ave the honor to make the followthe city of Manila. My duties with wing orders: Special Orders, No. 181, he Pacific and Eighth Army Corps, rs, No. 142, paragraph 5, Headquarters ly 31, 1899. Before receiving the first and had a relapse a few days after comwith the board of health really began on

the past year has been as follows: surgeon, U. S. A., in addition to his other J. S. Artillery, and attending surgeon to the ity on the board of health July 31, 1899. He anuary 7, 1900, and besides directing the bacteicipal laboratory has had charge of the plague

surgeon, U. S. A., reported for duty with the board
Brown, surgeon, U. S. V., January 9, 1900; Act-
dy, U. S. A., January 26, and Acting Asst. Surg.
the latter relieving Major Brown, who had been
h the transport Hancock. During the temporary
ert in Japan in March and April, Acting Asst. Surg.
ed the bacteriological department, made all autop-
other way

Triston Tata Lim, both of Manila, have been
Ith a la organization in September, 1898

Judge, Maj. John A. Hull, judge-advocate, U. S. V., July 1, 1899, to June 30, 1900. In three cases, on account of personal knowledge of the facts involved, upon application of the court, Capt. James M. Liddell, Twenty-ninth Infantry, U. S. V., was appointed to act as judge in the three cases, by paragraph 16, Special Orders, No. 74, Headquarters Department of the Pacific and Eighth Army Corps, March 17, 1900. The punishing power of the court was increased by General Orders, No. 46, office of the military governor, Oc ober 5, 1899, to confinement at hard labor for a period of two years or a fine of $5,000 gold, or both, at the discretion of the court. Very respectfully,

JOHN A. HULL, Major and Judge-Advocate, U. S. V., Judge.

INFERIOR PROVOST COURT,

Manila, P. I., August 29, 1900.

ADJUTANT-GENERAL, PROVOST-MARSHAL-GENERAL.

SIR: I have the honor to forward you herewith duplicate report of the work of the inferior provost court of the city of Manila for the year ending June 30, 1900, showing the business done each month by said court and a classification of the offenses tried. Very respectfully,

GEO. P. WHITSETT,

First-Lieutenant, Thirty-second Infantry, U. S. V., Judge.

Judges.-Capt. Frank T. Corriston, Thirteenth Minnesota Volunteer Infantry, July 1 to August 8, 1899.

Maj. John A. Hull, judge advocate, U. S. V., August 9 to September 4, 1899; February 21 to March 1, 1900.

First Lieut. Frank H. Lawton, Twenty-first Infantry, September 5, 1899, to February 20, 1900.

Capt. James M. Liddell, Twenty-ninth Infantry, U. S. V., March 2 to June 23,

1899.

First Lieut. George B. Whitsett, Thirty-second Infantry, U. S. V., June 24 to June 30, 1900.

HEADQUARTERS PROVOST-MARSHAL-GENERAL,
OFFICE OF THE BOARD OF HEALTH,
Manila, P. I., July 31, 1900.

The ACTING ADJUTANT-GENERAL, PROVOST-MARSHAL-GENERAL,

Manila, P. I.

SIR: In obedience to your letter of July 26, I have the honor to make the following report on the work of the board of health of the city of Manila. My duties with the board of health were pursuant to the following orders: Special Orders, No. 181, paragraph 10, Headquarters Department of the Pacific and Eighth Army Corps, Manila, P. I., July 5, 1899, and Special Orders, No. 142, paragraph 5, Headquarters Provost-Marshal-General, Manila, P. I., July 31, 1899. Before receiving the first order I was taken down with typhoid fever, and had a relapse a few days after complying with the second, so that my duties with the board of health really began on August 26, 1899.

The medical personnel of the board for the past year has been as follows:

Lieut. William J. Calvert, assistant surgeon, U. S. A., in addition to his other duties as regimental surgeon, Sixth U. S. Artillery, and attending surgeon to the prisoners of war, was assigned to duty on the board of health July 31, 1899. He was relieved from his other duties January 7, 1900, and besides directing the bacteriological department of the municipal laboratory has had charge of the plague hospital.

Capt. Charles Lynch, assistant surgeon, U. S. A., reported for duty with the board December 24, 1899; Maj. Ira C. Brown, surgeon, U. S. V., January 9, 1900; Acting Asst. Surg. Julius C. Le Hardy, U. S. A., January 26, and Acting Asst. Surg. Harry L. Gilchrist, June 16, 1900, the latter relieving Major Brown, who had been ordered for temporary duty with the transport Hancock. During the temporary absence of Assistant Surgeon Calvert in Japan in March and April, Acting Asst. Surg. Joseph J. Curry, U. S. A., conducted the bacteriological department, made all autopsies, and rendered valuable service in other ways.

Dr. C. H. Pardo-Tavera and Dr. Ariston Bautista Lim, both of Manila, have been honorary members of the board of health since its organization in September, 1898

As originally organized, the city had ten districts, with eight municipal midwives, and for each district a native physician, whose duties are to attend the indigent sick, report unsanitary conditions and infectious diseases, and investigate and give certificates of death to all cases that have died without medical attendance. By the extension of the city limits to Pandacan and Santa Ana a new district was created, which was provided with a physician, a native of the district.

Besides the general functions belonging to a board of health in supervising all works and conditions affecting the public health, the board had general supervision over the charitable institutions, prisons, and venereal hospital, and the direct control of the vaccine farm, municipal laboratories (bacteriological-chemical, which the board organized), free dispensary, hospitals for leprosy, smallpox, and bubonic plague, and much other work that the individual members were from time to time called upon to do.

REGISTRATION OF BIRTHS, MARRIAGES, AND DEATHS.

The department of registration of births, marriages, and deaths in former times was in charge of parochial priests. The board has endeavored to keep these records, but it only pretends to accuracy in the record of deaths. It also required the registration of physicians, pharmacists, and dentists practicing in their professions. It was with some difficulty that the superintendents of the parochial cemeteries could be prevented from interring bodies without a burial permit and make the weekly return of burials required. After a clear understanding of the necessity of these requirements the regulations were complied with.

A municipal dispensary where the indigent sick can obtain medicines free of cost has been in operation since December, 1899; nevertheless, the majority of births and deaths occur without medicines or medical attendance.

VACCINATION AND SMALLPOX.

After

The board continued the work of vaccination and revaccination begun by Major Bourne. The result of this work is shown in the table of mortality statistics. For the nine months from October, 1899, to July, 1900, there were 7 deaths in this city from smallpox; whereas in the month of March alone, in 1899, there were 75 deaths from this disease. The adjoined table shows the number of vaccinations by months. This work was done under difficulties, as the authorities thought it advisable not to permit forcible vaccination. Many cases of smallpox came into the city from the country districts, and the board sent its vaccinators to all outlying towns and villages for the purpose of vaccinating every inhabitant. Records of these vaccinations were not returned except from the town of Malabon. the dispersion of the Filipino army, as the country became opened up, the military surgeons in every district, under the direction of the chief surgeon's office, began the vaccination of the inhabitants, and the output of the vaccine farm had to be largely increased, as is shown in the attached table. This increase was made with little additional expense, and every demand for vaccine virus was promptly met. When the present wet season is over, and this subject of vaccination in the provinces is vigorously taken hold of and carried on until every person in these islands has been vaccinated and revaccinated, the vaccine station will be prepared to furnish the necessary amount of virus.

LEPROSY.

Leprosy was introduced here in 1633. The Emperor of Japan sent a ship with 150 lepers as a present to be cared for by the Catholic priests. These lepers were allowed to land, and as no practical methods were ever adopted to eradicate the disease or prevent its spread, it steadily increased, until now, according to the estimates of the Franciscan Fathers, there are not less than 30,000 lepers in the archipelago, the larger number being in the Visayas. Under the Spanish régime the order of the Franciscans had charge of the charity work among the lepers. Several hospitals and asylums were built, the largest of which, San Lazaro Hospital, is located in Manila and has a capacity for 400 patients. When a house-to-house inspection was inaugurated last January more than 100 lepers were found concealed in houses, and were sent to San Lazaro Hospital. Many others escaped into the surrounding country. The necessity of the segregation and isolation of the lepers on one of the islands was early recognized and agitated by the board of health. soon as the conditions permitted, the authorities appointed a commission to select a suitable island or islands for this purpose and to present plans and estimates of buildings and to formulate the necessary regulations. This commission is now engaged in this work.

As

BUBONIC PLAGUE.

The first case of plague in this city of which we have any knowledge occurred in No. 14, Calle Legaspi, Intramuros. On December 29, 1899, there was a death in this house, the diagnosis on the death certificate being typhoid fever. Two days later, December 31, a second death was reported from the same house, with a similar diagnosis. These two cases died without medical attendance, and the diagnosis was made by the municipal physician after death. On January 2 a boy was removed from this house to the San Juan de Dios Hospital, having been taken sick the day previous, and the notification required in cases of infectious diseases reached this office on the 2d, the diagnosis being typhoid fever. Assistant Surgeon Calvert and myself visited this boy at the hospital and found him presenting the clinical aspect of plague. The inflamed gland was in the left femoral group; was about the size of a pigeon's egg and very tender to the touch. The boy was at once removed to the pest hospital, which, in anticipation of an increase of smallpox, had been constructed of tents, as the authorities had decided that the state of the public funds did not justify the expenditure necessary to erect a pest hospital. On January 3 two cases were discovered at No. 8, Calle Legaspi, on the 6th, one case at No. 6, Legaspi; on the 13th, two more cases at No. 8, Legaspi. The accompanying map shows in detail the sequence of plague cases and the streets and districts in which they occurred. Bacteriological examinations and culture growths were made in nearly all cases. report of this work, with a description of the clinical features of the plague as it appears here, will be made by Assistant Surgeon Calvert.

The methods adopted to control and to eradicate the disease were: (1) The prompt detection and isolation of plague cases.

A

(2) Removal of persons who had been in close communication with an infected case to the suspect wards at the hospital.

(3) Removal of all other inmates in the infected houses to the detention wards at the hospital, or quarantining such inmates in the house for fourteen days.

(4) Thorough disinfection and redisinfection of the house, its contents, and inmates; clothing and bedding disinfected by steam. All articles that could not be

thoroughly disinfected were burned.

(5) The inspection of all dead bodies of Chinese.

(6) The distribution of rat poison in all houses by the inspectors themselves. (7) The disposition of the dead. Cremation principally. On account of the religious prejudices of the Chinese, their dead, the coffins filled with disinfectants and quicklime, were buried in the "plague plot."

To carry out the first provision, a house-to-house inspection was inaugurated at once. This is still continued in certain sections of the city. With the assistance of Major Tiernan, chief of police, a corps of 100 inspectors was organized within thirtysix hours. These inspectors were Filipinos, for the most part medical students. It was impossible to obtain soldiers for inspectors. The city was divided into ten districts and each district into three subdistricts, and instructions and regulations, written in Spanish, were furnished each inspector. Ambulances and carts for carrying disinfectants were provided. This force, on January 9, 1900, was turned over to Maj. Ira C. Brown, surgeon, U. S. V., and under the direction of that energetic and efficient officer did excellent service, much better than we had hoped for. No one who has not been in close touch with an Eastern city and the mode of life of its inhabitants can realize what a sanitarian has to wrestle with in this country. The density of population and the consequent overcrowding in the city is appalling, and if it continues is sure to bring disaster. Major Brown, in connection with his sanitary inspectors, utilized the fire department to clean a large part of the city. All drains were opened and flushed, the interiors and rears of houses were cleaned and whitewashed, and an immense amount of other work was accomplished by this officer. At the same time the regular sanitary department was doing its usual good work.

For the prompt detection of plague cases among the Chinese and the prevention of concealed cases much is due to the Chinese consul and Mr. Palanca. The latter is especially influential among his countrymen from Amoy. At his instance the Chinese merchants furnished from their own number forty inspectors, who made daily houseto-house inspections in the Chinese districts, and I do not believe that any case of sickness escaped them. This work was continued for two months at their own expense. The Chinese also built a pest hospital for the care of their own people and have paid all its running expenses. Acting Assistant Surgeon Le Hardy, a very energetic and capable young officer, was assigned to duty in the Chinese district, and every Chinaman dead of any disease was inspected by him. The disease has been confined almost entirely to the native and Chinese populations. Only two white men have contracted the disease. These were teamsters in the quartermaster's corral.