of all cases examined. Active therapeutic measures were inaugurated to rid the patients of the causes of these debilitating troubles and the result was immediately satisfactory-the death rate fell to about 20 per thousand.

The prevailing diseases treated in Hospital "A," Bilibid Prison, were ankylostoma, 1,537 cases; amoebic dysentery, 551 cases; acute dysentery, 174 cases; cholera, 18 cases; pneumonia, 62 cases; beriberi, 60 cases; conjunctivitis, 221 cases, and malaria, 174 cases.

During the previous year only 39 cases of ankylostomiasis were treated as compared with 1,537 cases during the present year. There have been 551 cases of amoebic dysentery treated as against 111 cases for the preceding year. These figures do not by any means indicate a greater prevalence of this disease and may be explained on the ground that they were detected by the systematic stool examinations which have been practiced. Among the rarer parasites that have been found are Paragonimus westermanii, 9 cases; Schistosoma japonicum, 15 cases; Opisthorchis sinensis, 5 cases; Balantidium coli, 14 cases; Tenia saginata, 20 cases; Tenia solium, 2 cases, and Tenia nana, 3 cases.

Plans have been drawn for a new sewer system and for new sanitary beds; these improvements, when installed, are expected to reduce the death rate still further.

Work will soon be begun upon a new prison hospital, which is greatly needed. With this new building and the completion of the improvements already in progress and a continuance of the same competent medical supervision, there is no reason why Bilibid should not be made the healthiest prison in the Orient.

Every new patient is subject to a routine treatment before he is assigned to a brigade. If these measures could be carried out throughout the city generally, it is believed that the infant mortality would be greatly reduced. Of course, in the very young infants intestinal parasites would not be found, but they suffer nevertheless indirectly from them because of the impoverished condition of their mothers, on whom they rely for support. If this office were asked to give the most common affliction of the natives of the Philippines, it would unhesitatingly name intestinal parasites.

BENGUET SANITARIUM DIVISION.

The erection of two sawmills, the installation of additional mining plants, and the increase in road work have contributed the usual percentage of accidents and other sickness, which, added to the steady increase in the medical work caused by the constantly augmenting number of visitors to Baguio, have increased the amount of work to be done in the hospital at a much more rapid rate than heretofore has been the

case. In addition to the foregoing, the Igorots have taken more kindly to hospital treatment, and their sick and injured have been brought for many miles around to the hospital at Baguio.

The prescriptions filled at the pharmacy show an increase of 55.29 per cent, or 710 more prescriptions filled than last year, which alone is an indication of the growth of the medical work.

Eighty cases of malarial fever were treated at the hospital and the results were uniformly satisfactory, much more so than those cases which are ordinarily treated at lower altitudes. All of these patients came from the lowlands, none of them originating in altitudes as high as that in which the sanitarium is located. The mosquito-transmissionof-malaria theory receives further confirmation in the experience at Baguio, because no Anopheles mosquitoes are found there.

The treatment of amoebic dysentery at the hospital met with the same excellent results that were obtained in years past. It has been proven beyond question that frequently a trip to Japan or to the United States can be avoided when this malady resists ordinary methods of treatment in the lowlands.

In addition to the routine work connected with the administration of the hospital and the treatment of the sick, the medical officer in charge, in his capacity as sanitary officer of the province, made many trips of inspection to markets, mining camps, water supplies, etc., and gave the necessary directions for maintaining them in proper condition.

One case of cholera was imported into Baguio, but was so promptly handled that no further spread of the disease took place. An outbreak of smallpox which occurred along the Benguet road was quickly suppressed and practically no spread took place from the time the original cases were discovered.

The work of the division has been seriously handicapped by the poor buildings which had to be used for hospital purposes during the year. It will be remembered that the former sanitarium building was transferred to private persons for hotel purposes, and only two cottages remained in which to conduct the hospital work. The appropriation for the new hospital was not made as quickly as anticipated, thus giving rise to great inconvenience and lack of facilities for doing the work properly. This omission has, however, now been supplied, the Commission having appropriated 50,000 for the construction of a hospital which, it is thought, will meet all demands which may be made upon it for some years to come. An excellent site has been chosen and it is hoped that within six months the new building will be ready for occupancy.

There were 26 Americans, 2 Europeans, 189 Filipinos, and 48 Japanese, making a total of 264 patients, treated in the hospital, which is an increase of 113 patients, or nearly 76 per cent over last year. The

number of surgical cases treated was 43, an increase of nearly 54 per cent over last year. The number of outdoor patients, mostly Igorots, was 1,371, an increase of over 129 per cent.

The meteorological advantages of Baguio have been spoken of elsewhere. The warmest day of the year was on May 5, when the temperature was 26° centigrade (791° F.), and the coldest was on January 9, when the temperature was 4.4° centigrade (40° F.). The highest monthly average or mean temperature was recorded in June, 23° centigrade (73.62° F.), and the lowest monthly mean temperature was recorded in the month of February, 9.25° centigrade (48.58° F.).

CULION LEPER COLONY.

At the close of the fiscal year there were 739 lepers at the Culion leper colony. The mortality during the year has been high, which may be ascribed to the miserable physical condition in which the lepers were found at the time they were gathered from their respective provinces. The great majority were beggars who eked out a precarious existence begging on the streets, from house to house, or existing on such charity as might be bestowed upon them. Many suffered from gangrenous ulcers. Before their arrival at Culion, some of them were afflicted with beriberi, and the weakened condition in which many of the others were found made them ready prey to this disease. It is not believed, however, that the transfer of the lepers to Culion in any way hastened their end; rather, life was prolonged in many instances, owing to the medical attention given and the excellent food which is furnished. It was simply a question of the survival of the fittest and among those remaining in this group death is comparatively infrequent. They are healthier, stouter, and generally more robust than when they were received and many of them bid fair to live a long time. The deaths, by months, were as follows:

Thus, for the first six months there were 230 deaths and for the last half of the year 107. In view of the fact that the colony during the latter portion of this period had almost double the population it had during the commencement of the year, the great reduction in the death rate will be apparent.

Practically all gangrenous ulcers, by proper medical attention, have healed and the number in the hospital from other causes has been

gradually reduced. The deaths among the lepers were due principally to gangrenous septicemia, beriberi, tuberculosis, or general debility.

On February 28 a mild case of smallpox attacked a young girl of the colony. Isolation and quarantine were maintained for a month subsequent to disinfection. Vaccination of all the lepers of the colony and also of the nonleper employees was performed, with the gratifying result that no other cases developed, which fact again speaks for the efficiency of vaccination as a preventive of smallpox. In this case it is quite interesting to note the result of the vaccinations. In the lepers we had practically virgin soil; some had been vaccinated during the Spanish régime, but the majority had not. Many adult lepers had not been vaccinated because of the very fact that they were lepers, and also leprous children were passed for the same reason by provincial vaccinators. Thus, with good fresh virus, it was interesting to watch results and compare the percentage of takes in the lepers under these conditions, and of the nonlepers (employees), among whom there were many laborers who had never been vaccinated. The number of takes among the lepers was as large as that in healthy subjects and in no particular could it be said that leprosy modified the effect of the vaccination.

The source of infection in this one case is not quite clear. None of the lepers had come in contact with persons from the outside world for several months. It is believed that the contagion came in some textiles which were sent to Culion by friends residing in infected districts.

Discipline. The behavior of the lepers has been good. Only one serious offense was committed and that was on the day of admission, which was November 1, 1906; a man stabbed his wife three times with a bolo, but though the wounds were of a grave character, she eventually recovered, and her husband was sentenced to six months' imprisonment and to be deprived of his gratuity indefinitely. A few minor offenses have occurred and suitable punishment administered. Eighteen lepers at various times have attempted to escape. All but three have returned or have been returned. Two groups of five each succeeded in reaching Cuyo, in a small open boat, but were apprehended by the Constabulary and returned on the leper boat.

Subsistence. The subsistence furnished has been excellent in quantity, quality, and variety. Four beeves were consumed per week, the same being inspected and slaughtered at Balala. Other food consists of rice, mongos, beans, fideos, salmon, codfish, tomatoes, lard, coffee, sugar, milk, salt, garlic, pepper, vinegar, and fresh fish caught by themselves. The lepers have requested that fresh vegetables be furnished them, but these they might easily raise themselves and probably will do so to a small extent this rainy season. Seeds have been given them and permission to plant at Baldat and Toboc.

Productive labor.-It is very difficult to accomplish any work with the lepers; many are reasonably strong robust persons who might do considerable work if they wished to do so. It is true that the majority are debilitated, more or less always ill, easily fatigued, and could accomplish little; but the majority of those who could work are lazy and indolent, and as long as they are clothed, fed, housed, and receive a weekly gratuity of 20 centavos from the Government, they do not take kindly to any form of manual labor, and it is with difficulty that even the ordinary work of cleaning up their premises is accomplished.

Births. During this year there have been six children born at the colony, three of whom survive. In four of the cases the mothers were pregnant before arrival at the colony; the other two are Culion children, born out of wedlock. This brings up probably the most difficult problem to handle under the existing conditions-the separation of sexes. There are some 89 houses on the colony, of varying accommodations, all located within a radius of some 500 yards, thus bringing the people in close contact nearly all the time. The houses have been numbered and certain ones designated to be occupied by males and others by females, except in the case of a family of different sex which may be permitted to occupy the same house when it can be satisfactorily arranged. At night the separation is not believed to be satisfactory. The police and others who are depended upon to carry out instructions regarding this matter are but human themselves and can not be depended upon to keep the inmates in their respective quarters.

The missionary work which is done among the lepers by the two members of the Jesuit order and the Sisters of Charity on duty there has had, no doubt, an excellent effect.

In order to give these unfortunates the greatest measure of liberty they are permitted to roam about the island at will during the daytime, so that additional opportunities for the meeting of the sexes are possible even though absolute separation could be enforced at night.

The question of the separation of the sexes has received the most serious consideration from the highest to the lowest official who is in any way connected with the care of the lepers in the Philippines, and while there is no unanimity, yet the consensus of opinion undoubtedly is that while the undesirability of the commingling of the sexes is fully appreciated and greatly to be deplored, yet, judging from the customs and habits of the people, it is thought that the complete separation of the sexes is impracticable, if not impossible. The remedy lies rather in persuasion than in the application of force, and it is believed that the former will yield the best results. It is a moral question, and since the government of the colony is made to conform as closely as practicable to that of the ordinary Philippine town, it would appear that the management of this question should be left to the church.