IN THE PHILIPPINES. 67 



The total reduction throughout the islands is more than 60,000 

 lives a year. The death rate among the civil employees steadily 

 declined and in 191 5 was 3.88 per thousand per annum. It is 

 small wonder that results such as these, achieved entirely under 

 civil regime and with the limited revenues of the islands, should 

 commend themselves to other countries, and it is a fact that the 

 achievement of American sanitation in the tropics has produced a 

 profound impression. When the Rockefeller Foundation, through 

 its International Health Board, entered the field, it found the world 

 in a receptive mood toward American methods. 



The conception that the establishment of public-health agencies 

 can be stimulated through hookworm control has won rapid ac- 

 ceptance and has already a good record of achievement. It is 

 realized that if public-health measures are to be successful they 

 must be brought about upon the demand of the people rather than 

 be imposed upon them. To gain this end much effort has been 

 expended in bringing home to the people of tropical countries the 

 practicability of curing hookworm disease. 



This disease is one of the few over which the medical profession 

 exercises complete control : first, its cause is definitely known ; 

 second, a person afflicted with it can be cured with certainty ; third, 

 its prevention is completely practicable. Furthermore, when meas- 

 ures to prevent soil pollution are carried out, other intestinal af- 

 fections such as typhoid, cholera, and dysentery, largely disappear. 

 Thus, the improvement made in public health more than justifies 

 the money spent in hookworm control. 



Even more important is the interest awakened in the people. 

 The work in connection with the relief and control of hookworm 

 infection comes very close to the home life. It causes the speedy 

 substitution of rosy cheeks for pale anemic faces, a result that can 

 be understood by the most ignorant of the community. JMoreover, 

 credulity is not strained by being asked to believe in bacteria which 

 can not be seen and which too often are regarded as mythical. 

 The worms which are expelled are plainly visible to the naked eye. 

 Hookworm measures, then, are capable of creating a genuine in- 

 terest in public health in the masses, who, quickened to a reali- 



