OBSTETRICS IN THE PHILIPPINE ISLANDS. 257 



Hospital ; but, taking them all together, what do 76 births, during a 

 period of six months, signify for a city the size of Manila? This insig- 

 nificant total is an eloquent proof of the exceedingly small moral in- 

 fluence the physician exerts on Filipino women of the lower classes and, 

 on the other hand, demonstrates the palpable preponderance of illegal 

 practitioners and ignorant midwives, monopolizers of almost all the 

 parturitions among. the poor and ignorant women of the city. It is even 

 true that the two externes in obstetrics have been compelled to avail them- 

 selves of the influence of illegal practitioners, by means of a wise policy 

 of attraction, in order to attend confinements. 



To eliminate the illegal practitioner is, for the moment, a problem 

 difficult of solution, for of what advantage would an energetic campaign 

 against them at present be when we lack competent midwives? If the 

 externs in obstetrics are reduced to attending maternity cases in miser- 

 able, small habitations, it will be possible for them to take along not more 

 than two or three students to each case, and for this jnurpose the students 

 would have to confine themselves strictly to fortnightly turns. Lacking 

 the most necessary things, at times even clean water, soap and towels for 

 washing their hands, the students have been compelled b} r circumstances 

 to perform operations in filthy beds in unsanitary places and in an unhy- 

 gienic atmosphere, the lying-in room serving at the same time as bed- 

 chamber, kitchen and even workshop to an entire family ! 



In view of the data cited, it is not difficult to foresee that the obstet- 

 rical pavilion of the future hospital will be a failure unless energetic 

 measures are resorted to and certain reforms adopted to bring the poor 

 and ignorant women of this city there for confinement. One of the 

 first steps, after the construction of this pavilion, should be the enact- 

 ment of a law establishing a school of midwifery for the entire Archipel- 

 ago, and, as a measure of attraction to induce the ignorant women of the 

 city to go there for confinement, I propose that some of the most popular 

 and best-known illegal practitioners from the several suburbs of Manila be 

 admitted as students in that school. This suggestion, however strange 

 it may seem, will give positive results in the field of practice, because 

 eight or ten of these practitioners, matriculated as students and enabled 

 to secure the degree of qualified midwife, would serve as excellent prop- 

 agandists for attracting parturients to the obstetrical ward, much better 

 than all theoretical means of doubtful success. In a word, the great 

 rjrestige which some of these illegal practitioners now enjoy among the 

 lower classes of Manila should be used, through a wise policy of at- 

 traction, to further the beneficent ends of scientific propaganda. 



The defective midwifery service now existing in Manila should be 

 organized by regulations rendering efficacious the gratuitous treatment 

 of poor parturients. Nothing would serve this purpose better than to 

 place the midwives under the immediate control of the externs in ob- 

 stetrics, whose duty it would be to approve the birth certificates issued 



