(b) Sterilize lancet in alcohol flame. (c) Shake tube of virus. (d) Take virus on blade of lancet. (e) Scarify, stretching skin with other hand. (f) Rub virus into scarified area with flat of blade. (g) Warn person vaccinated not to touch scarified area, nor to allow clothing to do so until thoroughly dry. (h) No further care is necessary. 8. Certificates of vaccination.—For each vaccination performed, the vaccinator will deliver to the subject thereof a certificate properly filled out on Form 36 B. H. Certificate numbers will run serially for each municipality. The attached slip will be delivered undetached from the certificate, to be subsequently detached and turned in by the vaccinator making the inspection. 9. Vaccinator's reports.—Each vaccinator, at the close of the day's work, will be required to make the proper entry upon Form 60 B. H. from the stubs of his certificate book. 10. Inspections.-When making inspections, each vaccinator acting as inspector will note the result of the vaccination on the certificate and detachable slip, and will take up the slips and turn them in at the close of each day's work. 11. Amount of work to be accomplished.-Vaccinators will be required to work at least eight hours each day, except Sundays and legal holidays. Local holidays will not be observed. It is expected that the average number of vaccinations performed daily will not fall below 100. 12. Other reports from vaccinators.-Vaccinators will be required to make report of all lepers, insane, blind, and deaf and dumb and of all dangerous communicable diseases encountered by them. The records of the municipal board of health or of the municipal secretary will be checked up with these reports, the necessary corrections made, and a copy sent to the Director of Health, through the inspector in charge of the party. If dangerous communicable diseases be encountered, the inspector in charge will at once notify the president of the municipal board of health or the municipal president, and, in conjunction with them, arrange for the necessary measures of isolation, disinfection, etc. 13. Relations with local officials.-Inspectors will cultivate cordial relations with the provincial and municipal officials, and seek their coöperation, and any failure to secure same, with the reasons therefor, will be reported by letter to the Director of Health. Attention is called, in this connection, to a circular letter from the Governor-General, addressed to all provincial governors under date of June 30, 1904, as follows: "The Bureau of Health for the Philippine Islands is inaugurating a system whereby it is hoped that every person in the Islands may be vaccinated and the danger of infection by smallpox effectually removed. "The Civil Governor requests that you issue instructions to every municipal president in your province in respect to this matter, inviting attention to the provisions of Act No. 309, Philippine Commission, and request them to render every assistance to the vaccinators of the Bureau of Health. "Kindly acknowledge receipt of this circular and advise this office of the action taken in the premises. (Signed) "F. W. CARPENTER, 14. Municipal boards of health.-Presidents of municipal boards of health will be under the orders of the district health officers while vaccination is being carried on in their respective municipalities, and will assist in the work. It is believed, however, that their coöperation in securing the assembling of the inhabitants of each barrio at some central point, and in other similar ways, will facilitate the work to a greater extent than their actual presence as a member of the group of vaccinators. The coöperation of the municipal president and the police should be secured toward the same end when necessary. 15. Supplies.—Requisitions for supplies, other than vaccine virus, required in the work of vaccination, will be made on Form 1 B. H., and will ordinarily be made in such quantities as to cover the estimated needs for one month, where communication with Manila is frequent and regular. Vaccinating parties operating in remote places where communication with Manila is infrequent and irregular should carry on hand a three or six months' supply, or sufficient to meet conditions. The following schedule may be used as a basis when preparing requisitions: 1 lancet, lb. cotton, and 8 liters of alcohol per man per month. 1 alcohol lamp per man. 4 Forms 1 B. H. per month, each party. 100 Forms 36 B. H. per man per day. 1 book, Form 20 B. H., per man per month. 4 Forms (8A) Auditor per man per month. Bills of lading to cover shipments of property returned to Manila. The stationery to be used by vaccinating parties will, so far as possible, be confined to the following articles: Letter heads, rubber erasers, paper fasteners, black ink, scratch pads, blotting paper, wrapping paper, lead pencils, pens, and twine. Variations from the above will be made when experience indicates that it is necessary. 16. Vaccine virus.-Shipments of vaccine virus for the supply of groups operating in provinces distant from Manila will be made in portable ice boxes, and requisitions will call for quantities in proportion to the frequency of communication, reliability of schedule, and facilities for preservation existing at the base of operations. Unless definite arrangements have been made with this office to have virus shipped at regular intervals, officials in charge of parties should invariably wire this office as to the number of units they desire shipped from Manila on a given date; for instance: "HEALTH, Manila. "Ten thousand, April ninth. RUIZ." Such information should always be forwarded several days before the steamer is expected to sail from Manila. Inspectors will be notified by wire of each shipment and will arrange to receive the virus promptly. Empty ice boxes will be returned to Manila by first available transportation, the date of shipment and name of vessel being wired to the Director of Health. Empty ice boxes should be returned by such steamship lines as have agreed to return them free of charge, to Manila. When the base of operations enjoys frequent and regular communication with Manila, and is not more than forty-eight hours' distant, vaccine virus may be sent by mail or other convenient method, without special measures for preservation, and requisitions should be frequent and for small quantities. 17. Alcohol. Whenever alcohol of 36 degrees strength can be purchased in the provinces for 0.50 per liter, or less, the same should be obtained there and separate bills, on Form 5-A, sent to this office for payment. 18. Pay of vaccinators.—Vaccinators will be paid by check from Manila, on pay rolls made up and forwarded by the official in charge of the vaccinators, under the following rules: (a) The pay rolls will be made out in triplicate for the entire party on the 23d of each month (including that date), and certified by the officer in charge of the party and forwarded to this office immediately. (b) The "Name," "Designation," "Period of service" (1st to 30th), and "Authorized monthly rate of pay" columns only, will be filled out before forwarding. The “Amount received,” “Signature," "Witness," and "Remarks" columns may be left blank. (c) On the last day of the month telegraphic reports will be made by the chief of the party of all absences during the month. The pay rolls will be held in this office until such a report is secured. (d) Each official in charge of a vaccination party will be furnished with a letter which will state the maximum number of vaccinators that may be employed and their rates of pay. In no case will pay rolls for an additional number be approved unless specific authority from this office is first had. The separate appointments heretofore issued by this office will no longer be required. Officials in charge of vaccination parties are authorized to use their own judgment with regard to promotions or reductions in salary, provided they do not exceed the highest rate authorized in the letter referred to above. It is sug gested, however, that except in extraordinary instances, vaccinators be paid at first a lower salary than that authorized, and gradually promoted as they show efficiency in their work. 19. Traveling expenses.-Traveling expense accounts must conform in all respects to the provisions of Circular F-6, March 9, 1907. Accounts for traveling expenses will be made out by each vaccinator, monthly, in duplicate, on Form 8-A, and will be accompanied by receipts on B. H. Form 20, also in duplicate. Vaccinators will be restricted to third-class transportation when traveling by rail or water, and to a moderate amount of baggage in all cases. No transportation expenses will be allowed for vaccinators in traveling short distances between barrios, and after the vaccination of a barrio is commenced, no transportation will be allowed except under extraordinary circumstances, until the vaccination of said barrio is completed. Where the hire of carromatas or other vehicles is necessary, two or three vaccinators will ordinarily occupy a single vehicle. Inspectors in charge of vaccinating groups will carefully scrutinize and check each item in the expense vouchers of his vaccinators, seeing that the accounts are properly rendered and that the prices entered are not in excess of those paid by native residents of the locality in which the expenses are incurred. Failure to have complied with these instructions or the approval of excessive or unusual charges will be considered grounds for deducting the excess of overpayment from the salary of the inspector checking the items and certifying to their correctness. The district health officer's certification of the account will be received in lieu of travel orders for travel within the province. 20. Whenever it is more economical for the Government, vaccinators will be expected to walk if the condition of the roads will permit it; in other words, if the salary of the vaccinators for the time consumed in walking would be less than the transportation, vaccinators will be expected to walk unless there is some excellent reason to the contrary. 21. Consolidated reports.-Immediately after the conclusion of each month, inspectors will forward to the Director of Health a consolidated report on Form No. 59 B. H. of all vaccinations and inspections accomplished during the month by their groups, and will note on the bottom of such form the amount of virus on hand on the 1st day of the month, the amount received during the month, and the amount expended during the month, and the amount remaining on hand on the last day of the month. All Forms 36 B. H. (stubs) pertaining to each municipality will, when completed, be delivered to the president or the municipal secretary as a part of the permanent records of such municipality. The foregoing instructions have been found so satisfactory in actual practice that very little friction has resulted. It is perhaps noteworthy to report that no case of loss of life on account of vaccination of these more than two millions of persons has come to the knowledge of the Bureau, nor have any limbs been sacrificed, nor has there been a case of very serious infection resulting from vaccination reported. It is believed that this record is more satisfactory than any that has heretofore been reported with regard to vaccination in any country in the world, and is conclusive evidence of the care with which vaccine is prepared at the Bureau of Science, and also, of the rigidness with which the instructions for performing vaccinations are carried out. PURE-FOOD LEGISLATION. Legislation guaranteeing more wholesome food and purer drugs has been earnestly asked for by the medical profession for many years, and it is therefore most satisfactory to report that the Congress of the United States, June 30, 1906, passed an act which went into effect January 1, 1907, which had for its object the accomplishment of the above purpose. It is reasonable to expect that no part of the United States will derive more benefit from this legislation than its tropical possessions, and it is confidently hoped that the enforcement of its provisions will result in still further improving the health conditions in the Philippine Islands. On the 9th day of November, 1906, the Governor-General of the Philippine Islands called attention to this act in a proclamation and named certain officials to enforce its provisions, but, later, on the recommendation of the Attorney-General, who held that on account of differences between the judiciary system in the United States and that of the Philippine Islands, the legal machinery for enforcing the act was not adequate, a new act was drafted embodying all of the act of Congress and making only such corrections and additions as would adapt the law to the Philippine Islands. This bill was passed as Act No. 1655, on May 18, 1907, on which date the Pure Food and Drugs Act of the Philippine Islands became effective. A committee was appointed by the Governor-General, consisting of H. B. McCoy, Collector of Customs, John S. Hord, Collector of Internal Revenue, and Victor G. Heiser, Director of Health, and instructed to form suitable regulations for the enforcement of the act. The committee completed its labors in June and the act and regulations were ready for distribution by July 1, 1907. Owing to the very short time which the merchants and others have had in order to become familiar with the requirements of the law, and the time required to procure chemists from the United States who are competent to make the necessary analyses, up to the present date, no active steps have been taken for its enforcement. The regulations provide that except for the collection of samples the enforcement of the law shall be carried out by the Bureau of Health, with the provision for appeals to the Secretary of the Interior. The laboratory work is to be done by the Bureau of Science. The act and regulations follow: [No. 1655.] An Act for preventing the manufacture, sale, or transportation of adulterated or misbranded or poisonous or deleterious foods, drugs, medicines, and liquors, and for regulating traffic therein, and for other purposes. By authority of the United States, be it enacted by the Philippine Commission, that: SECTION 1. It shall be unlawful for any person to manufacture within the Philippine Islands any article of food or drug which is adulterated or misbranded, within the meaning of this Act; and any person who shall violate any of the provisions of this section shall, for each offense, be punished by a fine not to exceed one thousand pesos or by imprisonment for one year, or by both such fine and imprisonment, in the discretion of the court, and for each subsequent offense he shall be punished by a fine of not less than two thousand pesos nor more than five thousand pesos, or by imprisonment for one year, or by both such fine and imprisonment, in the discretion of the court. SEC. 2. The introduction into the Philippine Islands from the United States or from any foreign country, or the shipment to the United States or to any foreign country from the Philippine Islands, of any article of food or drugs which is adulterated or misbranded, within the meaning of this Act, is hereby prohibited ; and any person who shall ship or deliver for shipment from the Philippine Islands to the United States or to a foreign country, or who shall receive in the Philippine Islands from the United States or from any foreign country, and having so received, shall deliver, in original unbroken packages, for pay or otherwise, or offer to deliver to any other person, any such article so adulterated or misbranded within the meaning of this Act, or any person who shall sell or offer for sale in the Philippine Islands any such adulterated or misbranded foods or drugs, or export or offer to export the same to the United States or to any foreign country, shall be punished for the first offense by a fine not to exceed four hundred pesos, and for each subsequent offense he shall be punished by a fine not to exceed six hundred pesos, or by imprisonment not to exceed one year, or by both such fine and imprisonment, in the discretion of the court: Provided, That no article shall be deemed misbranded or adulterated within the provisions of this Act when intended for export to the United States or to any foreign country and prepared or packed according to the specifications or directions of the purchaser in the United States or in any foreign country when no substance is used in the preparation or packing thereof in conflict with the laws of the United States or of the foreign country to which said article is intended to be shipped; but if said article shall be in fact sold or offered for sale for domestic use or consumption in the Philippine Islands, then this proviso shall not exempt said article from the operation of any of the other provisions of this Act. SEC. 3. The Insular Collector of Customs, the Director of Health, and the Collector of Internal Revenue of the Philippine Islands shall make uniform rules |