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 insignificant total is an eloquent proof of the exceedingly small moral influence 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 themselves 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 extent in obstetrics are reduced to attending maternity cases in miserable, small habitations, it will be possible for them to take along not more than two or three students to each case, and for this purpose 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 unhygienic atmosphere, the lying-in room serving at the same time as bedchamber, kitchen and even workshop to an entire family In view of the data cited, it is not difficult to foresee that the obstetrical 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 enactment of a law establishing a school of midwifery for the entire Archipelago, 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 propagandists for attracting parturients to the obstetrical ward, much better than all theoretical means of doubtful success. In a word, the great prestige which some of these illegal practitioners now enjoy among the lower classes of Manila should be used, through a wise policy of attraction, 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 extent in obstetrics, whose duty it would be to approve the birth certificates issued