza,
and other diseases carried by the dust. The drilling of artesian
wells for home, and municipalities should be encouraged and our
people should be also informed of the ways in which they could
get the cooperation of the Bureau of Public Works for such
purposes. With the use of artesian wells as sources of water
supply there has been a 50 per cent decrease in mortality due to
water infection. The proper installation of a system that de-
pends upon the underground water resource would greatly
decrease mortality because of the purity of the water and to this
measure should be added the proper disposal of waste both of
which bring about comfort in the community.

The development of the inland and shore waters for fishing
purposes has received but very little attention except in the
neighborhood of Manila. With the aid of modern equipment
in deep sea fishing, the culture of shore and inland fish, the
establishment of salting and canning factories, there will be
better economic condition and more properly fed and healthier
men, women, and children. Fish culture would decrease our
expenditures by f*5, 000,000, the value of fish products imported
annually. The City of Manila alone consumes about 1*4,000,000
worth of fish annually and f*500,444 worth of dried, smoked,
pickled, and canned fish.

The use of water for irrigation purposes is one which will
surely revolutionize the agricultural industry and bring the
Filipino people nearer to economic independence. Act No. 2652
of the Philippine Legislature authorizes the establishment of irri-
gation systems by private individuals, by private associations,
municipalities and provinces and by the Insular Government
itself. For this purpose private individuals and corporations
may borrow government funds payable within a period of twenty
years with interest at the rate of 4 per cent per annum. A prov-
ince may appropriate 25 per cent of its road and bridge fund for
this purpose and municipalities are authorized to construct and
operate irrigation systems and may receive as aid from the
Insular Government two-thirds of the costs of systems so con-
structed.

185G11 13

194

The money received from the sale of bonds in the United States
is soon to be appropriated for public works, the most important
of which is the establishment of irrigation systems. In order,
therefore, to help the community in averting the poverty and
distress which come as the result of arid lands and of droughts,
provincial, municipal and private corporations should not fail
to take advantage of the provisions of the Law.

Aside from the direct economic result of the irrigation systems,
they are supposed to help in the drainage of low and swampy
lands which are a constant enemy of the mosquito campaigner.

Forests cover 63.1 per cent of the Philippine area. Of this
eighty-ninth is commercial. From these forests lumber of the
best kind and minor products, such as dye woods, paper pulp,
and other products that all minister to health and wealth are
gathered. There is no question but that our woods are of the
best kind and they find ready markets in China and the United
States. In use, we have those for house building and furniture
making, for railway ties, ships, and in fact for every kind of
wood make which man needs beginning with his cradle to his
coffin. The volume of the timber resource of the Philippine
Islands is 777,000,000 cubic meters and from this 382,000 cubic
meters have been the maximum annual cut. Aside from the
commercial value of the forest we find that the government
which owns 99 per cent of the timber gives gratuitous licenses
for the taking of first, second, and third group timber to those
who utilize such products for the house and other personal needs.
Thus we see that if our people would take advantage of this
provision we would have better houses, and healthier families
and at the same time there would be a great decrease of the fire
menace that sweeps the nipa and cogon houses every windy day.

This treatment of the natural resources, incomplete as it is,
only shows what great wealth we have in our keeping. We can
only see now how rich we are, yet these riches do not mean very
much to us unless they are turned into something that will give
oil to a rusty machine, medicine to a dying patient, and salvation
to a sinking soul. If our resources are let alone we not only fail
to attain that ideal of economic, moral, intellectual, physical, and
spiritual perfection but that we shall have committed a crime
against our ancestry for not appreciating the legacy they have
handed down to us, and I say, we would commit a crime against
our posterity for not preparing for them a richer, happier, and
healthier place to live in.

Yet in our attempt to take advantage of our resources, we may
forget that they are exhaustible. The craze for the glitter of

195

money may cause a sacrifice of the future well-being. So that
hand in hand with the development there must be wise utiliza-
tion, in other words there should be conservation. Conservation
does not mean conservatism nor miserly keeping to the sacrifice
of our needs; it only means wise use in order that in that use
the resource may be left more productive than it was before
that use.

Just as it is necessary to conserve the human resource by
battling against the forces that drain him of his moral, intellec-
tual, and physical welfare with a view to making man efficient,
long-lived, and happy, leaving behind him a number of healthy
and intelligent children free from the mental and physical marks
of a deteriorated race, so should there be a conservation of the
natural resources that they may remain fertile, and undiminished
to provide work for and the needs of millions of future genera-
tions.

Thus, where the aim in hygiene and medicine is to improve the
human body so that organisms of disease can not grow upon it,
the aim in agriculture is to improve the soil so that the crops
will grow abundantly. Where man conserves himself by vac-
cination the lands are conserved by fertilization and just as euge-
nics enhances the development of the stamina of the human race,
so do seed selection and plant breeding result in the development
of hardier and more productive species.

But just as different individuals have to be treated differently
in the medical sciences, so must the conservation of the different
resources have different aspects.

The conservation of the mineral, the most exhaustible of the
resources require better mining and extracting methods, sub-
stitution of water power for coal, the conversion of old and use-
less metalic articles to other uses, the use of wood or cement
where such substitution would be better and cheaper and the
putting of a protective covering on metalic instruments to render
them safer from exposure to the weather.

The conservation of water means its complete utilization for
domestic purposes, for water power, for navigation, and for
irrigation.

The conservation of the soil is the greatest of all the problems
of conservation, for upon its products we depend for food and
clothing, the basal necessities of man. The rate of soil manu-
facture is very slow, about an inch in from 500 to 1,000 years.
The main problem is, therefore, not to allow erosion to occur
more rapidly than it is manufactured. The retention and sup-
plying of soil fertility should be done by rotation of crops, the ex-

196

termination of plant diseases, pests and other enemies. Hand in
hand with extensive cultivation should be the encouragement
of the people to acquire new lands of their own, firstly, to bring
about better economic conditions and thus lessen the struggle
for existence, and, secondly, to insure soil conservation, for
it is the owner of the farm that best takes care of it. It is the
private ownership of farms that guarantees economic stability,
and hence national prosperity. The tide of emigration should
be directed not to the cities or to Hawaii but to Mindanao, Min-
doro, and Nueva Vizcaya. Also, there should be a public senti-
ment against caciquism and those that fraudulently rob the
farmer of his farm he justly acquired from the Government by
the sweat of his brow for two or five years.

Reforestation is the keyword to forest conservation. The
kaingin system should be done away with, forest fires must be
prevented and, for every tree cut a young one must be planted.
With the retention of forests there is a security for the perma-
nence of all other resources. Let me take the Ilocos region for an
example. What causes the traditional industry of the Ilocanos?
The hard struggle for existence. The naked mountains receive
the rainfall of the season but because of the absence of trees
that should increase the amount of water that sinks into the
ground the rain runs off in torrents thru the precipitous gulleys
carrying away the loose and fertile soil from the plain and valleys
to the sea, at the same time causing floods that destroy life and
property. Without forests, there is no humus formed and
there is no natural soil fertilization. After the rains, the lands
are dry for lack of ground water, agriculture is very poor and
the people must work hard to find means of livelihood. Aside
from the drought and the flood, the locusts, favored by the cogon
which can grow on thin poor soil of the mountain slopes, present
another problem. Reforestation of the mountains, the planting
of trees on steep slopes, at the source and banks of streams and
on sand dunes will bring about the fertile valleys, the flowing
spring, the ever-flowing streams, and the whole country will
become a paradise inhabited by a people whose situation is more
favorable, whose mere subsistence is reduced to a subordinate
place and with opportunities for development to higher intellec-
tual and spiritual level.

This is the final aim of conservation. In your hands you
may have a pamphlet issued by the Philippine Conservation
League. Read it thru, and if my message this morning strikes
root in the hearts and minds of this best representative group
of the Filipino people, my fellow citizens, let me ask you to

197

join us in this campaign of educating the people in the wise
development and conservation of our natural resources, the very
foundation of public welfare and national prosperity.

DISCUSSION

Mr. M. CARAGAY (Delegate, Abucay Puericulture Center, Bataan). — In
connection with the paper of Miss Valdez, I suggest that the Public Welfare
Commissioner request the Legislature to prohibit the emmigration of Fil-
ipino laborers to Hawaii. If this is not possible, I suggest that a tax
be imposed on such laborers, the proceeds received therefrom to be turned
into the puericulture center funds of their respective home towns.

Miss ROSARIO SALAS (Iloilo). — I wish to suggest that the women of the
Philippine University under the direction of Miss Valdez request the Phil-
ippine Legislature to define fully the functions of the Land Registration
Office, and the Bureau of Lands, so that the former will cease to interfere
with the granting of homesteads by the Bureau of Lands.

Mr. JUAN GAERLAN (Delegate, Provincial Board, Mt. Province). — In the
Mountain Province, there are both gold and copper mines, besides the
coffee industry. We can also raise semi-tropical crops, but due to lack of
transportation, we are not able to receive much return. I therefore suggest
that, through the President of the Federation of Woman's Clubs, we request
the Insular Government to set aside a liberal sum of money for the
construction of good roa,ds and trails for automobiles.

Mr. RAMOS (Pangasinan) . — I suggest that a campaign for homesteaders
be started as soon as possible.

Miss AURELIA CUNANAN (Badoc Woman's Club). — The reason why so
many provinces are suffering from famine is that vast areas of land are
overrun by wild grass due to lack of an irrigation system. In the name
of the farmers of my province and the Woman's Club I represent, I re-
quest, through the Public Welfare Commissioner, that the Government set
aside a certain amount of money for the construction of an irrigation sys-
tem.

Miss VALENTINA NOBLE (Sta. Maria, Pangasinan). — Due to much ill
feeling between tenants and "hacenderos" on the "Hacienda Esperanza,"
Pangasinan, I suggest that the Government buy all the lands in this "ha-
cienda," then resell them to the former tenants and inhabitants of Sta.
Maria.

At present, the inhabitants are emmigrating to Hawaii and other places
because of this existing ill feeling.

Mr. E. S. RAMOS (Delegate, Hermosa, Bataan). — As there is a vast
area of land in Bataan offered for homesteads, I request the Public Welfare
Commissioner to help campaign for these homesteads so that people will
take advantage of these opportunities.

D. GENERAL WELFARE

RELIEF IN TIME OF DISASTER
CHARLES H. MAGEE, Manager, Philippines Chapter, American Red Cross

§THE RED CROSS AND DISASTER RELIEF
1. Character of Relief. — If relief is to be effective, it must
be swift and centralized. People on the scene of the disaster
must begin it, and they must work unitedly, rather than in
several independent groups. As a matter of fact, after calami-
ties, local citizens usually form relief committees. Considering
that they are hurriedly formed, usually amid conditions of confu-
sion, shock, and great mental stress, it is not surprising that
very commonly the activities of such committees are not
productive of the most expeditious and constructive results.
Serious confusion of effort and loss of time are always caused
if there is a failure to coordinate and centralize the work of
disaster relief. A central committee vested with complete re-
sponsibility for planning and administering relief is fundamen-
tally necessary.

Experience shows that relief administration after disaster
always divides into two periods:

1. The period of emergency relief.

2. The period of rehabilitation or restoration.

It is the province of emergency relief to provide for urgent
but temporary needs, such as shelter, food, and clothing for
refugees, and medical and nursing care for the injured. After
these needs have been met, the equally important and often
more difficult tasks of rehabilitation must be undertaken. It
is the province of rehabilitation to assist each afflicted family
to meet its particular needs so that as fully as possible its
future welfare will be assured. Success in disaster relief ad-
ministration depends, more than upon anything else, upon the
wisdom and skill with which rehabilitation measures are plan-
ned and executed. Due to conditions in jthe Philippines, the
Philippines Chapter limits its activities to "the period of emer-
gency relief."

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200

2. Outside Aid. — Rarely are the families and the community
visited by calamity able to recover without outside aid. It is
not only material losses, but the paralyzing psychological effect
of shock and bereavement upon the survivors that make out-
side assistance imperative. Moreover, as calamity seldom strikes
the same community twice, local experience in disaster relief
measures is apt to be lacking. In such circumstances every
humane impulse prompts the swift mobilization from without,
of funds, supplies, and relief workers for aid of the sufferers.

The principle on which the service of the Red Cross is ex-
tended in disaster-stricken communities is to place the resources
represented by its membership, preparedness, and influence at
the disposal of the afflicted community, assuming only such
leadership and responsibilities as appropriately belong to a
voluntary organization.

3. Red Cross Experienced in Disaster Relief. — Because of the
great and varied experience of the Red Cross, acquired through
participation in disaster relief operations in all parts of the
world; because in the course of this service it has built up a
trained and seasoned staff of relief workers; because of its
facilities for enlisting financial support from the public; and
because of its semi-official status and close relations with In-
sular departments, it has come about that the Red Cross is
looked upon as the Nation's chief reliance for organizing and
directing relief after disasters.

4. Preparedness for Disaster. — Hitherto, so far as local pre-
paredness is concerned, with a few notable exceptions, organ-
ization for relief has waited upon the occurrence of disasters;
henceforth, so far as it can be accomplished through the agency
of the Philippines Chapter, it is proposed to take certain very
important preliminary steps in anticipation of disaster. These
steps are outlined herein, and follow logically the organization
of branches and auxiliaries outlined in Circular No. 36 of the
Philippines Chapter. The advantage of forehandedness in or-
ganizing is that it will assure that prompt, smooth, and united
action which is indispensable in disaster relief.

The organization for disaster relief and the procedure in
disaster relief administration, outlined herein, are designed to
place the greatly expanded facilities of the Red Cross at the
disposal of the Filipino people.

COMMUNITY PREPAREDNESS FOR DISASTER RELIEF

5. Five Effects of Disaster. — The kinds of damage and misery
which disaster causes are five: death, permanent physical

injury, temporary injury, personal property loss, and real
property loss. Every disaster affects a community in one or
more of these ways, while some disasters afflict communities
with losses in all five ways.

Earthquakes, typhoons, terrific wind and rainstorms, floods,
city-wide fires, forest fires, factory fires, shipwrecks are the
contingencies which have produced disaster most frequently.
With respect to the problems of relief and restoration they
involve, these calamities may be divided into two groups.
Earthquakes, typhoons, storms, floods, city-wide fires and forest
fires commonly involve problems of housing, feeding, and cloth-
ing refugees; of prevention of looting and disorder; of sanita-
tion and health protection. Not infrequently they arrest and
prostrate community life by destroying large stores of food
and supplies, dislocating transportation, breaking off communi-
cation with the outside world, disorganizing business, and
producing extensive unemployment. Factory fires and ship-
wrecks present problems of family welfare brought about by
the death or serious injury of those upon whom families are
wholly or chiefly dependent for support. Property losses are
relatively incidental. It is the temporary or permanent loss of
means of support which is the essence of the calamity; the
physical structure of the community may remain virtually un-
altered and the customary processes of the community life may
continue with little or no outward evidence of interruption.
But whether the disaster fall within the first or second group,
whether it express itself primarily in loss of property, or loss
of life, whether the victims be a few score or many thousands,
its evil consequences register themselves in family life and
family welfare, and the family must therefore be the unit of
treatment in the administration of relief.

6. Every Community Liable to Disaster. — Any community is
liable to fire, and this contingency should be borne iniimind by
all in preparing for disaster relief. Therefore, it behooves
every community to recognize its liability to some form of
disaster; to. have regard to the type of calamity to which it
may consider itself particularly susceptible, what its danger
spots — from fire or flood or explosion — may be, and to plan for
the mobilization of its forces with particular reference to the
type of disaster it regards as most imminent, and with refer-
ence to these possible danger spots.

7. Relief Resources. — The resources necessary for disaster re-
lief are of four kinds: supplies, facilities for feeding and shel-

202

tering the homeless, facilities for the care of the sick and
injured, and organized personnel for service.

The supplies which will be required depend upon the nature
and extent of the catastrophe. Those likely to be most urgently
needed are surgical dressings and antiseptics for first aid to
the injured; clothing, blankets, cots, mattresses, sheets, tents,
fabricated houses, stoves and cooking utensils, rice, canned
goods, milk, and other food supplies, with which to provide
for the emergency needs of the refugees; antitoxins and disin-
fectants for protecting health.

Facilities for sheltering the refugees will also depend upon
the character and size of the calamity. If they have not been
destroyed, school houses, churches, and other public buildings
will afford emergency shelter. If these are not available, or
if they are inadequate, it may be necessary to establish tent
camps for refugees. In the Philippines, where warm weather
prevails, the question of housing is not at first of such vital
concern as in those places where cold weather obtains. It must
receive careful consideration and attention.

For the care of the sick and injured, local hospitals are
naturally the first reliance. Dispensaries and nursing agencies
are also important resources. If there are no hospitals, or if
they have been destroyed or are overcrowded, it will be neces-
sary to improvise hospitals, to use U. S. Army field hospitals,
or, in some instances the problem may be met, in part at least,
by utilizing hospitals of a neighboring community.

Organized personnel for service — physicians, nurses, social
workers, Red Cross home service, motor corps: and canteen
workers, and men of affairs who are accustomed to act with
promptness and decision — rank foremost among a community's
resources for disaster relief. Disaster relief plans which pro-
vide for the mobilization of supplies and the utilization of places
for emergency shelter and medical care, but which overlook the
fact that thoroughly competent men and women are indispensable
to the successful administration of relief, are dangerously in-
complete. Success in disaster relief administration depends
quite as much upon personnel as upon supplies.

8. Outside Aid. — In formulating a plan of preparedness, each
community should consider not only its local resources but those
of other communities to which it might naturally turn, and
also the help which may be had from such agencies as the
Philippine Constabulary and the Regular Army (both of which
have proved so useful in past disasters in preserving law and

order, protecting property and health and in the transportation
and distribution of relief supplies and in conducting refugee
camps) .

The potential resources of a community in supplies, institu-
tional facilities and workers depend chiefly upon its size. Many
small towns lack hospitals, nurses, and social workers. More-
over, they are not apt to have on hand the quantity and kind
of supplies which would be required in case of disaster. Such
places must depend largely on the more populous communities
which possess richer resources for such emergencies. Their
plans for disaster must accordingly contemplate the utilization
of such outside agencies as were mentioned in the preceding
paragraph. On the other hand, larger places possess supplies
and a variety of medical and social service agencies, which,
provided they are not destroyed or seriously impaired by the
calamity, cause them to be more nearly self-sufficient in such
exigencies. Indeed, it frequently happens that the resources
of the large cities are drawn upon by the American Red Cross
when disaster visits the small town, village, or countryside.
The administration of disaster relief calls for the participation
of men and women of sound judgment, capacity to work under
pressure, and experience in dealing helpfully with people in
pain, bereavement and want. The services of executives and
field workers of social welfare agencies, whose daily experience
brings them to grips with similar human problems, are there-
fore especially valuable. Such persons are to be found chiefly
in the larger centers of population. They constitute one of
the more valuable disaster relief resources of the country.

THE BED CROSS BRANCHES AND AUXILIARIES ARE THE COM-
MUNITY'S AGENT IN DISASTER REI/IEF

9. The Red Cross as a Disaster Relief Agency. — The people
have come to look upon the Red Cross as their agent in disaster
relief operations. The Red Cross is expressly authorized by
the Congress of the United States to function in this way.
It has developed a comprehensive disaster relief organization
centering in the Director General of Civilian Relief at Washing-
ton and consisting of skilled and experienced disaster relief
administrators and field agents and facilities for mobilizing
funds and supplies. It is now proposed that each Branch and
Auxiliary in the Philippines shall become an integral part of
the Red Cross disaster relief organization by the steps outlined
below.

204

10. Disaster Relief Committee. — The organization of this
Committee is outlined in Circular No. 36 of the Philippines
Chapter. It is based upon the provincial and municipal govern-
ments with the assistance of public spirited citizens.

11. Survey of Relief Resources. — A survey of resources for
disaster relief within the "auxiliary territory should be made
and in the case of Manila of the field unit. This survey
should make clear where emergency food supplies — groceries,
meat, canned goods, rice, milk — can be obtained; where to turn
for cots, petates, blankets, clothing, cooking utensils, and
stoves. It should note buildings, such as warehouses, schools,
and churches, suitable for the temporary housing of refugees.
It should take account of facilities for medical care — local
hospitals and those of adjacent communities, buildings which
in an emergency might be used for hospitals, ambulances, drugs,
sterile dressings, disinfectant, and anesthetics. Finally, the re-
sources in personnel should be canvassed and registered, espe-
cially physicians, nurses, social workers, and motor corps.

12. Plan for Mobilizing Aid. — A careful plan for mobilizing
these resources should be formed. The plan and the findings
of the survey should be recorded and placed in the hands of
each member of the Disaster Relief Committee and two copies
should be filed with the chairman of the committee. Annually
or oftener there should be a re-examination of the resources
and of the plan.

13. Advance Arrangements. — Whatever steps may be neces-
sary should be taken to expedite the operation of the disaster
relief plan in case of calamity. Definite arrangements with
bakers, provisions merchants, and milk dealers to give preced-
ence to disaster relief needs could with propriety be made.
Public officials and particularly fire and police departments and
local telephone and telegraph offices and newspapers should be
persuaded to notify the committee instantly in case of calamity.
The president or other ranking public official should be asked,
upon the occurrence of disaster, to call upon the Disaster Re-
lief Committee to form a committee to administer relief. It is
also desirable to arrange in advance, when possible, that local ap-
peals issued by public officials shall designate the Red Cross
Disaster Relief Committee as the authorized recipient of funds.

14. Organization for City Branches. — The procedure thus far
outlined is recommended to the Disaster Relief Committees of
all Branches. For those in large cities, in which there are
ample and varied medical, nursing, and social service facilities,
the further organization outlined below is recommended:

Thei

205

lere should be created under the Disaster Relief Committee
a Medical Service Unit and a Social Service Unit, each in charge
of a director, who should be a member of the Disaster Relief
Committee.

15. Medical Service Unit. — The Medical Service Unit should
be composed of physicians, surgeons, and nurses. Its province
is to plan and administer medical aid to the victims of disaster
and to cooperate with local and Insular authorities in measures
of health protection. The unit should be prepared to reinforce
the medical and nursing staffs of hospitals in disaster-stricken
communities, to improvise and administer hospitals, to mobilize
medical relief supplies, such as drugs, blankets, sheets, beds,
sterile dressings, disinfectants, anesthetics, and X-ray machines,
and to assist in devising and executing measures of sanitary
control.

16. Social Service Unit. — The Social Service Unit should be
composed of experienced social workers. Its personnel should
include those trained in the work of a registration bureau, a
Home Service Section or other family rehabilitation agency,
a child-caring agency, medical social service and housing in-
spection. One or more members experienced in directing
volunteers should also be members of the unit. In Manila the
Philippines Chapter has invited the various welfare organiza-
tions, charitable institutions, and lodges to name one or more
representatives to cooperate in time of disaster. Such members
are known as institutional members.

THE RED CROSS AT WORK IN THE COMMUNITY VISITED BY

DISASTER

17. First Steps on the Occurrence of a Disaster. — Immediately
upon the occurrence of a disaster within its branch territory,
the Disaster Relief Committee should take the following steps:

No time should be lost in notifying the Manager, Philippines
Chapter, at Manila. In this way, outside aid can be brought
to bear if it is needed.

18. Disaster Relief Committee. — The Disaster Relief Com-
mittee, outlined in Circular No. 36, is a permanent organization
at each provincial capital and in each town. Its plans for a
disaster should include securing the active assistance of the
most representative people in the community, public officials,
newspapers, and the woman's clubs. Its personnel should be
thoroughly representative and such as to inspire public con-
fidence. Persons who by virtue of their position or special skill
are likely to be particularly useful should be included.

206

Whatever is necessary should be done to cause the Disaster
Relief Committee to be recognized as the official agency for
the administration of relief. Appeals for funds and supplies,
through the press, from pulpits and elsewhere, should not fail
to designate the Red Cross Disaster Relief Committee as the
recipient. Groups starting relief operations independently
should be induced to withdraw or amalgamate with the Red
Cross Committee, in the interest of conserving time, effort,
supplies, and money by avoiding overlapping. It must not be
inferred from the foregoing that it is proposed to vest in the
Red Cross sole responsibility for relieving all needs caused
by the disaster. The public authorities and other local agencies
will have important services to render. All that the Red Cross
seeks to accomplish is to enable the community to apply its
forces as a unit rather than by unrelated action of several
groups.

19. Establishing Headquarters. — Headquarters should be
promptly established. A building commodious and centrally
located, with facilities for housing in separate rooms the several
administrative branches of the committee, is to be preferred if
it is available. Experienced disaster relief workers say that
a school building often makes a satisfactory headquarters.

A sub-committee should be deputized to make a hasty survey
to estimate the extent and nature of aid required and the
measures of assistance which are of most urgency.

The procedure thus far suggested has for its aim the mobil-
izing, organizing, and centralizing of local relief forces. It is
a prerequisite of successful ministration to the needs of the
disaster victims. The steps which have been recommended
niust be taken with dispatch — undue deliberation would be
intolerable in the face of pressing demands for the alleviation
of misery and want.

20. Administration Sub-committees. — The actual administra-
tion of relief should be in the hands of sub-committees or
bureaus. In the interest of close-knit organization, the chair-
man of each sub-committee may well be a member of the Execu-
tive Committee, whose province it should be to exercise general
oversight and to coordinate the work of the sub-committees
or bureaus. The sub-committees should be small and they
should be composed only of active workers. Upon them the
Disaster Relief Committee must depend for the execution of
its work. Manifestly, the number and the functions of these
sub-committees will be determined by the size and the nature
of the need occasioned by the calamity.

207

A sub-committee on Medical Aid and Hospital Care and one
on Relief will probably suffice in such disasters as shipwrecks,
railroad wrecks, and fires which do not involve the destruc-
tion of dwellings or destroy food supplies, or cause the suspen-
sion of the normal processes of the life of the community as
a whole, but which cause death and personal injury and in
these ways temporarily or permanently deprive families of their
accustomed means of support.

On the other hand, city-wide fires, typhoons, floods, and
earthquakes which affect family welfare not only by loss of life
and personal injury, but also by the destruction of dwellings,
household goods, and places of employment call for rather com-
plex administrative machinery. In disasters of these kinds the
sub-committees which will probably be required are:

Emergency Housing.

Food.

Clothing.

Medical Aid and Hospital Care.

Relief.

Health and Sanitation.

21. Housing. — Committee on Emergency Housing should pro-
vide shelter for the refugees in public buildings such as
churches, school houses, etc., in private homes, under canvas,
in fabricated houses, or in such combinations of these ways as
may be necessary. Where there are vast numbers of refugees
to care for, experience point to the wisdom of calling upon the
Philippine Constabulary or the Regular Army for assistance in
establishing and supervising refugee camps.

22. Food. — The Committee on Food should mobilize and
dispense food supplies. In disasters which destroy the houses
and disrupt the normal domestic processes of large numbers, of
people, it is commonly necessary at the outset to distribute
food supplied from food depots or "hot meal kitchen." Here
again, if the disaster be large, there is a distinct advantage in
using the military for handling the collection, storage, and dis-
tribution of food supplies.

23. Clothing. — The Committee on Clothing should assemble,
through purchase or donation, articles of clothing, beds and bed-
ding, and arrange for the distribution of these. Where large
supplies of clothing must be distributed with dispatch, the gar-
ments should be carefully sorted. There would be advantage
in having the work supervised by a person experienced in
merchandising.

208

24. Medical Aid. — The Committee on Medical Aid and Hos-
pital Care should, at the outset, provide first aid to the injured
and later devise and execute appropriate measures to, assure
the services of nurses and physicians for the sick and injured
in their homes or places of temporary shelter, arrange for their
care in local hospitals, or if these are lacking, or inadequate,
should improvise hospitals. The shock and exposure to which
disaster victims are usually subjected make them particularly
susceptible to disease and to mental and nervous disorders.
Manifestly the functions of this committee should be performed
by members of the medical profession.

25. Health and Sanitation. — The Committee on Health and
Sanitation should protect the community against infectious
diseases. Broken sewers, contaminated water supply, neglected
deposits of garbage, the debris left by disaster, the absence of
sanitary disposal facilities, the overcrowded, unsanitary condi-
tions under which refugees frequently live, all conduce to the
spread of disease. The need for skilled service and for prompt
and comprehensive measures for preventing disease and protect-
ing health, cannot be overstimated. Experience points to the ad-
vantage of instituting promptly a sanitary survey in order to
determine the location and nature of possible menaces to health
and also to the importance of adopting special sanitary regula-
tions and of unremitting vigilance in their enforcement.

The work to be performed by Medical Service Units (Para-
graph 15) comes within the province of the committees on
Medical Aid and Hospital Care and on Health and Sanitation.
Officers of the U. S. Army Medical Corps and the U. S. Public
Health Service, and army sanitary supplies have been found
to be great assets in the protection of health after large di-
sasters. Wherever local or provincial health authorities possess
the equipment to cope with the situation, it will be unnecessary
for the Disaster Relief Committee to assume these functions.

26. .Employment; Claims, Appraisals, and Awards; Relief and
Rehabilitation; Registration; Visiting Families. — The work of
these four committees has to do with the period of rehabilita-
tion or restoration. Due to prevailing conditions of climate
in the Philippines, the work of this period is not at present
included in the relief program of the Philippines but is left to
the Insular, provincial, and municipal governments. Should oc-
casion demand, the Philippines Chapter is prepared to handle
this phase of the situation.

209

RECORD FORMS

Classes of Forms. — The record forms which will be
needed in disaster relief operations are of two kinds: forms
for recording data respecting the circumstances and needs of
the families which receive the committee's service and financial
accounting forms. Only the minimun number of forms is here
recommended which it is believed will be required in all disaster
relief work.

28. Family Records. — Form 901 is known as the Registration
.Card, and has been prepared by the Philippines Chapter. It is
designed for recording the few items of information essential
for a working knowledge of each family's composition and most
pressing needs. A few moments conversation with a repre-
sentative of each family will usually give the desired information.

29. Family History Sheet. — Form 902 is known as the Family
History Sheet, and is designed to record the fuller, more signi-
ficant information as to the circumstances,. handicaps, resources,
and outlook for the family as these become known to the social
workers in the course of their personal contacts with the family
and efforts in its behalf.

30. Financial Records. — The Red Cross Disaster Relief Com-
mittee has a fiscal responsibility to the community, the persons
contributing, and the American National Red Cross. All funds
and supplies of whatever nature received and disbursed by the
committee must be accounted for. This information should be
given the largest amount of publicity through the press, and a
final report showing receipts and disbursements forwarded to
the Philippines Chapter, Manila, P. I., through the Executive
Bureau of the Insular Government. The provincial treasurer
will handle all funds and supplies for disasters under the control
of branches, and the municipal treasurer will do the same for
all disasters handled by the auxiliaries. The regular government
forms will be employed to insure uniformity. Form 204, P. I.,
of the Philippines Chapter will be used to summarize the finan-
cial report supplemented by the regular government forms.

31. Additional Information. — The outline given herein is made
as brief as possible. It contains enough information to enable
each Branch and Auxiliary to organize a Disaster Relief Com-
mittee to meet local disasters. The Manual of Disaster Relief,
A. R. C. 209, issued by the Department of Civilian Relief, Wash-
ington, D. C., will be supplied to all branches and auxiliaries,
and will give more complete information upon points only men-
tioned herein.

185611 14

CHARITY AS DISPENSED BY THE ASSOCIATED CHARITIES OF

MANILA

TEODORO R. YANGCO, President of the Associated Chanties of Manila

Charity has been my hobby for some time, and so I am truly
thankful that I have been given a few minutes' opportunity to
give you a brief and concise account of what the Associated
Charities strives to do ; how it goes about to accomplish its aims ;
and what difficulties it meets.

From the viewpoint of many people, "charity" means nothing
more than giving money, rice, and clothing to the needy. There-
fore, it frequently happens that persons who come to our asso-
ciation for assistance become somewhat disappointed if, in
response to their request, they are not given material relief
immediately. They do not realize that material aid is probably
the least of their many needs, and that it takes some time
before the association can decide on what is suitable to give
them.

People who think that relieving poverty means merely giving
money away, often make a mistake in distributing their wealth
indiscriminately. Every normal human being can not resist the
appeal of those in distress; thus, we find that in response to
this charitable impulse, men, women, and sometimes even chil-
dren will invariably give a few centavos to the beggar who
approaches them, inwardly congratulating themselves for having
done good to somebody. Yet, what they have done, is perhaps
not the best thing for the recipient, because it may have helped
to make him a professional beggar.

It is partly to prevent professional beggary, and partly to
champion the cause of those in trouble, regardless of nationality
and religion, that the Associated Charities of Manila was organ-
ized by humanely-minded and public-spirited people of the city.
In its efforts to accomplish these two aims, our association works
on the principles that there are men and women who suffer
from social ills as well as from physical ills, and that it takes
as much ability to mend broken lives as to mend broken legs.
When a person has a headache, he goes to a physician and tells
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511

him what he feels. The physician sees thru the headache some
other trouble which might have caused it and tries to discover
what the trouble is, before attempting to help him. The method
of the Associated Charities in treating its clients is very much
like that of a physician. It recognizes application for money,
rice, or employment, only as a symptom of some social trouble,
such as shiftlessness, indolence, poor health, disregard of family
ties, drink, insufficient income, defective housing condition, bad
associations, misdirected or inadequate education, bad industrial
conditions or unwise relief -giving. It attempts to discover the
causes of poverty with a view to removing them.

By way of illustration, I shall describe briefly a case from
our record, with the hope that it will convey to you some idea
of the different problems that confront us and how we solve
them.

Case No. 66. — A very sickly looking man sauntered helplessly
into our office one day, begging for financial assistance.
Our investigator found that he had been operated on in
Mindanao and was advised by his physician to come to
Manila for further treatment. He found himself in a
strange city without money, friends, or relatives. He had
heard of the Associated Charities and came to us. It was
evident that the man's urgent need was medical attention
more than money.

He was sent to one of the hospitals in the city, where he was
admitted as a free patient. The Associated Charities still takes
an interest in him and befriends him in every way. When the
man is discharged from the hospital, the association plans to
secure a position for him and to stand by him until he is able
to look out for himself. If it succeeds in doing this, then it can
say that it has been truly charitable, for it has saved one man
from joining the great army of the wretched and forlorn.

The case I have just cited is typical of the many cases that
come to our attention. It is by no means the only kind. There
are others whose problems are just as hard to; solve, if not
harder. For instance, we count among our wards, men and
women who, because of old age and chronic illness, can never be
self-supporting. Some have relatives who can be induced to
shoulder the responsibilities of caring for them. Others have
no relatives or friends, in which case they are obliged to live
upon what little the Associated Charities is able to give them.
Cases such as these need a home where they can spend their last
days in peace and comfort.

212

By far the greatest number of cases that have come to our
attention are the widows with no special training, but with
many children to support. Some are very plucky and unafraid
to tackle any honest work; others are perfectly helpless in time
of adversity, have no initiative, and unable to plan for their
future. We secure employment for them all ; we think and plan
for those who are unable to manage their own affairs; but we
regret that we do not have the facilities for giving these women
the vocational training which they sorely need.

I have thus far given you some idea of the method we employ
in treating special cases. It must be borne in mind that no
two cases are ever handled alike. Our method, however, may
be generalized as follows:

1. We investigate every case for the purpose of collecting
evidences that will reveal causes of difficulty and suggest plans
for remedy. During the investigation, when emergent relief
is needed, we furnish food, money, or clothing.

2. We weigh and test the evidences secured, for the purpose
of determining the real cause or causes of the difficulty.

3. We plan how best we can remove the difficulty.

4. We solve the problems according to urgency. Our ul-
timate aim is to rehabilitate the individual or family if pos-
sible. The process is rather slow, and is attended by many
obstacles and discouragements. At the beginning, we exercise
a small or great amount of control and supervision, depending
upon the nature of the case and the personality of the family
or individual. This power gradually develops into friendship,
advice, and counsel, and ultimately ends in the withdrawal of
direct supervision when the family or individual is able to
make its own living.

Although the Associated Charities of Manila has brought
sunshine into many cheerless lives and homes, yet it has had
trials and disappointments. It has failed to carry out many
of its pet plans on account of lack of funds and facilities. Its
friends send in more cases than money, and it has been im-
possible for the few friendly visitors that it employs to give
every applicant the prompt and proper attention. But this
has not been its only trouble. When employment is needed
for its worthy cases, there are no positions to be had; when
there are positions available, the shiftless and the indolent re-
fuse to take them.

In closing, let me impress upon you the necessity for or-
ganized charity. In small towns organized charity is not needed
because everybody knows everybody else, and so it is easy for

213

the people to help each other, and the human parasites are
easily detected. In large towns and cities it is necessary to
ascertain whether the person who asks for assistance really
deserves help or not. The poor in this community struggles
against many social problems which he can not solve alone.
The business men and women do not have time to investigate
the merits of each case that comes to them for assistance. An
association like the one I represent, can be of great service to
the large and busy community by acting as a go-between between
the philanthropist and the needy. Its function should be to see
that the money entrusted to it for charitable purposes is well
spent and that the needy who deserves help is relieved of
the burden of poverty. With the support and cooperation of
the able ones, organized charity can be a very vital factor in
public welfare; without them it can accomplish but little good.

THE ACTIVITIES OF THE "ASOCIACI6N DE DAMAS FILIPINAS"*

LEONARDA L. DE UBALDO, President, Asodacion de Damas Filipinas

The Asociacion de Damas Filipinas is an organization founded
in 1914, whose object is to protect and assist orphaned children,
the widows, and the poor mothers who have no means and
who are in need of help in order to take care of their children,
making them healthy, strong, and free, if possible, from all
sickness that cause so much infant mortality. In order to ful-
fill this object we have the Settlement House where orphaned
and unprotected children are admitted and taken care of; ba-
bies whose mothers died at or a few months after birth; and
those children whose mothers are sick and cannot take care
of them. For example, we take care of the little children of
mothers who, suffering from tuberculosis, typhoid or other
kinds of sickness that requires staying in the hospital, have
to go there for treatment. We help the poor mother-to-be
who is in need of proper nourishment; or if she desires to
remain in the Settlement House we admit her and let her stay
for one month before entering the hospital, so that she may
acquire the necessary strength for her confinement; and at
the same time to be examined physically by the physician in
charge, thus preventing the development of any sickness from
which she suffers, so that if she has beri-beri she may be
treated beforehand.

The poor mothers that have given birth in the hospital, and
who go out from there, still in a weak condition, unable to
cook or wash, are admitted to the Settlement House to recover
their strength.

In genferal, we admit to the Settlement House children and
mothers, who, being neither orphans nor widows, are in need
of any help. Just yesterday there came from the provinces a
mother with eight small children, two of them being two-month
old twins, abandoned by the father. What can a mother
in such a condition do, nursing her twin babies yet, without
any relative in Manila and without any means whatsoever?

* Read as the Conference by Mrs. Florentina Arellano.
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215

The trip to Manila was paid by a missionary, and we have
her now in the Settlement House.

The Settlement House not only furnishes nourishment to its
beneficiaries but also clothing, medicine, etc. We have a trained
nurse who sees to it that rules of hygiene and sanitation for
the preservation of the health of our beneficiaries are observed.
We have also the services of a physician from the Office of
the Public Welfare Commissioner, for the inspection of the
state of health of our beneficiaries and the treatment of their
ailments, and at the same time to give the necessary instruc-
tions about the quality and quantity of the babies' food ac-
cording to their health and physical condition.

Besides these resident beneficiaries we have non-resident ones
to whom we give rice weekly in different quantities depending
upon the number of individuals of which the family is composed.

The beneficiaries of the Settlement House are duly investigated
by the matron or by the social service nurses of the Public Wel-
fare Commissioner so that we may know their true conditions
and needs before they are admitted. This is done also with cases
recommended by other social agencies. Exception is made of
emergency cases that require immediate admission and help.

In cases of fire, the members of the association are required to
assist in giving relief to the injured persons. Thus in the fire
of Paco in March, 1919 the members of the organization went
immediately to the place of disaster, distributed rice until late
hours of the evening, and took to the Settlement House those
families that had small children; and there they lodged them
temporarily and supported them until they could reconstruct
their own houses.

In the great fire of Cervantes on April 1, of this year, even
before the fire had been extinguished, the President of the as-
sociation, the personnel of the Settlement House and other mem-
bers assisted at night in bringing help; and scattering them-
selves at different places, they distributed food among those
people who were hungry. The members of the association were
busy until the dawn of the next day looking for the victims of
the fire, who were in need of lodgings, and they took to the Set-
tlement House those who could be accommodated there.

Every year during Christmas, the members of the association
personally visit the poor in order to understand their conditions
and need and also, give them their presents at the same time.

At the beginning, the Asociacion de Damas Filipinas was sim-
ply maintained by the monthly fees of the members and by some
donations given by charitable persons. Its activities then con-

216

sisted simply in giving money, clothing, food, condensed milk,
etc., to the poor families for which the members of the association
accompanied by the nurses of the social service division of the
General Hospital, went around the districts to be acquainted
with the conditions and needs of the needy class.

Later, about 1919, as the work was developing, the association
requested and obtained from the Public Welfare Board an an-
nual subsidy, and opened the Settlement House in February of
the same year, 1919. During this year our beneficiaries num-
bered two hundred and forty-four including residents and non-
residents.

The Asociacion de Damas Filipinos in its desire to extend its
meritorious work does not leave out any possible means to in-
crease its resources. Aside from the fees and donations, it
opened a charity market in conjunction with the Woman's Club
of Manila in December, 1919. For this end, the members of the
associations, organized into committees, visited the stores, estab-
lishments and commercial houses and obtained donations for said
market. From the Bureau of Agriculture they obtained vege-
tables and other garden products, and from the provinces they
received fruits and other foodstuffs. During the three days the
market lasted, a total of !f*5,954.16 was made from the sale of
articles donated. For the lepers at Culion, they sent Chirst-
mas presents to the value of W,500 and from the rest of the sum
the association received a share of 1*2,200. They also distrib-
uted Christmas presents to the aged and to the tuberculous
persons at San Lazaro Hospital, the Hospicio de San Jose, Saint
Paul's Hospital; to the School for the Deaf and Blind, the two
reformatories for the boys and girls, the Santa Rita, Consola-
cion and Penafrancia schools also the Belgian Mothers' school in
Tondo and to all beneficiaries of the Settlement House.

In 1920, our beneficiaries numbered two hundred and forty-
seven. In this year, as the association had to meet large ex-
penses in its activities, the members decided to increase the fees
and also made each one of them find six new members to increase
the collections. And they created new memberships known as
junior members consisting of young students whose fees of only
1*0.50 per year are easily saved from their minor expenses, in
order to give relief to their unfortunate brothers.

In the Settlement House classes are given to children below
seven years with the object of preparing them for their work
in the public primary schools. Those above seven years attend
the public schools.

The prir

217

te principal object, however, of the Asociacion de Damas
Filipinas is to help in the campaign against infant mortality.
Ladies and gentlemen, now that we have this humanitarian work
so well founded and the cooperation of all well proved, well
shown at this National Conference by the presence of these repre-
sentatives who have willingly come from the most distant regions
of the Archipelago, let us continue our work, let us not be dis-
couraged before any obstacle whatsoever. I know well that
many of you work disinterestedly in this undertaking, without
receiving or awaiting any compensation other than the satis-
faction of having done what is good, of having practiced charity.
Let us continue, for there is no virtue which ennobles the human
heart best than charity. Charity has accomplished great won-
ders in the world and it is charity that has brought us here
together to communicate our mutual symphaties in this respect
and to acquire new courage, new strength, in order to work
together for the same end, for the health and welfare of our
country.

DISCUSSION

Mrs. RICARDA DE L.ABAO (Mogpog Woman's Club, Marinduque). — Having
just heard that the Settlement House has given aid to other institutions,
I suggest that financial aid be given by proper authorities to the children
under the care of the Woman's Club of Mogpog.

THE CARE OF DEPENDENTS, DEFECTIVES, AND
DELINQUENTS

RAMONA S. TIRONA, Special Agent of the Office of the Public Welfare

Commissioner

I believe it is appropriate for the purpose of this paper to
give first a general idea of what constitutes the classes of
people known as dependents, defectives, and delinquents. It is
generally accepted that "dependents are those persons who, from
any cause, exist by means supplied by voluntary acts of the
community, by gifts from public funds, or private sources."
Defectives are those who because of physical or mental defects
cannot very well support themselves in the community, such as
the insane, the cripple, the blind, the deaf and the dumb. De-
linquents are those persons who have committed offenses against
the law.

As far as dependency is concerned, we may say that in the
Philippines the individuals belonging to the dependent class are
mostly to be found in our large cities, particularly in Manila.
These persons are helped by certain established organizations
such as the Church, the Associated Charities, the Red Cross,
the Asociacion de Damas Filipinos, and many other agencies
engaged in philanthropic work. In the provinces and rural com-
munities, except for the presence of a few beggars, we happily
do not find what may be truly called the dependent class. This
is probably due to the constitution of the Filipino family. The
members cling to each other thru thick and thin and solve their
difficulties themselves before depending upon the community for
support. Indeed, the personal sacrifice which the members of
the family are capable of making in order to help the needy one
in times of adversity has no equal in the other parts of the world
that I have seen. This is certainly an admirable trait that we
should preserve. In fact one of the chief concerns of modern
philanthropy in the administration of relief, other than urgent,
is to enforce the moral or the legal responsibility of relatives
before the community assumes the support of a dependent person.

In our country the administration of relief to the poor has
not been systematized to a considerable extent. Of course it is

218

the privile

219

le privilege of private charity to give aid to whom it pleases;
but at the same time, if it aims to do real constructive work,
it should not encourage permanent dependence in those it helps.
It demoralizes and pauperizes the poor to let them depend upon
charity if they are still able bodied. The desire to live without
work is contagious. It should be the cardinal principle of our
private and public charities to rehabilitate the person aided by
wise administration of relief. Hence we should bear in mind,
in the care and treatment of our dependent class, that the help
we give is ultimately directed to making them 'more self-reliant
in the struggle for life; and consequently the methods of treat-
ment used should be systematized so as to realize the end in view.
The betterment of the condition of our defectives is a problem
that should be of great concern to the community. We have done
practically very little to improve their lot. With the exception
of the children in the School for the Deaf and Blind, people
belonging to this class are practically neglected. As for the
insanes we have not, as a rule, adopted yet modern methods of
taking care of them. Perhaps this is due to the fact that we
ordinarily do not think of them as sick persons needing special
treatment and care. In the rural communities the insane is
wrongfully kept at home until it is no longer possible to care
for him; and then in dire distress, when the fond family has
exhausted its energy in misplaced solicitude for his welfare,
he is turned over to someone who acts as a "bastonero." The
barbarous practices to which he is then subjected are too well-
known to be further discussed here.

In other progressive countries nowadays, particularly in Amer-
ica, much attention is given to making the life of the defectives
more worth living. The institutions for the insane, for example,
are not only hospitals where the patients are carefully classified
and treated according to their nature and needs. They are also
a sort of school where those who have almost recovered from
insanity are given occupational work in order to prepare them
to resume their places in society. Much emphasis is also put
in preventive work. Children are physically and mentally ex-
amined in the schools so as to detect any abnormality that might
be detrimental to their life activities.

Social protection and humanitarian considerations are motives
strong enough to arouse greater interest in the community in
behalf of the defectives. We should remember that what we
have so far done in favor of them does not keep pace with the
other features of our social progress.

220

Our penal system is much admired abroad, and I believe we
really have reasons to be proud of our treatment of adult delin-
quents. Penologists whom I met in my visits to the different
prisons and penal institutions of the United States complimented
me as a Filipino for having one of the best, if not the best,
penal systems in the whole world. Of course there is always
room for improvement, and we should try to introduce changes
for the better as occasions for them arise.

With respe.ct to delinquents I shall confine myself to our young
offenders. It is in this particular connection that there is much
to be done, for juvenile offenders as a rule, have not had the
proper care that they deserve, and also because preventive meas-
ures are best started with children.

It is worthy to note that recently a considerable part of the
public has become aware of the social problem involved in ju-
venile delinquency. But there seems to be a tendency to con-
sider the juvenile court as the cure for juvenile delinquency. We
certainly need a children's court in Manila and a law providing
for the protection and reformation of the juvenile offenders, ac-
cording to the most modern principles of juvenile court pro-
cedure. But we should keep in mind that the responsibility of
the community in connection with juvenile delinquency, does not
end with the juvenile court, nor with the enactment of a law
prescribing a more humane treatment of minor offenders. These
things are simply measures to make the child more amenable
to reformative processes; in other words, to prevent him from
becoming a criminal, a habitual and callous offender. What the
community should concern itself most is to prevent the possibil-
ity of a child's becoming a delinquent so that he may not have
the chance to be brought to court.

Three years ago, when making a study of about five hundred
children in the reformatories of the city of Manila, I found that
many of the causes that led those children to become delin-
quents were preventable. And, in most of these cases it was
either the community or the home that was at fault. Are we
aware that even the lack of such simple things as recreation,
healthful play, and expression of normal childhood life have
driven many a child to the downward path? Do we know that
some children have become truants because there is no place
for them in our overcrowded school-houses? That many a child
has become wayward due to the weakening of discipline in the
home? That many innocent children have been lured away
from their homes by unscrupulous people because these have
found in them possibilities for exploitation? Do we realize that

not a few children have become precocious offenders simply be-
cause of the attempt to imitate the villains in objectionable
moving pictures? There are hundreds of ways in which the
home, the neighborhood, and the community as a whole have
directly and indirectly caused the misfortune of many a delin-
quent child.

In Manila some sort of juvenile protective association is greatly
needed. The country lad that has run away from home finds
in the city many attractions that tantalize him. He moves about
and carelessly spends the little money that he has. Or, he may
not have any at all, and in this lonely and friendless existence he
wanders about, loiters in public places, acts suspiciously
"without being able to give a good account of hhnself," as the
court or police records state. A juvenile protective association
composed of civic-spirited citizens may render valuable services
in this and many other instances related to the possibilities
of juvenile delinquency. As individuals and as a body they can
cooperate with the police authorities or with the home of the
children in keeping the latter from going wrong. They can
recommend measures that will safeguard the welfare of chil-
dren. They may act as parole agents for young offenders who
have shown good conduct during their confinement in correctional
institutions. They may take care of the homeless juvenile de-
linquents who are released from the reformatories. Some of
these children have no place to go after the doors of the institu-
tion have closed behind them. If they are not morally strong
enough to avoid resorting to their bad habits, they become victims
again of the pernicious influence of bad associates or other
temptations. Thus every effort in their reformation may be
wasted.

It is a happy coincidence that as a people we are not by nature
susceptible to the commission of crimes. Most of the delin-
quencies that we commit are due to external conditions subject
to control. This is why we may very hopefully work by means
of prevention in the home and in the neighborhood, through
the removal of obnoxious factors such as vices, lack of occupa-
tion, etc. But removal of them alone is not sufficient. It is
necessary that something good and attractive should be substi-
tuted for them.

In closing, I must say that delinquency in its causes, its con-
sequencies, and its treatment is a social concern. One agency
alone is not responsible for it. The home, the neighborhood,
the church, and the school have some share in it ; and by proper
and efficient functioning of them all, the preventive form of

222

delinquency may be reduced to a negligible quantity in our
social statistics.

DISCUSSION

Miss ROSARIO SALAS (Iloilo).-l suggest that the Public Welfare Com-
missioner, through Miss Tirona, endorse the recent plan of the Governor-
General to appoint a committee of three including the Mayor of the
City of Manila to censure all picture show films coming into this country
from the United States and Europe.

Mrs. ROSARIO M. DELGADO (President, National Federation of Woman's
Clubs). — There is already a committee to censure the films. It has been
recently appointed by the Governor-General.

Miss WOLFSON (Delegate, American Guardian Association, Manila). —
In connection with prevention of delinquency in these Islands, I wish to
state that we are asking the cooperation of all Filipinos in helping
us place the American Filipino "mestizos" on their own feet. There
are 18,000 such children. We are soliciting memberships for the associa-
tion at 1*10 a year. We ask this audience to report to us any American-
Filipino "mestizo" in your respective communities that may need our help.

Miss PRESENTACION OBADO (Delegate, Bacarra Woman's Club, Ilocos
Norte). — I suggest that clubs for young boys be established in connection
with every school, so as to train them to work side by side with the
woman's clubs.

Mrs. EMILIA JARA (La Paz Puericulture Center, Iloilo). — I suggest that
municipalities be requested to separate delinquent children from the adults
in their places of confinement.

Miss VICENTA POSADAS (Pozorrubio Woman's Club, Pangasinan). — In
order to reduce the number of delinquents in the Philippines, I suggest
that the Philippine Legislature be petitioned to appropriate a certain sum
of money for establishing more public recreations, — playgrounds, and for
establishing more schools to accommodate all boys and girls so that they
may not have time to loiter around and commit crimes.

Miss SOFIA GALERA (Delegate, Currimao Woman's Club, Ilocos Norte). —
As there are many defective children in our town as well as in other
communities, I suggest that the authorities concerned send instructions
as to the care and support of such children, to the parents and relatives.

Mr. FELIPE FUENTES (Limay Puericulture Center, Bataan). — I suggest
that the Legislature enact a law prohibiting boys under 18 years of age
from smoking; and a law prohibiting merchants from selling cigars and
cigarettes to such boys.

Mrs. E. DE PERALTA (Ilocos Norte). — In our province there are many
insane persons at large, for their families are unable to keep them at
home. I therefore suggest that the Office of the Public Welfare Com-
missioner see to it that such persons be gathered and committed to the
insane asylum of the San Lazaro Hospital.

Mr. F. POBLADOR (Delegate, Cadiz Puericulture Center, Occidental Ne-
gros). — I suggest that the Office of the Public Welfare Commissioner
register all defective children in the Philippine Islands through puericul-

ture centers, woman's clubs and other charitable institutions in order that
the number of institutions to be established for them may be determined.

MISS TIRONA'S ANSWERS

We reallyneed a law providing for the proper handling of delinquent
children in order to insure their protection and reformation. In this
connection the suggestion that delinquent children be« separated from
adults in their places of confinement in the municipalities may be made
effective.

The suggestion that clubs for young boys be established in connection
with every school (where there are boys) is feasible. But the object
should not be exclusively "to train them to work side by side with woman's
clubs." We have to consider that children's interest vary greatly with
those of adults, and this circumstance is more true with boys' interests
compared with women's. Boys' clubs, by themselves, ha've their reason
for being such, because in such clubs the boys will have an outlet for the
normal expression of those feelings and desires characteristic of their
age, such as the desire to be of service, to join a gang, and the love
of play, activity, etc. If such clubs are properly supervised and directed,
they certainly will be a potential factor in the prevention of juvenile
delinquency.

As for the insane persons whom the families are unable to keep at
home, I must say that it is prescribed by law that the municipal president
shall provide for the proper custody of such persons and report such
facts immediately to the Director of Health who has the authority as
regards supervision over insane persons and the institutions to which
they are committed.

Mr. Poblador's suggestion of registering defective children in the Phil-
ippines is commendable. The authorities concerned may thus be able
to reach the parents who need instructions on the care of their defective
children.

THE INFLUENCE OF THE SCHOOL ON COMMUNITY WELFARE

NORTH H. FOREMAN, Superintendent of Agricultural Instruction,
Bureau of Education

There should be no line of demarcation between a school and
those factors in the development of a community which for
want of a more specific name are called welfare movements.
No discerning mind can divide the one into its basic elements
without at the same time separating- the other into its parts.
Every real school has for its foundation the physical, mental,
and material progress of the people. The ideals of educators,
therefor, always find their objective in public welfare achieve-
ments. To discuss, with any degree of completeness, all school
influences upon community development would result in a paper
too long for this occasion. I shall, however, speak in some de-
tail of certain great community welfare influences of the Phil-
ippine schools, and shall refer in some manner to a number of
lesser school activities which have a distinctive uplifting effect
upon one or more community problems.

A most significant work of the Philippine schools is that of
spreading the knowledge of English with the idea of making
it the common language of the people. From the standpoint
of both national solidarity and the maximum progress in com-
merce, industry, and science, the importance of the diffusion of
English cannot be overestimated. A common language will
enable the people to make for themselves the place in the world
that their opportunities and abilities fit them for. A natural
outcome of all this will be the formation of an enlightened and
effective public opinion without which democracies fail in their
making and oligarchies crumble to dust, bringing chaos, misery,
and degradation to the people. A common language enables
the public leader to reach his hearers and to make public opinion
effective in governmental administration.

The greatest exponent of the dignity of labor is the school of
today, with its industrial and agricultural courses that incul-
cate in the minds of the boys and girls a knowledge of, and
respect for, labor. The ability to perform physical tasks suc-
cessfully is considered as accomplishments. It becomes honor-

224

225

able for the mind and the hand to be trained to work together,
thus producing returns the excellence of which is unquestioned.
The extent to which preparation for a task and diligence in
the performance of that task influence accomplishment are well
taught by the repeated performance of school tasks. The great
welfare lessons taught are willingness to try and ability to
perform, both of which are factors that help to change sleepy
self-satisfied communities into active, hustling, and prosperous
neighborhoods. The schools, therefore, perform a great wel-
fare task by inculcating in the minds of the people the dignity
of labor.

The schools cultivate the habit of seeking recreation in whole-
some ways, and in other respects influence home life through the
fostering of better ideals. In some places the public school is
practically the only wholesome place for outdoor recreation.
Competitive games are taught and exercises required that tend
to develop and maintain a strong and healthy body. Physical
development is an important health measure which directly tends
to conserve the human resources of the country. Competitive
games and especially athletic meets have been a great force in
bringing the people together and in breaking down petty sec-
tionalism. School children are gathered together in games
without regard to the social distinction of their parents. Each
student soon learns that he must stand upon his own merits.
The girl or boy who is not proficient is relieved from his posi-
tion on a school team without even a thought of social stand-
ing. This is the very essence of democracy. Physical educa-
tion as provided in Philippine schools is a great welfare factor
in any community.

Schools dispel superstitions and help to uproot undesirable
customs, thereby preparing the minds for the introduction of
new ideas and new standards which enlighten the individual
and place the family and the community on a higher level of
progress and prosperity. Philippine schools have accomplished
much in such work. Civico-educational lectures are given to
adults each year, and girls are taught the care of babies in
such a manner as to correct errors that result in the present
high rate of infant mortality. There are many concrete exam-
ples of how habits inconsistent with a high standard of civiliza-
tion have been changed. I need only to mention the absence
of buyo-stained teeth among young people, the amount of smok-
ing among schoolboys and schoolgirls, and the sensible school
dresses of girls, in order to recall to mind numerous other de-

185611 15

226

velopments less apparent to the casual observer, but which are
of vital importance to the community. Schools have in many
ways opened the road to great welfare movements, and in these
things alone perform a great work in community service.

The youth of the land is trained for citizenship in such a
manner as to give confidence to all individuals. Civics, proper
government, and current events are daily school subjects.
Most agricultural schools are organized and operated as small
communities with the students themselves devising regulations
and enforcing them. These student communities have all fea-
tures of administration found in a modern community. Students
learn administration by participation in real problems. This
type of school instruction develops strong capable young men
fully prepared for the later duties Of citizenship. This is com-
munity welfare work of a high type.

In addition to the great welfare projects, mention may be
made of numerous specific influences that have a bearing upon
particular welfare movements. Schools and teachers are an ef-
fective distributing medium for information regarding smallpox,
dysentery, tuberculosis, cholera, typhoid, and beriberi. During
epidemics the schools are improvised into hospitals with the
teachers nursing the sick and visiting the home's. Pratically
the only health assistance for thousands of rural localities are
the simple remedies provided by teachers and most frequently
purchased from their own personal funds. The school curri-
culum includes instruction in personal hygiene and pupils are
taught how to care for their bodies, and for their homes and
surroundings. Dental clinics are held in a number of schools
and many schools maintain dispensaries. The thousands of
home gardens and the extensive agricultural club projects pro-
vide more food and a better balanced diet.

The school often fosters a welfare movement until it can
stand upon its own feet, and then passes it on to other entities
in the same manner that it takes young children and trains
them until they can take their places in the community.
Among such welfare projects are the school for nurses, clean-
up week, and household industry centers.

As a parting thought I wish to reiterate that the school is
the great welfare factor in a community's development, and it
stands forth as the ideal in many matters, since the people par-
ticipate so freely in its social activities, admire the well-lighted
airy and strongly constructed building, and view with satisfac-
tion the neat clean premises and the productive school garden.

DISCUSSION

Mrs. PELAGIA C. FRIGINAL (Delegate, Tayabas Puericulture Center). —
I suggest that a text on "Prevention of Infant Mortality" be introduced
in the sixth and seventh grades. As is well known, many of our young
people marry before they finish the intermediate grades, and it is readily
seen that they are not instructed in the 'responsibilities of true mother-
hood and fatherhood. This suggestion if approved of by proper author-
ities will be a protection to the health of our infants, as both fathers
and mothers will receive instructions in the care of babies.

Miss JOSEFA MORALES (Numancia Woman's Club, Capiz). — To make the
work of the puericulture center more effective, I suggest that the seventh
grade pupils be required to have the care of a baby as her practical work.
We can interest these pupils by giving them grades for the care of the
baby, in connection with their housekeeping work. By so. doing, the nurse
of the puericulture center can be relieved of some of the work, and can
direct her energy toward more difficult tasks.

Mr. LORENZO MALLILLIN (Cauayan, Isabela). — Due to lack of physicians
in the Islands, I suggest, through the Public Welfare Commissioner, that
the Legislature appropriate funds for pensioning two residents from each
municipality after graduating from the High School if recommended by
the Division Superintendent of Schools to study medicine in the University
of the Philippines.

Dr. ANTONIO S. HERNANDEZ (Sorsogon). — I suggest that the making
of spoons and forks of bamboo or coconut shell be introduced as part of
the Industrial work in the school to accustom the poor people to their
use. In this way we can eliminate one of the methods of infection, which
is the human hand.

Mrs. CANDIDA BELO (Capiz, Capiz). — I suggest that the laboring class
be given instructions in night schools especially on hygiene under the
auspices of the club in each municipality.

It is said that pupils in the public schools are held responsible for
the hygiene of their homes. This idea can be very well carried out with
the aid of the club.

Miss RITA PONCE (Paoay, Ilocos Norte).—! suggest that "First Aid"
and the "Use of Simple Remedies" be added to the curriculum of the
intermediate schools.

Miss SANTOS (Tarlac). — "First Aid" is taught to girls in the public
schools in connection with domestic science.

Mr. E. GONZALES (Puericulture Center, Mariveles, Bataan) . — I suggest,
through the Public Welfare Commissioner, that the Director of Education
and all private schools give courses in maternity care and public welfare
in general in all secondary schools.

Dr. VICENTE KIERULF (Delegate, Provincial Board, Occidental Negros). —
I suggest that the teaching of maternity care be made compulsory for all
girls above 15 years of age, in all private and public schools.

MR. NORTH H. FOREMAN'S ANSWERS

I take pleasure in stating that I find the points brought out in the
discussion indicative of a wholesome interest in the subject. The only

228

comment which I believe necessary to offer is to state that the care of
babies both prenatal and after-birth is covered very definitely in textbooks
used in intermediate grades especially in classes attended by girls only.
The work outlined requires the actual care of a baby which is usually
brought to the domestic science school by one of the girls. The use of
simple remedies and advice regarding first aid is included in the text
matter taught in all intermediate schools in connection with the instruc-
tion given in physiology and health. The making of spoons and forks
of bamboo and coconut shell has been tried out in a number of places
as an industrial feature and it has been demonstrated that the people
are unwilling to use these articles. Personally, I do not believe that the
practice of eating with the fingers is entirely one of poverty. Most
families are able to provide themselves with knives, forks, and spoons
as soon as they are willing to abandon the custom and ancient practice
of eating with the fingers.

The suggestion that there be night schools wherein instruction may
be given adults in hygiene and health is wholesome. I believe it would
be a most excellent idea if some competent person could work out a com-
prehensive short course in hygiene and health which would be interesting
enough to hold the attendance of adults in night school classes.

HOME GARDENING, HOG AND POULTRY RAISING

SILVERIO APOSTOL, Assistant Director, Bureau of Agriculture

I have been asked to speak on the combined subject of home
gardening, and hog and poultry raising. It is too broad a sub-
ject to be covered with any degree of thoroughness within the
10 to 15-minute time allowed each speaker, and I would have pre-
ferred to split it into two separate numbers but I have been over-
persuaded by those in charge of preparing the program. In
view of this limited time, I shall not attempt to go into details
but rather dwell on such general principles and facts which the
homekeeper or the amateur gardener or hog or poultry raiser
should essentially know.

Home gardening, including the culture of both vegetables and
fruits and flowers, as a means of promoting the health and the
general welfare of the people is far more beneficial than is
commonly realized. Primarily, gardening is engaged in to in-
crease the food supply of the family, but it has a distinct value
especially for the children in that it provides a healthful, gainful
occupation and outdoor exercise as an outlet for their super-
abundant energy. It stimulates and develops their power of
observation, and is a sort of stepping stone from the play-
ful days of childhood to the toilsome days of manhood. A veget-
able garden, however small, and a few fruit trees should be
planted in every home where there is land available. They
afford variety in the diet and tend to balance the ration and
consequently make it more healthful. Moreover, a house will
be more of a home for a garden and an orchard attached to it.

For our purpose, both vegetables and fruits can be classed
into two groups: first, those which are important as food;
second, those which stimulate digestion or furnish the so-called
vitamines — those mysterious substances which as yet we do not
understand though we know that they exist and are vital to the
proper growth of the body and the maintenance of health.

The most important of our vegetables as food plants are
the following: kamote, gabi, ubi, beans, cowpea, sitao, and
mongo, but there are others, like the cassava, tongo, seguidilla,
anipay, and guar, wholesome and highly nutritious foods, the

229

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culture of which ought to be extended. The majority of the other
vegetables, while not furnishing so much body building elements,
are unquestionably of value because of the variation they in-
troduce into the diet, and because of their vitamine content.
Among such plants are the tomato, eggplant, upo, squash, patola,
onion and what are generally termed European or American
vegetables, such as cabbagge, radishes, turnips, mustard, lettuce,
and carrots.

As regards fruits, we have the same conditions. A limited
few are real foods — that is — containing liberal quantities of
protein, starch and fat. Others are deficient in these elements,
for which they make up by their agreeable flavor and taste, com-
bined with a greater or less vitamine content, which latter I
should say is perhaps at present largely conjectural because
our fruits have yet not been studied from this point of view.

The fruits which are real foods include the nuts, such as the
coconut, pili, kubili, bulso, banago, and the kayam, the avocado,
and fruits rich in starch or sugar, such as the banana, bread-
fruit, mango, chico, and nanka, all of which should be exten-
sively planted. Dessert fruits which deserve the most attention
include the naranjita and various. other citrus fruits, the lanzon,
pineapple, papaya, roselle, and duhat, all of which, except the
last two named, are already grown to a considerable extent
though by no means on the scale they should. In addition to
these fruits, there are a host of others of much value — too
many to mention but which you can readily call to mind — grow-
ing in the different parts of the Philippines, including apples,
kakis or persimmons, and other temperate or semi-temperate
species introduced by the Bureau of Agriculture into the Moun-
tain Province a few years ago. Children are by nature fond of
plants and instinctively inclined to physical exertion. No
sooner do they see an older number of the family go out with
a hoe than they run behind him, inquisitive, imitative and ready
to take a hand at the job. These natural tendencies should be
encouraged and properly directed.

Many of our native vegetables, like the sitao, patola, ampa-
laya, gabe, do well during the rainy months, but almost all of
the so-called European vegetables should be planted in the lat-
ter part or towards the end of the wet season so as to mature
in the dry season.- Loamy soils are preferable, although al-
most any other type may be successfully used under good hand-
ling. At any event, the tillage must be deep and thorough, as
vegetables are fast growers. Proper tillage can not be accom-
plished either when the soil is soggy or when it is so dry as to

231

form clods when plowed. Poor soils should be improved by the
addition of well-rotted stable or farm manure. The texture of
heavy soils may likewise be greatly improved.

Standing water is detrimental to vegetables, and so low places
and poorly drained locations should not be selected unless they
are to be provided with ditches for drainage. While this is
true, water plays an essential and direct function in vegetable
life, and the supply must be adequate. The season of the year
and the kind of both the soil and the crop grown determine the
quantity of water needed. Many plants are known to transpire
as much as 400 kilos of water to make 1 kilo of growth normally,
The water must be supplied through the roots. Frequent scanty
watering is dangerous, especially in the dry or hot season, as
it encourages surface rooting. Irrigate only when plants need
water; then water thoroughly. Irrigation should never be ap-
plied during the heat of the day. Cultivate as soon as con-
venient after each irrigation. This will conserve the soil
moisture and prevent the crusting and baking the surface soil.
Cultivation should moreover be so practiced as to completely
control the weeds. In small gardens this may be accomplished
by hoeing and raking. Weeds near the plants should be re-
moved by hand.

Generally speaking, with adequate water supply, vegetable
seeds should be planted as shallow as possible, especially those
plants which are to be grown first in the seedbed and then
transplanted to the place where they are to be allowed to mature.
In the wet season the depth should be relatively less than in
the dry season, just as it should be less in a heavy than in a
light soil. But more than anything else, the size of the seed
determines the proper depth. For instance, small seeds like
lettuce, mustard, eggplant, tomato, pepper, celery, etc., should
not be buried deeper than 1 centimeter; while somewhat larger
seeds such as cucumber, ampalaya, pumpkin, upo, and the like
should be planted at an average depth of about 3 centimeters;
and larger ones still deeper.

Corn, and nearly all beans, patola, ampalaya, squash, cucum-
ber, and also root crops such as carrots, beets, turnips, etc., are
planted direct in the field ; but most of the other crops, especially
those with fine seeds like the cabbage, pepper, eggplant, tomato,
pechay, etc., must first be grown in seedbeds and then the young
plants or seedlings set out where they are to reach maturity.
The reasons for this fatter practice are many, the foremost per-
haps among them being that it better enables the gardener to
give the more delicate seeds the necessary attention in germ-

232

inating them and in caring for the young plants. It is of the
utmost importance to give the plants a good start so that they
will later thrive under field conditions. For the seedbed a
sandy or loamy soil should be chosen. Per contra, a heavy soil
makes a poor seedbed, and a stiff clay should never be used.
Where the soil is heavy, some sand and well-rotted stable man-
ure or other organic matter should first be added and worked
evenly into it.

Seed should be saved only from the best, normally developed
individual plants, from plants that are thrifty, vigorous and
productive, with excellent products. Good seeds must be reason-
ably heavy, plump, well-proportioned and properly seasoned.
A heavy seed promises a strong root system — the feeding organ
of the plant. The seed should first be tested for germination,
especially when it is to be planted direct, so that the rate of
seeding may be regulated accordingly. When the sowing hap-
pens to have been too thick, the seedbed should be thinned by
removing some of the plants in such a way as to aiford the
remaining seedlings the necessary space for their proper devel-
opment. Should it become necessary to make use of all the
plants, the thinning should not be done before the seedlings
have made sufficient root and top growths to be replanted in a
new bed having as nearly the same conditions as those of the
one whence they were removed. Whether for thinning or for
transplanting, the bed should first be well watered so as to
facilitate the pulling up of the young plants. In transplating,
especially with delicate plants, the seedling must be removed
with some soil around their roots. This can be easily accom-
plished with the aid of a trowel or even a broad, carefully
sharpened piece or bamboo. The transplanting should be done,
preferably, on a cloudy day, or early in the morning and late
in the afternoon. Seedlings set out in the morning, especially
the more delicate plants, should be provided with partial shade,
for which purpose there is perhaps nothing better than the
sheaths of the banana stalk. There are, however, a large num-
ber of good substitutes already known to most of us always
handy. Only a few seedlings should be picked at a time for
transplanting even if we had to make more trips between the
field and the seedbed. In any event the seedlings, after they
are so removed from the seedbed, must be constantly kept moist
and out of range of the direct rays of the sun. As a general
rule, they should be planted to the same depth as they stood
in the seed bed. The soil at planting time should be rather dry

233

than wet, and then water is applied liberally but carefully so
that the force thereof will not injure the newly planted plants.
Swine and Poultry. — As to swine and poultry, there certainly
should be many more of these very highly useful domestic ani-
mals raised in the Philippines, even if it is just for the purpose
of adequately providing for local consumption so that there will
not be any necessity of importing any, aside from the considera-
tion that fowls particularly are a very healthful food for people
of all ages. Our people are also very fond of pork and use
large quantities of lard in their cooking. In Manila, alone,
during 1920, 108,362 hogs were slaughtered. Most of us would
be very much surprised to know the large sums of money leaving
the country annually on account of these two articles of food —
swine and poultry. Statistics show the following importations
during 1920:

Swine, live . 30 ?*3,600

Pork, fresh kilos 37,718 52,250

Pork, canned , do 38,617 65,518

Sausages do 259,658 401,079

Hams and shoulders do........ 418,620 697,387

Bacon do 49,247 85,664

Lard do 2,080,891 1,102,073

Lard compounds and other substitutes do 191,671 205,676

2,613,247

Poultry and Game 67,461

Eggs dozens.... 4,231,356 1,805,578

1,873,039
Grand total .'. 4,486,286

Almost four and a half million pesos thus leave the country
every year for things that we could well produce ourselves.
Both swine and poultry do well all over the Philippines, and
I fell sure that with a little more effort in the part of every
one of us, particularly the housewives we would not only suc-
ceed in retaining home this much-needed sum of money but
also be able to feed ourselves better — for who does not ap-
preciate a chicken dinner? And who does not know the value
of poultry, both the fowl and the egg as food? If no more
chickens and eggs are consumed nowadays it is simply because
the supply is limited and consequently the price is prohibitive
for most people. There are no justifiable reasons for the ex-
istence of this deplorable condition in the Philippines; but it
exists just the same, and we cannot evade its bitter conse-
quences. I am not in the position to present statistical figures,

234

but we have to admit that our high rate of infantile mortality
are to a considerable extent traceable to the improper feeding —
oftentimes underfeeding — of the pregnant or nursing mother.
Well, ladies and gentlemen, the remedy is in our hands ; to plant
a home garden and to raise some poultry and swine. What has
been said in the foregoing paragraphs about the natural liking
of children for plants is equally true for animals. They like
fowls particularly (perhaps because of the early training they
receive in caring for papa's fighting bulik or talisain) but they
would learn to like and care for swine as well if given the proper
encouragement.

In view of the limited time, there are just two points that I
want particularly to touch upon relative to hog and poultry
raising, namely, (a)' the selection of the sow and the care of
young pigs; and (b) the care of the laying hen and the little
chicks.

As with the plant, the sow, and the boar for that matter, in-
tended for breeding should be selected from among the progeny
of individuals or strains known to possess desirable characteris-
tics and superior qualities. The sows should be obtained only
from prolific mothers that have plenty of milk and of gentle
disposition. In selecting brood sows the breeder should look for
individuals having the following conformation : the forehead,
wide between the eyes ; the neck, moderately thin with smooth,
deep shoulders and a clean throat; the body, rather long but
compact, with a wide, straight, deeply fleshed back and well
sprung ribs, and the sides deep and straight also, indicating
roominess for the vital organs ; the hams deep and well rounded,
supported by moderately short but strong legs. These charac-
teristics are indicative of a strong conformation and capability
of producing strong hardy pigs. Besides, a good brood sow
must be a good grazer, a good feeder, and, needless to say, give
enough milk for her litter.

For best result the sow should not be bred before she is one
year old. The period of pregnancy of swine is on the average
114 days, though it may vary from 112 to 118, and during this
time she should be especially well fed and allowed plenty of
exercise in order that she may be in proper condition for far-
rowing. No feed should be given the sow for the first 24 hours
after farrowing or till she gets up of her own accord, but she
should have plenty of good drinking water. Then she may be
given a light ration of tiqui-tiqui slop, and the feed is increased
gradually to normal or full feed. This stage is reached in 3 to

235

4 weeks from farrowing. For brood sows the ration should be,
in general, plentiful, succulent in nature, and somewhat high
in protein.

The pigs should not be weaned till they are 3 to 4 months old.
If separated too early from the mother, they are stunted. The
best guide, of course, is the ability of the little ones to take and
assimilate feeds; and unless one is in the position to give the
little pigs the proper feed and care, the safest method both for
the mother and the young is self-weaning — i. e., let the litters
run with the mother until they separate from her on their own
accord. The objection made to this is that it delays breeding
and consequently the sow may not be able to drop but one litter
to the year instead of three or even four or five in every two
years as will be the case if the forced weaning is practiced. In
this latter case, however, the rearing (feeding) of the young
pigs is more difficult and requires more expert attention to be
successful.

Generally speaking, the so-called Cantonese chicken is un-
doubtedly the best suited to Philippine conditions of all the
breeds or varieties of chickens heretofore imported into this
country. As its name indicates, it is of Chinese origin. It is
of the small type, being in general smaller than our native
chicken, but it is a good rustler and hardy and a better layer.
The average egg-laying capacity of Cantonese hens is 120 a year,
although individuals often reach the 160 mark, as compared
with the 80 eggs a year of our native hens. Its meat is tender
and of good flavor, and as a whole superior to the native fowl.
It is not nervous as a rule, being easily kept within inclosures,
and the hens are good sisters and good mothers.

As it has been stated, in this paper I shall confine myself to
that feature of poultry raising that deals with the proper care
of laying hens and little chicks. Among domestic animals, the
chicken is one of those that is readily affected by proper or
improper feeding. This is particularly true of the laying hen
and the chicks. The quality and flavor of both the meat and
the egg of a given hen can be changed almost at the will of the
poultry man according to the quantity, kind, and quality of the
materials he uses for feed.

Generally speaking, the laying hen should be fed liberally.
The ration should not only contain good proportions of protein
and carbohydrates but also plenty of mineral matter. The pro-
blem of feeding is greatly simplified if the poultry is provided
with an ample and good pasture where the fowls may obtain

236

their green and animal food and at the same time have the neces-
sary physical exercise. Where this is not possible, they should
be supplied the necessary green and animal feeds. Then the
laying hen should be given plenty of grain and provided with a
constant supply of clear water to drink. It is surprising how
much water the chicken drinks, especially on a hot day and if
confined and subjected to dry, concentrated feeds. Two dozen
full grown fowls would need 3 to 4 liters of water daily. The
best guide for feeding is of course the appetite of the hen. She
may be allowed to go a little hungry during the day, and then
given all the feed she can eat before she goes to sleep. The lay-
ing hen requires calcium for the formation of the egg-shell, and
she must be supplied plenty of this mineral in the form of ground
shells.

The period of incubation for chickens is three weeks. During
this period the hen spends most of her time sitting on her eggs,
turning them constantly so that they may be evenly heated. She
usually leaves them in the morning for a short while to scratch
and look for food, except the last 3 days, when she goes without
eating and stays in the nest continuously. Then the eggs are
hatched.

The hen should at once be given a light feed but plenty of
good water to drink. The amount of the feed is gradually in-
creased from day to day to full feeding as the hen recovers
strength. No feed whatsoever should be given the chicks for
the first day or two after hatching. Nature has provided for
their early maintenance in the form of the yolk of the egg
deposited in their little abdomens in which it is absorbed by
the body. Both the feeding and the watering of the chicks
should be done with much care and good judgment; they should
be very light at first. The failure commonly experienced by
many in raising chicken is traceable to the over-feeding of the
chicks. The common practice is to occasionally place in the
coop a liberal supply of feed and let the chicks help themeslves
to it, and consequently they soon become sick due principally
to overfeeding and poor digestion. The best way is to feed
them four times a day at first, but to give them just enough
feed that they can eat it all at the time, and then let them scratch
and work. After a week three meals will do and later two.
The first meal should be at daylight and the last before they go
to sleep. Scratching is a natural form of exercise for chickens.
Binlid is a good feed for little chicks, but a mixture of 10 parts
of this by weight, 6 of ground corn, 3 of tiqui-tiqui, 2 of ground
copra, and 1 of ground mongo, fed three times a day, has given

237

the Bureau of Agriculture better results. Of course, in con-
junction with the grain feed, green and animal feeds should be
supplied. Ground bone makes a good feed. Good drinking water
and a box containing fine sand and ground charcoal and another,
sand and ground shells should be provided in such a way that
the chicks may have easy access to them. The sand and shell
aid in grinding the food in the stomach, and the charcoal helps
digestion. As the chicks grow larger and learn to scratch, the
feed should not be given in receptacles but rather spread about
in the feeding yard. Moreover, odd as it may seem, the dust
bath of which chickens are so fond is necessary for their health
and protection — it cleanses their skin and helps to relieve them
from parasitic insects — and it should be provided them.

The time during which the chicks go with the mother vary
usually from 6 to 8 weeks. Then they are separated entirely
from her. The cockerels should be segregated at once from
the pullets and the two cared for separately until they are sold
or otherwise disposed of.

Just one more piece of advice: Do not try to keep any more
pigs or chickens than you can conveniently and properly care
for, and remember that an animal in confinement can not look
for its own food and water and consequently must be supplied
all it needs.

HOW WE SHOULD PROTECT THE MOTHERS AND CHILDREN
OF OUR LABORERS

FAUSTINO AGUILAR, Director, Bureau of Labor

Before answering this question, I believe it advisable to
mention some facts. In our industrial cities, especially in
Manila, women are employed in the following centers: hemp
presses, rice mills, storehouses, telephone companies, photo
studios, shops for the manufacture of ampao, apa, etc., aerated
water factories, breweries, distilleries; candy, vermicelli, and
chocolate factories; laundries, barber shops, dry-cleaning, and
tailor shops ; slipper, shoe, and hat factories ; cigar and cigarette
factories; cinematographs, lithographs, printing and binding,
artificial flower, and mat factories.

Child labor — workers below 16 years of age — is employed in
the following industries : in the manufacture of oil, candles,
matches, boxes, buttons, hats, glass, furniture, caramels, ver-
micelli, pastries, ampao, apa, ice, cigars and cigarettes, etc.; in
automobile repairing, electrical installations, foundry, black-
smithing, brasswork, brick factories, storehouses, barber shops ;
tailor shops, millineries, embroideries, printing, lithographs
and binding, newspapers, stables, laundries, fish industry,
bakeries, and dairy products. It should be understood that
both sexes are included in child labor.

In provinces wherein shops and factories are scattered in
various municipalities, women are employed in the following
centers: hemp press, saw, rice and sugar mills, fisheries, salted
and dried fish industries, distilleries, bejuco concessionaires,
maguey and nipa industries, storehouses, potteries, bakeries,
brass smithing, watch repairing, telephone and railroad serv-
ices; embroidery industry, laundries, carpentry shops, electrical
installations, lithographs, printing and binding; and in the
following factories: oil, aerated water, perfume, chocolate,
vermicelli, sinamay, hat, and wooden shoe.

Both in Manila and in the provinces, child labor is employed
in the following industries: hemp press, storehouses; aerated
water factories, distilleries; saw, rice, corn and sugar mills;
nipa and maguey industries; storehouses, carpentry shops and

238

239

carriage factories; fishery industries, tobacco factories, ship
yards, sinamay industries, slipper factories, machinery shops,
bakeries, and printing and binding. Again it should be ob-
served that child labor includes both sexes below 16 years.

Summing up the number of women and children employed
in different industries, there are 7,818 of the former and 1,189
of the latter, in accordance with the data compiled by the
Bureau of Labor for the period covering January 1, 1921, up
to this date. It is needless to state here that there are still
centers of labor to inspect and consequently the total numbers
heretofore stated are incomplete.

The average hours of labor in the industries and shops so
far inspected are 9 hours daily. Taking for granted that the
actual crisis sustained by business as a whole has given rise
to the suspension of many industrial activities resulting in con-
sequence to a paralyzation of labor and to unemployment, you
will have to agree with me that the numbers heretofore mem-
tioned are representatives of a portion only of the women and
children who are compelled to enlist themselves in the grand
army of the proletariat, who are daily struggling to exist.
But even if the number of women and children now employed
is a small portion only of the total population of our country,
it should be admitted that there is now a need of establishing
the basis for an adequate protection of their health and life,
so that they may develop in the future, particularly when the
business lull disappears and the industries now closed revive
their former activities, to the welfare of all.

The absence of a law clearly defining what protection should
be given to woman and child laborers is emphasized by the fact
that there is an absolute lack of protective measures in force
in many industries, and if there are any rules and regulations
in others, they are hardly adequate or else incomplete.

I am convinced that a law compelling industrial centers to
adopt measures for the safety of woman and child laborers
would the more awaken and encourage the individual initia-
tives of various industries which, for humane and altruistic
spirit, have so far established certain measures. It would also
disseminate such practice in such a way that the protection
afforded in consequence thereto, will not only be for the particu-
lar benefit of our female workers and children but also for the
welfare of the community. One of the protective measures
may consist, for example, in the complete prohibition of the
employment of those below 14 years of age. This measure
will protect the child laborer from deplorable consequences

240

arising from ignorance, especially if every boy or girl is to
be required to present before admission to employment a cer-
tificate showing that he or she has passed grade seven in any
public school or private school recognized by the Government.

Another protection which is urgently needed is a legal meas-
ure for the protection of our women laborers when they are
in the state of pregnancy. It is obvious that during this
period the woman should be entitled from the industry in
which she is engaged not only to a consideration in view of
her condition but also to a protection in the form of leave of
absence with pay for a period of time before and after
childbirth.

A proposed bill to this effect defining the rules and regula-
tions which should be established relative to woman and child
labor is now being presented to this Conference for delibera-
tion and necessary action. Should this law be enacted there
would probably be a need of investing certain branch of
the Government the power to enforce additional regulations
through periodical inspections, for the protection of women and
children working in the shops and factories. At present the
Bureau of Labor has the duty of inspecting centers of labor
but it has no authority to enforce any regulation. It is sug-
gested therefore that this matter be discussed at this Confer-
ence in order to formulate some recommendations that will
tend to better in this respect the service of the Government.

The individual initiative of our employers with respect to
the protection of laborers employed by them is now taking a
definite stand in the form of different measures. As an in-
stance which may illustrate this fact to you, I may cite the
system of insuring the life of laborers now in force in various
industries; but the benefit of this insurance does not extend
at present to woman and child laborers. However, the estab-
lishment of a day nursery in a factory in the city should be
mentioned, wherein the children of women workers are prop-
erly cared for during the day by competent persons. The
children, including both sexes, are given elemental instructions
under the charge of a nun. They are also given their lunch.
In some of our large plantations, mines, and lumber companies,
dispensaries are maintained to attend to cases resulting both
from labor accidents and illness; but as may be clearly seen
those who are benefited by such measure are the male laborers ;
and the fact that only one of the many factories that we have
has a day nursery for the children of our female laborers, in-

241

dicate very clearly that even this kind of protection is not
general, and this is due to lack of legal provisions requiring
industries employing women to establish this kind of centers
of protection for our laborers' children. As a precedent it
may be mentioned in this connection that in the Republic of
Chile a law was approved on March 22, 1921, requiring the
owners of factories employing 50 women or more, of 18 years
of age or above, to establish day nurseries for the children of
such laborers. According to this law a competent person paid
by the employer takes charge of these children who are housed
in rooms each accommodating not more than 25 children.
Plans of these buildings have to be previously approved by the
"General Directorate of Sanitation" of the Republic of Chile.
A medical certificate which may be obtained from a hospital
or from a dispensary is required for the admission of a child
into this factory day nursery, inasmuch as children suffering
from contagious diseases are not admitted. Every mother of
a child less than a year old has two one-half-hour periods per
day for nursing her child in addition to the regular rest period.
A similar measure should be adopted in our cigar factories,
for example, in which the number of women employed exceeds
4,000; then comes in importance the embroidery shops, cotton
factories, and laundries.

Another proper remedy which is very necessary for our in-
dustrial workers as well as for the laborers working in the
fields where a great number of women and children are fre-
quently employed periodically, is the limitation of hours of
labor. A proposed bill on this matter is now before you for
your consideration and discussion. Moreover, an intensive
propaganda for the care of the health should be carried on in
our great rural masses, inasmuch as any measure tending to
awaken in these masses the idea of adjusting themselves to
hygienic and sanitary habits should only be the result of a
social movement, rather than of a legal measure. The Woman's
Club which perfectly befits itself in its mission among our
small communities in the provinces, conscious, as I believe it,
of the true mission which it has to realize for the general
welfare, is the only instrument which may be availed of at
present to inculcate among our masses hygienic and sanitary
measures tending to preserve life and health.

In conclusion, I believe that for the protection of our women
and children now employed in shops, factories, and in the fields
the following remedies should be adopted:

185611 1«

242

1. A law regulating woman and child labor in all factories
and centers of labor and granting leave of absence with pay
for women workers during the period of pregnancy, before and
after childbirth.

2. A law regulating hours of labor.

3. A law empowering a certain branch of the government to
enforce measures, within the shops or factories, which would
best insure the protection of the laborers.

4. A law requiring the employer to establish in his factory
or shop day nurseries similar to those required in the Republic
of Chile.

5. An intensive campaign by woman's clubs to inculcate
among the rural masses hygienic and sanitary habits.

[Act No. ]

AN ACT REGULATING THE DAYS AND HOURS OF WORK
AND PRESCRIBING PUNISHMENT FOR EACH VIOLA-
TION THEREOF.

Be it enacted by the Senate and the House of Representatives
of the Philippine Islands, in Legislature assembled and by
the authority of same:

SECTION 1. It shall be unlawful for any person employed in
any occupation or work to work on Sundays, except in such works
as hereinafter provided.

SECTION 2. It shall be unlawful for any person, firm or cor-
poration to require its employees, or any one of them, to work
on Sundays, except as hereinafter provided.

SECTION 3. For the purposes of this Act, Sunday begins from
12 o'clock Saturday evening and ends at 12 o'clock of Sunday
evening.

SECTION 4. The following are excepted from prohibited labor
in accordance with this Act :

(a) Works in the preparation of meals and other necessaries
for the day's subsistence;

(b) The manufacture and production of gas and electric cur-
rent for lighting and other work necessary for life;

(c) The recording and distribution of heat and motor power
and the distribution of water for domestic use and other neces-
sities ;

(d) The use, operation, and repair of telegraph and tele-
phone apparatus;

(e) The retail sale of drugs and medicines or other articles
called for in a physician's prescription;

243

(/) The retail sale of cigars and cigarettes in stores licensed
to sell them;

(g) The preparation, printing, sale and distribution of news-
papers in any of its forms;

(h) The sale of lemonades, sodas and other aerated waters
and refreshments of all kinds, excepting beer and other intox-
icating drinks;

(i) Work in cafes, restaurants, bakeries, confectionaries,
public markets and slaughter houses;

(j) The preparation and retail sale of medicines and other
articles in drug stores;

(k) The work of porters, wagon, carriage, calesa and cart
drivers, chaff eurs, and others of the same form ;

(I) The works for the running of a train, car, electric car
or wagon on any railway ;

(m) Work in the boats and ships anchored in the rivers,
ports, bays, etc.;

(n) Transfer work in barges, ferry-boats, bancas or other
kinds of vessel from one side to the other of a river, estuary,
lake, canal, etc.;

(o) Milking, sale and delivery of milk to the stores and
homes ;

(p) Boot-blacking and works in barber shops;

(q) Embalming and burial of corpses and the preparation
and service at funeral parlors;

(r) All work done in the service and cult of any religion;

(s) Janitor, guard or night-watch work;

(t) All works which are of absolute necessity in avoiding
any evil that may seriously injure the interests of the agent.

SECTION 5. The hours of work for laborers of both sexes is
hereby limited to not more than eight per day and to- not more
than seven for pregnant women from the sixth month of preg-
nancy and for those below 16 years of age in industrial and
commercial establishments, excepting those which are herein-
after prescribed: Provided, That no laborer who has worked
for a day shall be admitted to work in the evening of the same
day, And provided further, That no man or woman above sixty
and below sixteen years of age shall be admitted to night work
in said establishments.

SECTION 6. No laborer shall be compelled or required to work
longer than the time fixed in the preceding section, except in
cases of extraordinary emergency.

SECTION 7. For the purposes of this Act those cases which
constitute a danger to life, property, order, public welfare and

244

public health shall be considered cases of extraordinary emer-
gency; and the threat of losing employment shall be considered
as an act of compelling a laborer to work longer than the time
fixed in Section 1.

SECTION 8. The reduction of wages which laborers actually
receive shall not be authorized with the application of this Act,
all stipulation to the contrary notwithstanding.

SECTION 9. The following are excepted from the provisions
of this Act:

(a) Persons who hold positions of trust, of vigilance or ad-
ministration.

(b) Persons who are engaged in contract or piece work.

SECTION 10. The violation of any of the provisions of this
law shall be punished with a fine of not less than fifty pesos
nor more than two thousand, or subsidiary imprisonment in
case of insolvency.

SECTION 11. The Secretary of Commerce and Communication
is hereby empowered, thru the Director of Labor, for the pur-
pose of this Act to prescribe and establish rules and provisions
convenient for the laborers and employees and for the industrial
capitalists and merchants.

SECTION 12. This Act shall take effect upon its passage.

Enacted,

[Act No. ]

AN ACT REGULATING THE EMPLOYMENT OF WOMEN
AND CHILDREN IN THE SHOPS, FACTORIES,
AGRICULTURAL, MERCANTILE AND INDUSTRIAL
ESTABLISHMENTS AND OTHER CENTERS OF
LABOR IN THE PHILIPPINE ISLANDS, PUNISHING
VIOLATIONS THEREOF, AND FOR OTHER PUR-
POSES.

Be it enacted by the Senate and the House of Representatives
of the Philippine Islands, in Legislature assembled and by
the authority of same:

SECTION 1. It shall be unlawful for any person, firm or cor-
poration, to employ women or children less than 14 years of
age as laborers in mines or other centers of labor wherein ex-
plosives are used or manufactured.

riON 2. Every person, firm or corporation, who is owner
of a factory, shop, industrial or mercantile establishment, is
required to provide and set, in his establishment for the use
of his laborers, seats especially for women and children and
allow them to sit upon them, provided they would be able to
comply with their duties sitting and accomplish the work as-
signed to them, without any detriment to the efficiency, or
whenever they are free from their respective work.

SECTION 3. No person, firm or corporation shall employ nor
allow any person less than 16 years of age to be employed to
work in their shops, factories, commercial or industrial firms
or other centers of labor for more than 7 hours during the day,
or for more than 42 hours in the week.

SECTION 4. No person, firm or corporation shall employ nor
allow any boy or girl to be employed in their factory, shop,
commercial or industrial firm, or center of labor during school
days unless he or she shall have passed Grade VII prescribed
in the public schools or in any private school duly recognized
by the government, in which case, he or she may be admitted
upon showing the certificate of his or her studies; provided
he or she is not excluded by any sections of this Act.

SECTION 5. It shall be unlawful for any person, firm or cor-
poration licensed to conduct a bar for the sale of liquor to em-
ploy or allow minors to be employed therein.

SECTION 6. It shall be unlawful for any person, firm or cor-
poration, to employ women in factories, shops and other simi-
lar establishments wherein the work requires the employee to
be standing always.

SECTION 7. It shall be unlawful for any person, firm or cor-
poration to employ or allow persons less than 16 years of age
to be employed in their factories, shops or other centers of labor
wherein the work has to do with the preparation of any sub-
stance poisonous or injurious to the health, or of explosive or
infectious substances.

SECTION 8. It shall be unlawful for any person, firm or cor-
poration, to employ or allow persons less than 18 years of age
to perform hazardous work, such as to build houses, bridges,
telegraph posts, telegraphical installations and the like.

SECTION 9. It shall be unlawful for any person, firm or cor-
poration to employ or allow boys less than 12 years of age, or
girls less than 14 years of age to be employed, as newspaper
peddlers on public streets.

246

SECTION 10. It shall be unlawful for any person, firm or cor-
poration to employ boys or girls less than 14 years of age in
commercial or industrial firms, except during school vacation,
in which case they may be employed in the factories of pre-
served fruits between 7:00 a. m. to 7:00 p. m.

SECTION 11. Any person, firm or corporation being proprietor
or administrator of a factory, shop or center of labor what-
soever, is required to provide two separate and sanitary toilets
for the use of their workers, one for males and the other for
females.

SECTION 12. No person, firm or corporation shall employ or
allow to be employed in the factory, shop or center of labor
whatsoever, any person less than 16 years of age, to do the
work of an elevator man, or cleaning machines, or to do any
underground work and the like.

SECTION 13. No person, firm or corporation shall employ nor
allow to be employed any person less than 16 years of age to
work at night in the factory, shop or any other center of labor.

SECTION 14. It shall be unlawful for every minor to do any
of the following acts:

(a) To earn a living by begging.

(b) To be employed or accept an employment in billiard halls
or other places wherein gambling with money, betting or its
equivalent is conducted :

Provided, That the person, firm or corporation who may em-
ploy or allow to be employed any person under age in the con-
ditions above referred to, shall be held responsible, in the same
degree as the agent.

SECTION 15. Any person, firm or corporation, proprietor or
administrator of a factory, shop or any center of labor, is re-
quired to grant leave with pay to every woman laborer who
is pregnant, 30 days leave before delivery and another 30 days
thereafter :

Provided, That the principal shall not dismiss, without suffi-
cient cause, the laborer aforesaid, unless she is indemnified with
a salary covering two entire months beginning with the date
of her dismissal.

SECTION 16. It shall be unlawful for any person, firm or cor-
poration to employ or allow any person less than 16 years of
age to be employed as drug store keeper or to engage him in
any sort of work which may affect the public health.

SECTION 17. Any person, firm or corporation violating any of
the provisions hereof, shall be punished either with fine of not

247

less than 50 pesos and not more than 200 pesos, or with im-
prisonment for not less than 10 days nor more than 6 months
or both, at the discretion of the court.

Referring to commercial firms or corporations, their respec-
tive presidents, directors or managers, or in default thereof,
the persons who are acting in their steads, shall be held res-
ponsible criminally for every violation of this act.

SECTION 18. This Act shall take effect upon its passage.

Enacted,

PART III

MISCELLANEOUS

249

MINUTES OF THE BUSINESS SESSION

[Saturday afternoon, December 10]

The Hon. Teodoro M. Kalaw, Secretary of the Interior, pre-
sided over the business session of the Conference, which was
opened at 2.15 p. m. The matter which was taken up in this
session was the consideration of the resolutions presented by
the delegates.

There were more than 100 resolutions presented. In view,
of the impossibility of discussing all of them during that after-
noon, the Chairman asked for suggestions for handling them.
Dr. Fernando Calderon, President of the Council of Hygiene,
therefore, moved that a committee to study and report on the
resolutions be appointed by the Chairman. Dr. Andres Catan-
jal, Philippine Health Service, seconded the motion. Dr. Ale-
jandro Albert, Under Secretary of Public Instruction, amended
the motion, by suggesting that the committee to be appointed
should report to the Public Welfare Commissioner on the action
taken by them with respect to each resolution, and that they
should communicate with the authors of the resolutions in order
to acquaint them with the result of their suggestions. The
amendment and the motion were successively voted upon favor-
ably. Accordingly, the Chairman appointed the following to
compose the Committee on Resolutions:

Dr. Fernando Calderon, Chairman.

Members:

Mrs. Rosario M. Delgado,
Mr. Manuel Aguinaldo,
Dr. Andres Catanjal,
Dr. Carmelo Penaflor.

Then Governor-General Wood addressed the Conference. He
thanked the delegates for having come, and assured them of
the Government's cooperation in their undertakings concerning
public welfare.

Mrs. Wood kindly consented to speak also in compliance with
the request made by the women at the Conference.

Finally, the Chairman delivered his closing address.

251

CLOSING REMARKS OF THE HONORABLE TEODORO M. KALAW,
SECRETARY OF THE INTERIOR

Mr. GOVERNOR-GENERAL, LADIES AND GENTLEMEN:

I believe the moment .has come to close this important Con-
ference. The work performed by you has surpassed our hopes.
To be true, we can not yet judge it properly; but I hope that in
the near future the results of this Conference will speak for
themselves and will at the same time remind our children and
descendants of the great significance of these last five days in
which you all, impelled by a patriotic duty, have come here to
cooperate in a great common enterprise.

To those who look for immediate results of this Conference,
I would counsel faith and patience. Before embarking upon
any great national undertaking, we must prepare the atmos-
phere; we must put the masses in a condition of receptiveness ;
we must clear the ground, as it were, in order that the seed
planted may bear fruit in due time. The chief object of this
Conference is to initiate the campaign of propaganda and to
open the channels through which the currents of energy and
organized activity are to flow. Just as a railroad is not built
where there is no inducement for the company, where the people
do not realize the necessity of transportation or where there are
no products for outside markets, and just as it would be unwise
to establish a hospital where no need for one is felt or where the
idea of sending a patient to the hospital is not understood, so
our scientific plans, in order that they may not result in failure,
require a preliminary education, a propitious milieu, a favorable
atmosphere.

Although work for studying and solving the question of in-
fant mortality in the Philippine Islands has been undertaken
before, yet I believe this is the first gathering held and the
first work performed in the field which can be said to have a
general and national character. This gathering has been at-
tended by delegations from the several provinces of the Ar-
chipelago, prominent among whom is the feminine element, which
constitutes an overwhelming majority of the members of this
Conference. The beginning has been magnificent and astonish-
ing. I expect the continuation and development to be the same,

252

253

provided there be tenacity and perseverance. Technical men
and laymen, Government officials and private citizens, men and
women, have mingled on this occasion to demonstrate the neces- -
sity of that element which is indispensable in all undertakings
of this nature ; cooperation. We must, in the first place, educate
the mothers, preparing them to receive and accept the instruc-
tion they are to be given by the trained personnel. If the
mothers do not put that which they are taught into practice,
then any campaign of this kind will be useless. The expen-
diture of the thousands and even millions of pesos which the
Government is ready to spend in this undertaking would then
be useless. This is a popular undertaking directed and or-
ganized by science. The two elements have to 'unite and aid
each other in order that the desired results may be obtained.

I hope the suggestions and resolutions presented this after-
noon, of which there are altogether over a hundred, will be of
great assistance to the persons at the head of this campaign.
I likewise hope that the committee just appointed will carefully
study the practicability and efficacy of each of the suggestions
and resolutions received. Some of them are of a merely local
character; others can be disposed of by mere administrative
proceedings; but some are of such real importance that I truly
regret that this Conference cannot be extended for their proper
discussion.

At all events, we, and the Filipino people in general, must
be grateful to our dear Governor-General for the idea of calling
this Conference. We have more than sufficient reason for pro-
claiming the transcendency of this Conference, not so much on
account of the valuable papers which have been read here, or
the important suggestions and measures introduced; but as
popular propaganda, as an event which has awakened general
enthusiasm and has put us on the defensive against the common
peril.

I hope that when you go to your respective municipalities,
when you get in touch with your people, you will communicate
the instructions and the enthusiasm that you are now taking
away with you to whomsoever may be in need of them, especially
to our ignorant poor mothers. Ajid when the agents of our
Central Government, the officials and agents of the Health Serv-
ice or of the Public Welfare Commissioner, shall come to your
provinces to fulfill their missions, then I hope you will receive
them as heralds of a new era in the history of health in the
Philippine Islands. They will come not so much as Government

254

agents merely performing their official duties, but as impelled
by constructive patriotism, and in this spirit they will conduct
and direct a campaign in which we are all vitally interested.
They will represent our Governor-General who is so deeply in-
terested in the Filipino children, and also the Government and
the whole people of the Philippines, whose health and welfare
it is the duty of all of us to foster. I hope you will receive
them with open arms and will take them to the remotest corners
of your municipalities, in order that through your aid and in-
spiration, the benefits of this great campaign may reach even
the most neglected mass of our people and make it possible for
us to form in the future a sound, great, and vigorous race.

REPORT OF THE SPECIAL COMMITTEE ON RESOLUTIONS

February 16, 1922.
The PUBLIC WELFARE COMMISSIONER,

Manila, P. I.

SIR: The Committee appointed at the closing session of the
First National Conference on Infant Mortality and Public Wel-
fare convened in Manila from December 6th to December 10th,
inclusive, to study, deliberate and submit recommendations upon
the resolutions, suggestions and propositions presented at said
last session, has the honor to render the following report:

The Committee had four sittings which took place on De-
cember 23, and 28, 1921, January 4, and February 3, 1922, under
the chairmanship of Dr. Fernando Calderon and with Dr. C. Pe-
naflor acting as Secretary.

The bulk of work submitted to the consideration of the Com-
mittee consisted of 168 individual communications classified as
follows :

Petitions • 78

Suggestions 104

Recommendations for Legislature 24

Consultations 4

Complaints 4

A preliminary examination of the subject-matters dealt with
by the foregoing communications demonstrated a wide range
and variety of activities which, for the purpose of this report,
can be tabulated as follows :

Food production 1 Supplies 1

Financial help 13 Quackery 1

Education 12 Organization 1

Midwives 8 Legislature 12

Playgrounds 1 Philippine Health Service 17

Inquiries 4 Hospital 1

Agriculture 2 Refuse disposal 1

Nurses . 23 Doctors 1

Maternity houses 3 Antivice 2

Follow-up after Conference.. 3 Red Cross 1

Artesian wells 6 Reformatory 2

Labor problem 3 Puericulture Centers 1

Publications 10 Woman's Clubs 1

Right feeding 3 Miscellaneous 22

Marriage Law 2 Personal questions 3

255

256

Three entire sittings out of the four celebrated by the Com-
mittee were exclusively devoted to the discussion and delibera-
tion of the suggestions, propositions, petitions, and resolutions
submitted to the Committee. As result of these discussions and
deliberations, the Committee has been able to dispose of such
a mass of questions. A great majority of them were directly
answered and resolved by the Committee ; others that necessitated
the authoritative opinions of officers of the Government and
private individuals were referred to officers and persons con-
cerned, some of them bearing the recommendation of the Com-
mittee for favorable action. The following table gives the final
disposition of the papers handled by the Committee:

Referred to —

Executive Secretary 6

Red Cross 2

Bureau of Education 8

Woman's Club 2

Personal 6

Provincial Boards 5

Municipal Councils 2

Secretary of Public Instruction 2

Bureau of Agriculture 1

Philippine Health Service 26

Bureau of Public Works 2

Bureau of Lands 2

Board of Medical Examiners 1

Legislature 20

To be answered directly by the Committee 80

The Committee desists from undertaking an individual de-
scription of each paper presented to its consideration, because
it would be an endless task to do so. But a careful study and
analysis of the entire bulk of work have shown the following
vital and paramount problems that demand careful and pains-
taking consideration:

1. There is a great demand for a more liberal financial aid
from the Government to help the development of child welfare
campaign in the provinces.

2. There is a country-wide cry for more nurses and trained
midwives.

3. The necessity of enacting adequate legislation to protect
mothers and children from diseases, vices, hardships, abandon-
ment, and inadequate medical care.

257

4. There has been shown a pressing need of improving the
community's health and sanitation in general to pave the way
for a more effective campaign against our excessively high
infant morality.

In view of the importance and urgency of said problems,
the Committee begs leave to submit to you the following recom-
mendations :

First. That steps be taken by the Office of the Public Welfare
Commissioner to obtain from authorities concerned some changes
In the prerequisites required of those who wish to pursue
studies as Red Cross or Welfare Auxiliaries, as suggested in
many of the communications submitted to the consideration of
the Committee.

Second. That financial facilities be given to those poor munic-
ipalities who cannot meet the 50-50 basis laid down by the Office
of the Public Welfare Commissioner in the matter of extending
Insular aid. The committee leaves to the best judgment of the
Commissioner the most adequate plan for carrying out this
recommendation .

Third. That a more extensive and intensive propaganda be
carried out by the Office of the Public Welfare Commissioner so
as to keep every municipality, social organization, and private
individual well posted in the functions and purposes of said
Office.

Fourth. That steps be taken by the Office of the Public Wel-
fare Commissioner to obtain from the Legislature the enactment
of a measure whereby those poor municipalities who are unable
to raise the required five or ten per cent of health funds be
entitled to receive some Insular or provincial aid for the purpose
of furthering the campaign against infant mortality in those
localities.

Respectfully submitted,

(Sgd.) FERNANDO CALDERON, Chairman
(Sgd.) C. PENAFLOR, Secretary
(Sgd.) ANDRES CATANJAL, Member
(Sgd.) R. M. DE DELGADO, Member
(Sgd,) MANUEL AGUINALDO, Member

185611 17

258

DISTRIBUTION OF MEMBERS OF THE CONFERENCE BY PROVINCES AND
ORGANIZATIONS REPRESENTED

elegates o

r—

Names of provinces.

Woman's
clubs.

Puericul-
ture Cen-
ters.

Pro-
vincial
boards.

Other
members.

Total.

1. Abra .

2. Albay

3. Antique

4. Bataan

5 Batanes

6. Batangas _. ..

7. Bohol

8. Bulacan . ._

9. Cagayan ». .

10. Camarines Norte -

11. Camarines Sur

12. Capiz '_

13. Cavite _ .

14 Cebu

15. Department of Mindanao and Sulu .

16. Ilocos Norte

17. Ilocos Sur .

18 Iloilo

19. Isabela

20. Laguna

21 La Union

' 3

• 35

22. Leyte

23 Manila

a 385

385

24. Marinduque

25 Masbate

26 Mindoro

27 Misamis

28 Mountain province

29. Nueva Vizcaya __

30 Nueva Ecija

31. Occidental Negros...

32 Oriental Negros

33. Palawan . .. .

34. Pampanga

35. Pangasinan .. .

36. Rizal . .

37 Romblon

38. Samar .....

39 Sorsogon

40 Surigao

41. Tarlac

42 Tayabas

43 Zambales

44 Foreign

Total

113

1,076

1,293

a Includes representatives of woman's clubs and other organizations.

ORGANIZATIONS REPRESENTED IN THE CONFERENCE ON

INFANT MORTALITY AND PUBLIC WELFARE,

DECEMBER 6-10, 1921

Provincial Boards of —

1. Abra 14. Cebu 27. Nueva Vizcaya

2. Albay 15. Davao 28. Occidental Negros

3. Antique 16. Ilocos Norte 29. Oriental Negros

4. Bataan 17. Ilocos Sur 30. Palawan

5. Batangas 18. Isabela 31. Pampanga

6. Bohol 19. Jolo 32. Pangasinan

7. Bontoc 20. Laguna 33. Rizal

8. Bulacan 21. La Union 34. Romblon

9. Cagayan 22. Leyte 35. Sorsogon

10. Camarines Norte 23. Marinduque 36. Tayabas

11. Camarines Sur 24. Masbate 37. Zambales

12. Capiz 25. Mindoro 38. Zamboanga.

13. Cavite 26. Nueva Ecija

Puericulture Centers, Child Welfare Institutions and Associations — -

1. Abucay Welfare Association, Bataan.

2. Bagac Puericulture Center, Bataan.

3. Hermosa Puericulture Center, Bataan.

4. Limay Puericulture Center, Bataan.

5. Mariveles Puericulture Center, Bataan.

6. Moron Puericulture Center, Bataan.

7. Orani Puericulture Center, Bataan.

8. Pilar Puericulture Center, Bataan.

9. Malolos Puericulture Center, Bulacan.

10. Naga Puericulture Center, Camarines Sur.

11. Barili Puericulture Center, Cebu.

12. Cebu Puericulture Center, Cebu.

13. Dumanjug Puericulture Center, Cebu.

14. Ronda Puericulture Center, Cebu.

15. Dumangas Puericulture Center, Iloilo.

16. Jaro Puericulture Center, Iloilo.

17. Iloilo Puericulture Center, Iloilo.

18. La Paz Puericulture Center, Iloilo.

19. Oton Puericulture Center, Iloilo.

20. Pagsanjan Puericulture Center, Laguna.

21. Boac Puericulture Center, Marinduque.

22. Naujan Puericulture Center, Mindoro.

23. "Las Amigas de la Infancia," Bacolod, Occidental Negros.

24. Bago Puericulture Center, Occidental Negros.

25. "Vida de la Infancia" Cadiz, Occidental Negros.

259

260

26. Asingan Puericulture Center, Pangasinan.

27. Romblon Puericulture Center, Romblon.

28. Calbayog Puericulture Center, Samar.

29. Guiwan Puericulture Center, Samar.

30. Atimonan Puericulture Center, Tayabas.

31. Candelaria Puericulture Center, Tayabas.

32. Dolores Puericulture Center, Tayabas.

33. Gumaca Puericulture Center, Tayabas.

34. Infanta Puericulture Center, Tayabas.

35. Lucban Puericulture Center, Tayabas.

36. Lucena Puericulture Center, Tayabas.

37. Macalelon Puericulture Center, Tayabas.

38. Pitogo Puericulture Center, Tayabas.

39. Tayabas Puericulture Center, Tayabas.

40. Unisan Puericulture Center, Tayabas.

41. Gota de Leche.

42. Liga Nacional Filipina para la Proteccion de la Primera Infancia.

43. Hospicio de San Jose.

44. Government Orphanage.

Hospitals —

Bilibid Hospital, Manila.
Chinese General Hospital, Manila.
Mary Chiles Hospital, Manila.
Philippine General Hospital, Manila.
San Lazaro Hospital, Manila.
St. Luke's Hospital, Manila.
San Juan de Dios Hospital, Manila.
Saint Paul's Hospital, Manila.
Santol Tuberculosis Colony, Manila.
Sallie Long Read Memorial Hospital, Ilocos Norte.
Emmanuel Hospital, Capiz.
Silliman Mission Hospital, Oriental Negros.

Religious Organizations —
Roman Catholic Church.
Methodist ^Episcopal Church.
Methodist Church Mission.
Presbiterian Church Mission.

Labor and Employees' Organizations —
Federacion Obrera de Filipinas.
Congreso Obrero de Filipinas.
Asociacion de Empleados Civiles.

Colleges and Schools —
University of the Philippines, Manila.
University of Santo Tomas, Manila.
National University, Manila.
San Juan de Letran College, Manila.
Ateneo de Manila.
Philippine Normal School, Manila.
Manila High School.
Manila College of Pharmacy.

261

Philippine Women's College, Manila.

Centre Escolar de Senoritas, Manila.

Institute de Mujeres, Manila.

Colegio de Santa Isabel, Manila.

Colegio de Looban, Manila,

Manila City Schools.

Harris Memorial Bible Training School, Manila.

Chinese Community School, Manila.

Women's Organizations —
Asociacion de Damas Filipinas, Manila.
University of the Philippines Woman's Club, Manila.
Faculty Woman's Club, Philippine Normal School, Manila.
Student Woman's Club, Philippine Normal School, Manila.
Catholic Women's Club, Manila.

Catholic Federation of Women of the Philippines, Manila.
Woman's Club of Manila.

Women's Christian Temperance Union, Manila.
National Federation of Woman's Clubs, Manila.
Dalit Woman's Club, Abra.
Bacacay Woman's Club, Albay.
Virac Woman's Club, Albay.
Camalig Woman's Club, Albay.
Calolbon Woman's Club, Albay.
Guinobatan Woman's Club, Albay.
Pandan Woman's Club, Albay.
San Jose Woman's Club, Antique.
San Remigio Woman's Club, Antique.
Sibalom Woman's Club, Antique.
Balanga Woman's Club, Bataan.
Batangas Woman's Club, Batangas.
Tanawan Woman's Club, Batangas.
Loboc Woman's Club, Bohol.
Meykawayan Woman's Club, Bulacan.
Obando Woman's Club, Bulacan.
Quingua Woman's Club, Bulacan.
Santa Maria Woman's Club, Bulacan.
Capiz Woman's Club, Capiz.
Numancia Woman's Club, Capiz.
Sapian Woman's Club, Capiz.
Imus Woman's Club, Cavite.
San Roque Woman's Club, Cavite.
Argao Woman's Club, Cebu.
Carcar Woman's Club, Cebu.
Bacarra Woman's Club, Ilocos Norte.
Badoc Woman's Club, Ilocos Norte.
Bangui Woman's Club, Ilocos Norte.
Banna Woman's Club, Ilocos Norte.
Curimao Woman's Club, Ilocos Norte.
Dingras Woman's Club, Ilocos Norte.
San Nicolas Woman's Club, Ilocos Norte.
Paoay Woman's Club, Ilocos Norte.

262

Pasuquin Woman's Club, Ilocos Norte.
Piddig Woman's Club, Ilocos Norte.
Pinili Woman's Club, Ilocos Norte.
Sarrat, Woman's Club, Ilocos Norte.
Solsona Woman's Club, Ilocos Norte.
Laoag Woman's Club, Ilocos Norte.
Batac Woman's Club, Ilocos Norte.
Cagubao Woman's Club, Ilocos Sur.
San Esteban Woman's Club, Ilocos Sur.
San Ildefonso Woman's Club, Ilocos Sur.
Santa Cruz Woman's Club, Ilocos Sur.
Santa Maria Woman's Club, Ilocos Sur.
Narvacan Woman's Club, Ilocos Sur.
Sinait Woman's Club, Ilocos Sur.
Calinog Woman's Club, Iloilo.
Alimodian Woman's Club, Iloilo.
Arevalo Woman's Club, Iloilo.
Cabagan Woman's Club, Isabela.
Agoo Woman's Club, La Union.
Bawang Woman's Club, La Union.
San Fernando Woman's Club, La Union.
Ormoc Woman's Club, Leyte.
Tacloban Woman's Club, Leyte.
Mogpog Woman's Club, Marinduque.
Cagayan Woman's Club, Misamis.
Baguio Woman's Club, Mountain Province.
Bontoc Woman's Club, Mountain Province.
Cabana tuan Woman's Club, Nueva Ecija.
Cabiao Woman's Club, Nueva Ecija.
San Isidro Woman's Club, Nueva Ecija.
Santa Rosa Woman's Club, Nueva Ecija.
Dupax Woman's Club, Nueva Vizcaya.
Bago Woman's Club, Occidental Negros.
Saravia Woman's Club, Occidental Negros.
Silay Woman's Club, Occidental Negros.
Valladolid* Woman's Club, Occidental Negros.
Dumaguete Woman's Club, Oriental Negros,
Larena Woman's Club, Oriental Negros.
Lazi Woman's Club, Oriental Negros.
Siquijor Woman's Club, Oriental Negros.
Tayasan Woman's Club, Oriental Negros.
Bacolor Woman's Club, Pampanga.
Camp Stotsenburg Woman's Club, Pampanga.
Alcala Woman's Club, Pangasinan.
Bautista Woman's Club, Pangasinan.
Bayambang Woman's Club, Pangasinan.
Dagupan Woman's Club, Pangasinan.
Dasol Woman's Club, Pangasinan.
Infanta Woman's Club, Pangasinan.
Lingayen Woman's Club, Pangasinan.
Manaoag Woman's Club, Pangasinan.

263

Pozorrubio Woman's Club, Pangasinan.
Resales Woman's Club, Pangasinan.
San Carlos Woman's Club, Pangasinan.
San Fabian Woman's Club, Pangasinan.
San Manuel Woman's Club, Pangasinan.
Santa Barbara Woman's Club, Pangasinan.
Santa Maria Woman's Club, Pangasinan.
Sual Woman's Club, Pangasinan.
Urdaneta Woman's Club, Pangasinan.
Villasis Woman's Club, Pangasinan.
Malabon Woman's Club, Rizal.
Romblon Woman's Club, Romblon.
San Fernando Woman's Club, Romblon.
Borongan Woman's Club, Samar.
Laoang, Woman's Club, Samar.
Cantilan Woman's Club, Surigao.
Surigao, Woman's Club, Surigao.
Camiling Woman's Club, Tarlac.
Gerona Woman's Club, Tarlac.
Santa Ignacia Woman's Club, Tarlac.
San Clemente Woman's Club, Tarlac.
Paniqui Woman's Club, Tarlac.
Moncada Woman's Club, Tarlac.
Tarlac Woman's Club, Tarlac.
Candelaria Woman's Club, Tayabas.
Castillejos Woman's Club, Zambales.
Iba Woman's Club, Zambales.
San Felipe Woman's Club, Zambales.
San Marcelino Woman's Club, Zambales.
San Narciso Woman's Club, Zambales.

Other Organizations —
Balik-Balik Welfare Association, Manila.
Philippine Islands Antituberculosis Society, Manila.
Red Cross, Manila.
Associated Charities, Manila.
Pharmaceutical Association, Manila.
Fortnightly Club, Manila.
Dimas Alang Society, Manila.
Time Investment Club, Manila.
Young Men's Christian Association, Manila.
Ormoc Young People's Union, Leyte.
Rockefeller Foundation, Peking, China.
Manila Railroad Co., Manila.
The Press, Manila.

APPENDIX

ITEMS OF INFORMATION REGARDING THE OFFICE OF
THE PUBLIC WELFARE COMMISSIONER *

WHAT IS THIS OFFICE?

Officially, this Office is known as the "Office of the Public
Welfare Commissioner." It has been created by Act No. 2988
of the Philippine Legislature enacted on February 24, 1921.

WHAT ARE ITS FUNCTIONS?

The functions of the Office are clearly defined by various Acts
of the Philippine Legislature, and from which the following
parts are quoted:

«* * * To study, coordinate, and regulate as far as possible and prac-
ticable the efforts of all Government agencies and influences interested in
public welfare or social service work, and of such private agencies or organ-
izations as receive Government support for similar ends, to secure as far
as possible a wise expenditure of all Government funds appropriated for
charity and all public welfare purposes; to promote, inspect, and regulate
the organization of private institutions for charitable purposes, and to
investigate social conditions in the Philippine Islands with a view to relief
or other remedy where necessary."

In another Act, it says :

"The Secretary of the Interior, through the Office of the Public Welfare
Commissioner shall have authority and it shall be his duty to investigate,
promote, coordinate, inspect, and regulate all work related with maternity,
hygiene, and child welfare in the Philippine Islands, any provisions of
existing laws to the contrary notwithstanding. And said Secretary, through
the Public Welfare Commissioner, may establish and maintain maternity
hospitals, puericultural institutions, dispensaries, hospitals, and other
establishments for the care of children and for the instruction of the
personnel whiJch shall have charge of this work."

* It was found out from the discussions carried on at the First National
Conference on Infant Mortality and Public Welfare that many people were
not familiar with the functions of the Office of the Public Welfare Com-
missioner. Hence it was considered necessary to produce here the Items
of Information Regarding the Office of the Public Welfare Commissioner
(Publication No. 7).
264

265

In short, the aims of this Office can be summarized as follows :
To promote all the work directed to an early reduction of infant
mortality in the Philippines by employing adequate means for
this purpose and for such other related work intended to im-
prove the general welfare of the community, and especially that
which concerns the child in particular.

MEANS AND PROCEDURES TO CARRY OUT ITS PURPOSE

It is proposed to carry out its purpose through the following
means :

(1) By arousing the interest of the public in social and wel-
fare work, and by directing official and private efforts along
this line towards the consummation of a lasting- betterment for
the community.

(2) By rendering financial or technical assistance to com-
munities or to any organized societies, established or to be
established, doing public welfare or social service work, partic-
ularly those devoting to maternity, child welfare, and hygiene.

(3) By offering facilities for the establishment of maternity
houses or other institutions to render maternal help, wherein
mothers and expectant mothers could receive the necessary in-
struction and means of how to take care of themselves before,
during, and after delivery.

(4) By establishing puericulture centers or similar institu-
tions to detect and correct troubles among our infants and
children and to teach parents how to take care of, and keep
their babies well.

(5) By establishing hospitals and dispensaries for the care
of sick children.

(6) By establishing institutions to take care of special classes
of children, dependent, destitute, and delinquent, with the pur-
pose not only of providing temporary assistance for their
handicapped condition but also of transforming them through
discipline, training, and education into better citizens and useful
elements of the community.

(7) By extending aid to charitable private organizations so
as to enable them to take care of needy persons who would be
otherwise left unprovided for by lack of proper means to carry
on their work.

HOW THE OFFICE CAN RENDER ASSISTANCE TO PRIVATE
ORGANIZATIONS

1. Extension of financial aid by the Government. — There is
a number of institutions which, in spite of their careful organ-

266

ization and commendable purposes, fail to put into effect their
intended services because of insufficient funds necessary for
the proper accomplishment of their plans. Institutions of this
kind must necessarily lag in their activities and eventually go
out of existence. The Government through the Office of the
Public Welfare Commissioner can assign to such institutions
that needed financial help consistent with the regulation gov-
erning appropriation of public funds.

2. Extension of technical advice and service. — It has been
found out that it is not always economical stringency what
makes some organizations fall behind in their operation and
function. In many instances faulty organization, defective ad-
ministration, and inappropriate methods are the stumbling-
block in their achievement of success. The Office of the Public
Welfare Commissioner is always ready to help these institutions
in order to place them in good operating condition.

3. Promotion of cooperation, coordination, and co-relation. —
The sudden impetus which thrusted social, civic, relief, and
welfare work into the community life in the Islands, had brought
into existence a great number of organizations, some of which
undertake different aspects of social activities, while others
pursue similar work, not to say identical enterprises. Unavoid-
able overlapping must be naturally the result of such a varied
and multiform organizations. One way in which the Office of
the Public Welfare Commissioner could be of some assistance to
these organizations is to work for the promotion of the spirit of
cooperation among those different institutions, to coordinate
their activities, and to co-relate their functions in order to fill
gaps and to avoid waste occasioned by overlapping.

HOW TO OBTAIN ASSISTANCE FROM THE OFFICE OF THE
PUBLIC WELFARE COMMISSIONER

1. Financial aid. — Petition for financial aid will be given
proper consideration based on the following requirements:

(a) Any organization, either association, club, committee, or
league soliciting aid, must give positive proof that it is estab-
lished on a stable basis. It must have a suitable by-laws, a
responsible Board of Directors or other governing body, and
must preferably be duly incorporated under the laws of the
Philippine Islands.

(&) The organization must exhibit a commendable and a well-
defined purpose, and it must show that the personnel other than
the Board of Directors who will be entrusted to carry out the
work or purpose by which the organization was established
possess the required qualifications.

267

(c) The organization must give a full and detailed statement
of its financial means and condition by which it proposes to
carry out its purpose. If the organization has been in operation
prior to making the request, a complete report of their activi-
ties, administration, and expenses shall be submitted.

2. Technical aid. — The procedure in receiving technical aid
consists simply in filing the petition with the Public Welfare
Commissioner, who upon consideration of the merits of the case
will take all the necessary steps to extend, free of charge, this
kind of help to the organization concerned.

HOW THIS OFFICE CAN SAFEGUARD THE PUBLIC REGARDING PRIVATE
COLLECTION OF MONEY FOR CHARITABLE PURPOSES

To safeguard the public and give the assurance that a private
charitable organization is spending wisely and honestly the
money received from public subscription, collection or donation,
the Office of the Public Welfare Commissioner will issue a cer-
tificate to serve as a warrant of reliability to each organization
that leaves its books of accounts open for inspection and
allows the examination of its administrative operation by officials
authorized by this Office.

THIS BOOK IS DUE ON THE LAST DATE
STAMPED BELOW

AN INITIAL FINE OF 25 CENTS

WILL BE ASSESSED FOR FAILURE TO RETURN
THIS BOOK ON THE DATE DUE. THE PENALTY
WILL INCREASE TO SO CENTS ON THE FOURTH
DAY AND TO $1.OO ON THE SEVENTH DAY
OVERDUE.

SEP 29 1945

LD 21-100m-8,'34

YC 35766

UNIVERSITY OF CALIFORNIA LIBRARY

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Full text of "Proceedings of the first National conference on infant mortality and public welfare; organized and conducted by the Office of the public welfare commissioner and held under the patronage of His Excellency Leonard Wood. Manila, Philippine islands, December 6, 7, 8, 9, 10, 1921"

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