UNSOLVED HEALTH PEOBLEMS. 177 



The entire situation is hindered by our inability to secure proper sta- 

 tistical information. This is due to a lack of officials in the provinces 

 sufficiently skilled to make reliable reports on the causes of death. 

 Whether the municipal officials can be trained and educated to do this 

 remains to be seen. As stated in the beginning, our work is first one 

 of discrimination, a placing of our heaviest artillery -where the enemy 

 is strongest. This we can not always determine on account of the inac- 

 curacy and incompleteness of available data. 



SUMMARY. 



To summarize, it is to be understood that the health of these people 

 is the vital question of the Islands. To transform them from the weak 

 and feeble race we have found them into the strong, healthy, and en- 

 during people that they yet may become is to lay the foundations for 

 the successful future of the country. But it is not alone the problem 

 of the Bureau of Health; it is an economic and educational question as 

 well. Every branch of the Government has its part to perform, and 

 cooperation is essential. Good roads ; agricultural improvements ; the 

 elimination of rinderpest and other animal diseases; the general develop- 

 ment of the country, which will gradually bring about a better standard 

 of living; education, particularly along the lines of hygiene and sanita- 

 tion (to which we give all the aid possible, but for the dissemination of 

 which we will have to depend upon the teachers and the public schools) ; 

 the special training of the young men and women of the Islands in the 

 professions of medicine and nursing — all the foregoing factors, with 

 which we, as a Bureau, have nothing to do, are as important to the 

 health conditions of the Islands as is the actual holding in check of 

 epidemics and disease, the sanitary inspections, enforcement of regula- 

 tions, etc., the opening and maintenance of hospitals throughout the 

 Islands, and the various other things for which the Bureau of Health 

 is directly responsible. 



The Government is not a rich one. How to do the most and the 

 best with a limited income is still an acute question. You can see 

 what an enormous proportion of that limited income it would take to 

 carry out successfully any one of the various health projects enumerated. 

 To give thorough attention to a particular one would involve an un- 

 warranted neglect of the rest. Hence we have concluded we must do 

 the best we can with the entire proposition, going slowly but making 

 headway each year, each month, perhaps each day. 



It should be remembered that much of our appropriation is consumed 

 in ways unusual for a health bureau. The maintenance and manage- 

 ment of general and insane hospitals, orphan asylums, homes for the 

 aged, etc., falls to our lot and is no small burden. We are practically 

 cleaning up these Islands, left foul and insanitary and diseased by 



