172 HEISER. 



classes, to whom neither Spanish nor English is intelligible. It is 

 handicapped by the lack of a sufficient number of medical employees who 

 are sufficiently interested in the cause of humanity to undergo the in- 

 numerable hardships and discomforts which accompany most of the 

 medical service in the provinces. Untold credit is due those who are at 

 present carrying on the work, the burdens of which fall more heavily 

 upon them because of their limited numbers. We are also handicapped 

 by a treasury of which it is quite possible at times to see the bottom, so 

 that it is not put to us, "do all you can regardless of expenditure," but 

 "your expenditures must not go beyond this or this ; do the best you can 

 with the funds available." So our very largest problem is that of discrim- 

 ination : Shall we devote our energies to this or that question ; we cannot 

 do all; shall we attempt this one and abandon that, or do a little toward 

 each ? Thus far it has been our policy to do a little toward each, although 

 the problems are many and great. 



Malaria. — For instance, the malaria problem alone is a very large 

 one. In the Province of Ambos Camarines, which has a population of 

 233,472 persons, there were 745 deaths from this disease reported for 

 the year ended June 30, 1909. A conservative estimate of 10 cases for 

 each death with an illness of ten days makes 74,500 days lost, which, 

 valued at only 50 centavos Philippine currency or 25 cents United 

 States currency a day, would amount to 37,250 pesos or 18,625 dollars 

 United States currency a year. This being for only 1 out of 30 provinces, 

 we can conservatively multiply this sum by 20, which would make an 

 economic loss to the country of 745,000 pesos. If a human life can be 

 economically valued at 1,000 pesos of $500 or £100 in this country, 

 making deductions for children, etc., we find ourselves confronting a loss 

 of at least 5,000,000 pesos per annum from this disease alone, and yet 

 this represents but a small portion of the total loss which can be attributed 

 to preventable diseases. 



The number of malarial cases has been greatly decreased, however, by 

 instituting drainage wherever possible, by the free distribution of qui- 

 nine, and by campaigns of education, particularly in the schools, where 

 pupils are taught the value of mosquito nets, the danger from mosqui- 

 toes, and how they may be destroyed, etc. 



Mosquitoes. — There recently has been an active newspaper agitation 

 concerning the eradication of mosquitoes in Manila, but few persons 

 realize the obstacles that block our way in such an undertaking. Ma- 

 nila is on low land, much of its area being in fact below sea level. To 

 bring the city to a drainable level would be a necessity in such a propo- 

 sition, and is estimated to cost 4,000,000 pesos at least. When we reflect 

 that the annual income of the city is under 3,000,000 pesos we naturally 

 pause before recommending a measure so financially disproportionate, 

 especially when some authorities consider such an undertaking problem- 

 atical and more especially since there are practically no reliable data on 



