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Krause and Mahan’s Food
& The Nutrition Care
Process

15TH EDITION

JANICE L. RAYMOND, MS, RDN, CSG

Clinical Nutrition Director, Thomas Cuisine Management at Providence Mount St. Vincent, Seattle,
Washington
Affiliate Faculty, Department of Nutrition and Exercise Science, Bastyr University, Kenmore, Washington

KELLY MORROW, MS, RDN, FAND

Associate Professor, Nutrition Clinic Coordinator, Department of Nutrition and Exercise Science, Bastyr
University, Kenmore, Washington
Table of Contents
Instructions for online access

Cover image

Title page

How to use

Copyright

Dedication

Contributors

Foreword

Preface

Acknowledgments
PART I. Nutrition Assessment

Introduction

1. Intake: Gastrointestinal digestion, absorption, and excretion of nutrients

The gastrointestinal tract

Brief overview of digestive and absorptive processes

The small intestine: Primary site of nutrient absorption

The large intestine

Summary

Useful websites

References

2. Intake: Energy

Energy requirements

Components of energy expenditure

Estimating energy requirements

Physical activity in children

Calculating food energy

Useful websites/apps

References

3. Clinical: Water, electrolytes, and acid–base balance

Body water

Electrolytes
 Acid–base balance

Acid generation

Acid–base disorders

References

4. Intake: Assessment of food- and nutrition-related history

Nutritional status

Nutrition screening

Nutrition assessment

Nutrition-related history

Food and nutrient intake

Food and nutrient administration

Nutrition knowledge, beliefs, and attitudes

Nutrition behaviors

Medication and complementary or alternative medicines

Nutrition access

Physical activity and physical function

Nutrition quality of life

References

5. Clinical: Biochemical, physical, and functional assessment

Biochemical assessment of nutrition status

Nutrition interpretation of routine medical laboratory tests

Assessment of hydration status

Assessment for nutritional anemias

Fat-soluble vitamins

Water-soluble vitamins and trace minerals

Chronic disease risk assessment

Physical assessments

Nutrition-focused physical examination

Useful websites

References

6. Nutritional genomics

Genetic and genomic fundamentals

Modes of inheritance

Genetic variation, inheritance, and disease

Nutritional genomics and chronic disease

Summary

Useful websites

References

7. Inflammation and the pathophysiology of chronic disease

Epidemic of chronic disease

Concepts of chronic disease pathophysiology

Inflammation: Common denominator of chronic disease

 Nutrient modulators of inflammation

Reducing inflammation in the body

Summary

Useful websites

References

8. Behavioral-environmental: The individual in the community

Social determinants of health

Nutrition practice in the community

Needs assessment for community-based nutrition services

National nutrition surveys

National nutrition guidelines and goals

Food assistance and nutrition programs

Foodborne illness

Food and water safety

Disaster planning

Healthy food and water systems and sustainability

Summary: A work in progress

Useful websites

References

PART II. Nutrition Diagnosis and Intervention

Introduction

9. Overview of nutrition diagnosis and intervention

The nutrition care process

Documentation in the nutrition care record

Influences on nutrition and health care

Nutrition interventions

Nutrition for the terminally ill or hospice client

Useful websites

References

10. Food-nutrient delivery: Planning the diet with cultural competence

Determining nutrient needs

Worldwide guidelines

Nutritional status of americans

National guidelines for diet planning

Food and nutrient labeling

Dietary patterns and counseling tips

Cultural aspects of dietary planning

Useful websites

References

References

11. Food and nutrient delivery: Bioactive substances and integrative care
 Complementary and integrative medicine

Use of complementary and integrative therapies

Dietary supplementation

Dietary supplement regulation

Assessment of dietary supplement use in patients

Useful websites

References

12. Food and nutrient delivery: Nutrition support methods

Rationale and criteria for appropriate nutrition support

Enteral nutrition

Enteral nutrition access

Parenteral nutrition

Complications

Refeeding syndrome

Transitional feeding

Nutrition support in long-term and home care

Useful websites

References

13. Education and counseling: Behavioral change

Behavior change

Models for behavior change

Models for counseling strategies

Models for educational program development

Skills and attributes of the nutrition educator or counselor

Assessment results: Choosing focus areas

Counseling approaches after the assessment

Evaluation of effectiveness

Summary

Useful websites

References

PART III. Nutrition in the Life Cycle

Introduction

14. Nutrition in pregnancy and lactation

Preconception and fertility

Conception

Pregnancy

Postpartum period = preconceptual period

Lactation

Useful websites

References

15. Nutrition in infancy

 Physiologic development

Nutrient requirements

Milk

Food

Feeding

Useful websites

References

16. Nutrition in childhood

Growth and development

Nutrient requirements

Providing an adequate diet

Nutritional concerns

Preventing chronic disease

Useful websites

References

17. Nutrition in adolescence

Growth and development

Nutrient requirements

Food habits and eating behaviors

Nutrition screening, assessment, and counseling

Special topics

Useful websites

References

18. Nutrition in the adult years

Setting the stage: Nutrition in the adult years

Setting the stage: Messages

Information sources

Lifestyle and health risk factors

Health disparities and global health

Nutritional factors affecting adult women and men

Interventions, nutrition, and prevention

Food trends and patterns

Nutritional supplementation

Functional foods

Adult health next steps

Useful websites

References

19. Nutrition in aging

The older population

Gerontology, geriatrics, and the spectrum of aging

Nutrition in health promotion and disease prevention

Theories on aging
 Physiologic changes

Quality of life

Nutrition screening and assessment

Nutrition needs

Medicare benefits

Nutrition support services

Community and residential facilities for older adults

Useful websites

References

PART IV. Nutrition for Weight Management

Introduction

20. Nutrition in weight management

Weight management and obesity: Its foundation in nutritional medicine

Body weight components

Regulation of body weight

Overweight and obesity

Elements of energy balance dysregulation

Management of obesity in adults

Weight management in children and adolescents

Excessive leanness or unintentional weight loss

Useful websites

References

21. Nutrition in eating disorders

Clinical characteristics and medical complications

Treatment approach

Psychologic management

Nutrition management

Medical nutrition therapy and counseling

Summary

Useful websites

References

22. Nutrition in exercise and sports performance

Bioenergetics of physical activity

Fuels for contracting muscles

An integrative approach to working with athletes

Nutritional requirements of exercise

Weight management

Weight management and aesthetics

Macronutrients

Carbohydrate

Protein

Fat
 Fluid

Vitamins and minerals

Minerals

Ergogenic AIDS

Popular ergogenic AIDS

Performance enhancement substances and drugs: Doping in sport

Useful websites

References

23. Nutrition and bone health

Introduction

Bone structure and bone physiology

Osteopenia and osteoporosis

Nutrition and bone

Treatment of osteoporosis

References

24. Nutrition for oral and dental health

Nutrition for tooth development

Dental caries

Early childhood caries

Caries prevention

Tooth loss and dentures

Other oral disorders

Periodontal disease

Oral manifestations of systemic disease

Useful websites

References

PART V. Medical Nutrition Therapy

Introduction

25. Medical nutrition therapy for adverse reactions to food: Allergies and intolerances

Definitions

Prevalence

Etiology

Pathophysiology of food allergy

Immune system basics

Food-dependent, exercise-induced anaphylaxis (FDEIA)

Food intolerances

Medical nutrition therapy

Diagnosis

Intervention

Monitoring and evaluation

Prevention of food allergies

Useful websites
 References

26. Medical nutrition therapy for upper gastrointestinal tract disorders

The esophagus

The stomach

Gastroparesis

Useful websites

References

27. Medical nutrition therapy for lower gastrointestinal tract disorders

Common intestinal problems

Diseases of the small intestine

Intestinal brush-border enzyme deficiencies

Inflammatory bowel disease

Nutritional consequences of intestinal surgery

Useful websites

References

28. Medical nutrition therapy for hepatobiliary and pancreatic disorders

Physiology and functions of the liver

Diseases of the liver

Complications of esld: Cause and nutrition treatment

Nutrition issues related to end-stage liver disease

Nutrient requirements for cirrhosis

Herbal and dietary supplements and liver disease

Liver resection and transplantation

Physiology and functions of the gallbladder

Diseases of the gallbladder

Complementary and integrative medicine for gallstones

Physiology and functions of the exocrine pancreas

Diseases of the exocrine pancreas

Complementary and integrative medicine for pancreatic disorders

Pancreatic surgery

Useful websites

References

29. Medical nutrition therapy for diabetes mellitus and hypoglycemia of nondiabetic origin

Incidence and prevalence

Categories of glucose intolerance

Screening and diagnostic criteria

Management of prediabetes

Management of diabetes

Implementing the nutrition care process

Acute complications

Long-term complications

Hypoglycemia of nondiabetic origin

 Useful websites

References

30. Medical nutrition therapy for thyroid, adrenal, and other endocrine disorders

Thyroid physiology

Assessment in thyroid disorders

Hypothyroidism

Polycystic ovary syndrome

Hyperthyroidism

Managing imbalances of the hypothalamus-pituitary-thyroid axis

Adrenal disorders

Useful websites

References

31. Medical nutrition therapy for anemia

Iron-related blood disorders

Iron overload

Megaloblastic anemias

Other nutritional anemias

Nonnutritional anemias

Useful websites

References

32. Medical nutrition therapy for cardiovascular disease

Atherosclerosis and coronary heart disease

Genetic hyperlipidemias

Hypertension

Heart failure

Cardiac transplantation

Useful websites

References

33. Medical nutrition therapy for pulmonary disease

The pulmonary system

Chronic pulmonary disease

Asthma

Chronic obstructive pulmonary disease

Pulmonary hypertension

Diffuse parenchymal lung disease

Tuberculosis

Lung cancer

Obesity hypoventilation syndrome

Pleural effusion

Chylothorax

Acute respiratory distress syndrome

Pneumonia
 Lung transplantation

Bronchopulmonary dysplasia

Useful websites

References

34. Medical therapy for renal disorders

Physiology and function of the kidneys

Renal diseases

Education, adherence, and compliance

Acute kidney injury (acute renal failure)

Chronic kidney disease

End-stage renal disease

References

35. Medical nutrition therapy for cancer prevention, treatment, and survivorship

Pathophysiology

Nutrition and carcinogenesis

Chemoprevention

Medical diagnosis and staging of cancer

Medical treatment

Medical nutrition therapy

Integrative, complementary, and functional oncology

Nutritional impact of cancer treatments

Nutrition monitoring and evaluation

Pediatric cancer

Nutrition recommendations for cancer survivors

Useful websites

References

36. Medical nutrition therapy for HIV and AIDS

Epidemiology and trends

Pathophysiology and classification

Medical management

Medical nutrition therapy

HIV in women

HIV in children

Integrative and functional nutrition (IFN)

Useful websites

References

37. Medical nutrition therapy in critical care

Metabolic response to stress

Hormonal and cell-mediated response

Starvation versus stress

Systemic inflammatory response syndrome, sepsis, and organ dysfunction or failure

Malnutrition: The etiology-based definition

 Trauma and the open abdomen

Major burns

Surgery

Useful websites

References

38. Medical nutrition therapy for rheumatic and musculoskeletal disease

Etiology

Pathophysiology and inflammation

Medical diagnosis and treatment

Pharmacotherapy

Antiinflammatory diet

Complementary and integrative health approaches

Microbiota and arthritis

Osteoarthritis

Rheumatoid arthritis

Sjögren’s syndrome

Temporomandibular disorders

Gout

Scleroderma (systemic sclerosis or SSc)

Systemic lupus erythematosus

Spondylarthritides

Useful websites

References

39. Medical nutrition therapy for neurologic disorders

The nervous system

Dysphagia

Neurologic diseases of nutritional origin

Neurologic disorders from trauma

Head trauma or neurotrauma

Spine trauma and spinal cord injury

Neurologic diseases

Useful websites

References

40. Medical nutrition therapy in psychiatric and cognitive disorders

The enteric nervous system

Blood glucose regulation

The role of nutrients in mental function

Addiction and substance abuse

Anxiety

Bipolar disorder

Dementia and alzheimer’s disease

Depression
 Fatigue, chronic fatigue syndromE (CFS), and fibromyalgia syndrome (FMS)

Schizophrenia

Useful websites

References

PART VI. Pediatric Specialties

Introduction

41. Medical nutrition therapy for low-birthweight infants

Infant mortality and statistics

Physiologic development

Nutrition requirements: Parenteral feeding

Transition from parenteral to enteral feeding

Nutrition requirements: Enteral feeding

Feeding methods

Selection of enteral feeding

Nutrition assessment and growth

Discharge care

Neurodevelopmental outcome

Useful websites

References

42. Medical nutrition therapy for genetic metabolic disorders

Newborn screening

Disorders of amino acid metabolism

Phenylketonuria

Disorders of organic acid metabolism

Disorders of urea cycle metabolism

Disorders of carbohydrate metabolism

Disorders of fatty acid oxidation

Role of the nutritionist in genetic metabolic disorders

Useful websites

References

43. Medical nutrition therapy for intellectual and developmental disabilities

Medical nutrition therapy

Chromosomal abnormalities

Neurologic disorders

Fetal alcohol syndrome

Community resources

Useful websites

References

Appendix 1: Milliequivalents and milligrams of electrolytes

Appendix 2: Equivalents conversions and portion scoop sizes

Appendix 3: Growth charts

Appendix 4: Tanner stages of adolescent development for girls and boys

Appendix 5: Direct methods for measuring height and weight and indirect methods for measuring height

Appendix 6: Determination of frame size

Appendix 7: Adjustment of desirable body weight for amputees

Appendix 8: Body mass index table

Appendix 9: Percentage of body fat based on four skinfold measurements

Appendix 10: Physical activity and calories expended per hour

Appendix 11: Nutrition focused physical assessment

Appendix 12: Laboratory values for nutritional assessment and monitoring

Appendix 13: Nutritional implications of selected drugs

Appendix 14: Nutritional facts on fluid and hydration

Appendix 15: Enteral tube feeding formulas for adults marketed in the United States

Appendix 16: Sample stepwise method to calculate a parenteral nutrition PN formula

Appendix 17: Dietary approaches to stop hypertension DASH diet

Appendix 18: Exchange lists and carbohydrate counting for meal planning

Appendix 19: The ketogenic diet

Appendix 20: The international dysphagia diet standardisation initiative IDDSI

Appendix 21: Renal diet for dialysis

Appendix 22: The antiinflammatory diet

Appendix 23: The mediterranean diet

Appendix 24: Nutritional facts on alcoholic beverages

Appendix 25: Nutritional facts on caffeine containing products

Appendix 26: Nutritional facts on essential omega fatty acids

Appendix 27: Nutritional facts on a high fiber diet

Appendix 28: Glycemic index GI and glycemic load GL of selected foods

Appendix 29: Nutritional facts on a high protein diet

Appendix 30: Nutritional facts on vegetarian eating

Appendix 31: Nutritional facts on folic acid vitamin B6 and vitamin B12

Appendix 32: Nutritional facts on choline

Appendix 33: Nutritional facts on biotin

Appendix 34: Nutritional facts on vitamin A and carotenoids

Appendix 35: Nutritional facts on vitamin C

Appendix 36: Nutritional facts on vitamin E

Appendix 37: Nutritional facts on vitamin K

Appendix 38: Nutritional facts on vitamin D

Appendix 39: Nutritional facts on calcium

Appendix 40: Nutritional facts on chromium

Appendix 41: Nutritional facts on iodine

Appendix 42: Nutritional facts on iron

Appendix 43: Nutritional facts on magnesium

Appendix 44: Nutritional facts on potassium

Appendix 45: Nutritional facts on selenium

Appendix 46: Sodium in food

Appendix 47: Nutritional facts on zinc

Index

End sheet 1

End sheet 2
Dietary Reference Intakes of Energy and Protein From Birth to 18 Years of Age per Day*

Protein
Age Estimated Energy Requirement
(g)
Infants 0 to 3 (89 ×Weight [kg] − 100) + 175 kcal 9.1
months
4 to 6 (89 × Weight [kg] − 100) + 56 kcal 9.1
months
7 to 12 (89 × Weight [kg] − 100) + 22 kcal 11
months
13 to 36 (89 × Weight [kg] − 100) + 20 kcal 13
months
Boys 3 to 8 years 88.5 − (61.9 × Age [yr] + PA × (26.7 × Weight [kg] + 903 × Height 19
[m]) + 20 kcal
9 to 18 years 88.5 − (61.9 × Age [yr]) + PA × (26.7 × Weight [kg] + 903 × Height 34 to 52
[m]) + 25 kcal
Girls 3 to 8 years 135.3 − (30.8 × Age [yr]) + PA× (10.0 × Weight [kg] + 934 × Height 19
[m]) + 20 kcal
9 to 18 years 135.3 − (30.8 × Age [yr]) + PA × (10.0 × Weight [kg] + 934 × Height 34 to 46
[m]) + 25 kcal
*PA,
Physical activity level. Data from the Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber,
fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: National Academies Press; 2002.
Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Total Water and
Macronutrients*
Food and Nutrition Board, Institute of Medicine, National Academies

Life Stage Total Watera Total Fiber Linoleic Acid α-Linolenic Acid Proteinb
Group (L/d) (g/d) (g/d) (g/d) (g/d)
Infants
Birth to 6 mo 0.7* ND 4.4* 0.5* 9.1*
6-12 mo 0.8* ND 4.6* 0.5* 11.0
Children
1-3 yr 1.3* 19* 7* 0.7* 13
4-8 yr 1.7* 25* 10* 0.9* 19
Males
9-13 yr 2.4* 31* 12* 1.2* 34
14-18 yr 3.3* 38* 16* 1.6* 52
19-30 yr 3.7* 38* 17* 1.6* 56
31-50 yr 3.7* 38* 17* 1.6* 56
51-70 yr 3.7* 30* 14* 1.6* 56
>70 yr 3.7* 30* 14* 1.6* 56
Females
9-13 yr 2.1* 26* 10* 1.0* 34
14-18 yr 2.3* 26* 11* 1.1* 46
19-30 yr 2.7* 25* 12* 1.1* 46
31-50 yr 2.7* 25* 12* 1.1* 46
51-70 yr 2.7* 21* 11* 1.1* 46
>70 yr 2.7* 21* 11* 1.1* 46
Pregnancy
14-18 yr 3.0* 28* 13* 1.4* 71
19-30 yr 3.0* 28* 13* 1.4* 71
31-50 yr 3.0* 28* 13* 1.4* 71
Lactation
14-18 yr 3.8* 29* 13* 1.3* 71
19-30 yr 3.8* 29* 13* 1.3* 71
31-50 yr 3.8* 29* 13* 1.3* 71
Source: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005) and Dietary
Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005). The report may be accessed via www.n
*
NOTE: This table (taken from the DRI reports, see www.nap.edu) presents Recommended Dietary Allowances (RDA) in boldface type and Adequate
Intakes (AIs) in ordinary type followed by an asterisk (*). An RDA is the average daily dietary intake level; sufficient to meet the nutrient requirements
of nearly all (97-98%) healthy individuals in a group. It is calculated from an Estimated Average Requirement (EAR).
If sufficient scientific evidence is not available to establish an EAR, and thus calculate an RDA, an AI is usually developed. For healthy breastfed
infants, an AI is the mean intake. The AI for other life stage and gender groups is believed to cover the needs of all healthy individuals in the groups,
but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.
aTotal water includes all water contained in food, beverages, and drinking water.
b
Based on grams of protein per kilogram of body weight for the reference body weight (e.g., for adults 0.8 g/kg body weight for the reference body
weight).
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KRAUSE AND MAHAN’S FOOD & THE NUTRITION CARE PROCESS, FIFTEENTH
EDITION 978-0-323-63655-1

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Dedication

This 15th edition is dedicated to the students, professors, and practitioners who use this text.
We are also incredibly grateful to our authors for sharing their wisdom, experience, and insight and
for their dedication to the field of nutrition and dietetics.

—The Authors, 15th Edition

To the residents and patients at Providence Mount St. Vincent who remind me every day why I chose
to work in a health care field devoted to older people. To my grandparents who helped raise me and
taught me the value of listening to and learning from our elders. Thank you to my husband, Greg,
who has become an enthusiastic chef and did most of the cooking while I was busy editing. And to
Kathy Mahan, who is the reason this book has existed for over 60 years and has always been cutting
edge. Thank you for the inspiration.

—Janice

To my students at Bastyr University. You continuously inspire me with your energy and enthusiasm.
To my husband Gregg, son Ian, sister Wendy, the chair of the Nutrition Department at Bastyr, Debra
Boutin, and my friends and colleagues. Thank you for believing in me and providing unending
support and encouragement. To Kathy Mahan: I am honored and grateful that you have entrusted us
to continue your work.

—Kelly
Contributors
Diane M. Anderson, PhD, RDN, FADA, Associate Professor, Pediatrics, Baylor College of Medicine,
Houston, Texas
Christine Avgeris, RDN, CD, Clinical Dietitian, Nutrition, Seattle Children’s Hospital, Seattle,
Washington
Cynthia Bartok, PhD, RDN, CD, Associate Professor, Nutrition and Exercise Science, Bastyr University,
Kenmore, Washington
Britta Brown, MS, RDN, LD, CNSC, Clinical Dietitian, Nutrition Services, Hennepin Healthcare,
Minneapolis, Minnesota
Lindsey Callihan, MS, RDN, CSG, CVS/Coram, Boise, Idaho
Karen Chapman-Novakofski, PhD, RDN, LDN, Food Science and Human Nutrition, University of
Illinois, Urbana, Illinois
Ashley Contreras-France, MA, MS, CCC-SLP, Director of Rehabilitation Therapy, Covenant Living at
the Shores, Mercer Island, Washington
Mandy L. Corrigan, MPH, RDN, CNSC, FAND, FASPEN , Clinical Manager, Home Nutrition Support
and Center for Gut Rehabilitation and Transplantation, Center for Human Nutrition, Digestive Disease and
Surgery Institute, Cleveland, Ohio
Sarah Couch, PhD, RDN, Professor, Rehabilitation, Exercise, and Nutrition Sciences, University of
Cincinnati, Cincinnati, Ohio
Jean T. Cox, MS, RDN, LN
Patient Educator, Maternity and Family Planning Program, University of New Mexico Hospital;
Volunteer Faculty, Department of OB/GYN, University of New Mexico, Albuquerque, New Mexico
Sheila Dean, DSc, RDN, LDN, CCN, IFMCP
Adjunct Professor, Health Sciences and Human Performance, University of Tampa, Tampa, Florida;
Co-Founder, Integrative and Functional Nutrition Academy, Palm Harbor, Florida
Ruth DeBusk, PhD, RDN, Family Medicine Residency Program, Tallahassee Memorial HealthCare,
Tallahassee, Florida
Judith L. Dodd, MS, RDN, LDN, FAND , Assistant Professor, Sports Medicine and Nutrition, University
of Pittsburgh – SHRS, Pittsburgh, Pennsylvania
Lisa Dorfman, MS, RDN, CSSD, CCMS, LMHC, FAND, CEO/Director, Sports Nutrition & Performance,
Food Fitness International, Inc, Miami, Florida
Lorena Drago, MS, RDN, CDN, CDE, Diabetes Education, Hispanic Foodways LLC, Forest Hills, New
York
L. Karina Díaz Rios, PhD, RDN, Cooperative Extension Specialist in Nutrition, Division of Agriculture &
Natural Resources, University of California, Merced, Merced, California
Sharon A. Feucht, MA, RDN, CD
Nutritionist LEND Program (Retired), Center on Human Development and Disability, University of
Washington, Seattle, Washington;
Nutritionist, Holly Ridge Early Intervention Center, Bremerton, Washington
Laith Ghazala, MD, FRCP, Fellow, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
F. Enrique Gómez, MSc, PhD, Researcher, Nutritional Physiology, National Institute of Medical Sciences
and Nutrition, Salvador, Zubiran, Mexico City, Mexico
Michael Hahn, BA, Health Science Policy Analyst, All of Us Research Program, National Institutes of
Health, Bethesda, Maryland
Jeanette M. Hasse, PhD, RDN, LD, CNSC, FADA, Transplant Nutrition Manager, Simmons Transplant
Institute, Baylor University Medical Center, Dallas, Texas
Ginger Hultin, MS, RDN, CSO, Registered Dietitian, Nutrition, Bastyr University, Seattle, Washington
A. Christine Hummell, MS, RDN, LD, CNSC, Clinical Dietitian, Advanced Practitioner I, Center of
Human Nutrition, Cleveland Clinic, Cleveland, Ohio
Carol S. Ireton-Jones, PhD, RDN, LD, CNSC, FASPEN, FAND, Nutrition Therapy Specialist, Good
Nutrition for Good Living, Dallas, Texas
Jessica Jones, MS, RDN, CDE , Founder, Private Practice, Jessica Jones Nutrition, Richmond, California
Veena Juneja, MSc, RDN, Senior Renal Dietitian, Nutrition, St. Joseph’s Healthcare, Hamilton, Ontario,
Canada
Martha Kaufer-Horwitz, MSc, DSc, NC, FTOS, Researcher in Medical Sciences, Obesity and Eating
Disorders Clinic, National Institute of Medical Sciences and Nutrition, Salvador, Zubiran, Mexico City,
Mexico
Rachel E. Kay, MS, RDN, CD, CNSC, Clinical Dietitian, Gastroenterology, Seattle Children’s Hospital,
Seattle, Washington
Bette Klein, MS, RDN, CSP, LD, Advanced Practice II Pediatric Dietitian, Pediatric Gastroenterology,
Cleveland Clinic Children’s, Cleveland, Ohio
Lauren Kruse, MS, RDN, CNSC, Dietitian, Home Nutrition Support, Center for Human Nutrition,
Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
Glenn Kuz, BSP, PharmD, Clinical Pharmacist, Harborview Medical Center, University of Washington
Medical Center, Seattle, Washington
Camille Lyn Lanier, RDN, CD, Pediatric Dietitian, Nutrition, Seattle Children’s Hospital, Seattle,
Washington
Nicole Larson, PhD, MPH, RDN, LD, Senior Research Associate, Division of Epidemiology and
Community Health, University of Minnesota, Minneapolis, Minnesota
Tashara M. Leak, PhD, RDN
Lois & Mel Tukman Assistant Professor, Division of Nutritional Sciences, Cornell University, Ithaca, New
York;
Assistant Professor of Nutrition Research in Medicine, Division of General Internal Medicine, Weill Cornell
Medicine, New York, New York
Maureen Lilly, MS, RDN , Registered Dietitian Nutritionist, Nutrition, Chicken Soup Brigade, Seattle,
Washington
Mary Demarest Litchford, PhD, RDN, LDN, President, Executive, CASE Software & Books,
Greensboro, North Carolina
Michelle Loy, MPH, MS, RDN, Associate Professor, Nutrition and Foods, Fullerton College, Fullerton,
California
Lucinda K. Lysen, RDN, RN, BSN, Nutrition Consultant in Private Practice, Orland Park, Illinois
L. Kathleen Mahan, MS, RDN, CD
Functional Nutrition Counselor, Nutrition by Design;
Clinical Associate, Department of Pediatrics, School of Medicine, University of Washington, Seattle,
Washington
Gabriela E. Mancera-Chávez, MSc, NC
Professor, College of Sciences and Humanities, Autonomous University of Mexico City;
Independent Consultant, Mexico City, Mexico
Laura E. Matarese, PhD, RDN, LDN, CNSC, FADA, FASPEN, FAND, Professor, Brody School of
Medicine and Department of Nutrition Science, East Carolina University, Greenville, North Carolina
Mari O. Mazon, MS, RDN, CD, Nutritionist, Center on Human Development and Disability, University of
Washington, Seattle, Washington
Kelly N. McKean, MS, RDN, CSP, CD, Clinical Pediatric Dietitian, Nutrition, Seattle Children’s, Seattle,
Washington
Maggie Moon, MS, RDN, Author, The MIND Diet, Nutrition Communications, Los Angeles, California
Kelly Morrow, MS, RDN, FAND, Associate Professor, Nutrition and Exercise Science, Bastyr University,
Kenmore, Washington
Diana Noland, MPH, RDN, CCN, IFMCP, LD, Owner, Integrative & Functional Medical Nutrition
Therapy, FoodFAX, Burbank, California
Patricia Novak, MPH, RDN, Nutrition Consultant, Feeding and Nutrition, Professional Child
Development Associates (PCDA), Pasadena, California
Kim Nowak-Cooperman, MS, RDN, CD, Registered Dietitian Nutritionist, Clinical Nutrition, Seattle
Children’s Hospital, Seattle, Washington
Beth Ogata, MS, RDN, CD, CSP, Lecturer, Department of Pediatrics, University of Washington, Seattle,
Washington
Constantina Papoutsakis, PhD, RDN, Senior Director, Nutrition and Dietetics Data Science Center,
Research International Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
Mary H. Purdy, PhD, Professor, Communication Disorders, Southern Connecticut State University, New
Haven, Connecticut
Janice L. Raymond, MS, RDN, CSG
Clinical Nutrition Director, Thomas Cuisine Management, Providence Mt. St Vincent, Seattle, Washington;
Affiliate Faculty, Nutrition, Bastyr University, Kenmore, Washington
Rickelle Richards, PhD, MPH, RDN, Associate Professor, Nutrition, Dietetics & Food Science, Brigham
Young University, Provo, Utah
Dorene Robinson, RDN, CDN, Editor, website, beyonddiets.com, Seattle, Washington
Justine Roth, MS, CEDRD, Clinical Nutrition Director, Columbia Psychiatry, New York State Psychiatric
Institute, New York, New York
Rebecca Rudel, MPH, RDN, CNSC, Graduate Teaching Fellow, DrPH Program, Boston University
School of Public Health, Boston, Massachusetts
Mary Russell, MS, RDN, LDN, FAND
Medical Science Liaison II, Medical Affairs, Baxter Healthcare Corporation, Deerfield, Illinois;
Lecturer, Nutrition, Chicago Medical School, North Chicago, Illinois
Janet E. Schebendach, PhD, RDN, Assistant Professor, Psychiatry, Columbia University Medical Center,
New York, New York
Elizabeth Shanaman, RDN, Lead Dietitian, Nutrition, Northwest Kidney Centers, Seattle, Washington
Lisa I. Shkoda, RDN, CSO, CSP, CNSC, FAND
Owner, Nutrition for Health RDN Consulting, LLC, Charlottesville, Virginia, Corporate Regional Dietitian,
Medical Facilities of America;
Founding Dietitian, Ketogenic Diet Therapy Program, University of Virginia Health System, Charlottesville,
Virginia
Jamie S. Stang, PhD, MPH, RDN, Director, Leadership, Education and Training Program in Maternal
and Child Nutrition, Director, Center for Leadership in Maternal and Child Public Health, Associate
Professor, Division of Epidemiology and Community Health, University of Minnesota, School of Public
Health, Minneapolis, Minnesota
Catherine S. Sullivan, MPH, RDN, LDN, IBCLC, RLC, FAND, Director, Assistant Professor, Maternal
and Child Health-Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina
Kathie Madonna Swift, MS, RDN, LDN, FAND, Co-Founder, www.IFNAcademy.com, Palm Harbor,
Massachusetts
Kelly A. Tappenden, PhD, RDN, FASPEN, Professor and Head, Kinesiology and Nutrition, University of
Illinois at Chicago, Chicago, Illinois
Christina Troutner, MS, RDN, Research Dietitian, Nutritional Genomics & Digital Health, GB
HealthWatch, San Diego, California
Solenne Vanne, MS, RDN, Nutrition, Chicken Soup Brigade, Seattle, Washington
DeeAnna Wales VanReken, MS, RDN, CD, IFNCP, Clinical Nutrition Specialist - Gastroenterology,
Nutrition Services, Swedish Medical Center, Seattle, Washington
Katy G. Wilkens, MS, RDN, Manager, Nutrition and Fitness Services, Northwest Kidney Centers,
Seattle, Washington
Martin M. Yadrick, MBI, MS, RDN, FAND, Director of Nutrition Informatics, Sales & Marketing,
Computrition, Inc., West Hills, California

Reviewers
Michael Hahn, BA, Health Science Policy Analyst, All of Us Research Program, National Institutes of
Health, Bethesda, Maryland
Cristen L. Harris, PhD, RDN, CSSD, CD, CEP, FAND, Senior Lecturer, Core Faculty, School of Public
Health, Nutritional Sciences Program, University of Washington, Seattle, Washington
Marion F. Winkler, PhD, RDN, LDN, CNSC, FASPEN, Associate Professor of Surgery and Surgical
Nutrition Specialist, Brown University School of Medicine and Rhode Island Hospital, Providence, Rhode
Island
Foreword
When I was first asked to revise this text in 1975, I said no. Why would I want to take on this
herculean task? Times were good. We were wearing miniskirts, bell bottoms, and platform shoes; the
Vietnam war was over, and a new Environmental Protection Agency (EPA) had just been established.
The Women, Infants, and Children (WIC) program for maternal and child nutrition was beginning,
and total parenteral nutrition (TPN), the new “wow” therapy, had just entered the scene. TPN was a
powerful tool, and nutritionists knew it. Now we had a way to feed patients with nonfunctioning guts
so that they could heal and survive. Feeding a very sick person could be targeted, scientific, and
aggressive. TPN enabled premature infants to survive as I would learn with my own preemie a
decade later. It was an exciting time for a young dietitian. And then to be able to take over the
authorship of this already reputable text—well, wow! It couldn’t have been a better entry into a
career. I said yes.
Marie Krause first penned this text in 1952, revised it for several editions and then handed it over
to me for the 6th edition. Since that time other co-editors (Arlin, Escott-Stump, and Raymond) and I,
along with many, many contributors, now considered family, have sought to keep this text in the
forefront of nutrition and dietetic education. We have navigated it through the waters of expanding
nutrition science and changing clinical care, aiming to offer it as a beacon of learning for students
and a reliable reference for clinicians and practitioners. Our goal has been to dispel myths and
illuminate the truth. Over the 45 years that my team has been writing and editing this text, we have
been honored to hear it referred to as the “nutrition bible.” Many of our contributors are nationally
acclaimed specialists in their fields and have gone on to write their own books as well as lead major
professional nutrition organizations. This tome has become the students’ link to these leaders in
nutrition.
During its almost 70 years, this textbook has changed considerably. It has been streamlined;
content that can more efficiently be found in other texts was omitted. More importantly, new content
reflecting current science was added: chapters covering medical nutrition therapy (MNT) for HIV
and AIDS and nutrition for sports and performance appeared with the 8th edition (1992), a chapter
on nutrigenomics and integrative medicine and herbal therapy in the 10th edition (2000), a chapter
on MNT in psychiatric disease in the 12th edition (2008), and one on inflammation and chronic
disease in the 14th edition (2017), just to name a few.
This edition has a new name—Krause and Mahan’s Food and the Nutrition Care Process—and I
leave as senior editor and author. My feelings are mixed. I am sad to say goodbye to such a fulfilling
and rewarding occupation after four and a half decades, and yet thrilled to leave it in the capable
hands of Janice Raymond and Kelly Morrow. Janice has been co-editor and author for the previous
two editions. She is experienced in ensuring the information is evidenced-based and logical, and
because she continues to work as a clinical dietitian, she ensures it remains relevant. Kelly, who has
been a Krause author, will now add her influence as a leader in integrative and functional nutrition
in her role as editor.
Using an integrative and functional approach to nutritional care means considering nutrition
status as a reflection of not only the nutrient intake of the individual but also the environmental
influence on that nutrient intake. For example, what is the influence of the microbiome in the gut on
nutrient absorption? Where is the individual’s food grown? How is it grown and how does this affect
its nutrient content? During processing, are chemicals added to the food, either with or without
intent? What is the effect of lifestyle or culture on the individual’s food choices? It is exciting and
intriguing to think about adding this content to the text.
We plan that the Krause and Mahan text will continue to be the go-to resource for professors and
students to learn not only the science of nutrition but also the art of nutrition care. We envision that
new learners will turn to it to gain the skills of dietetic/nutrition practice—relating to the individual
by asking the right questions, learning the person’s story, assessing nutritional needs, and providing
nutrition care and learning in a way that the individual and the family can respond to and use.
I hope the writers of future editions will include content with a consciousness toward sustainability
and planet renewal as we deal with nourishing an ever-growing population on our limited planet.
How will we, the human global population, do that? How and when will we stop contaminating the
water and air that provides for life? What changes will need to be made in our food systems to
ensure they are sustainable? How will we continue as a species without causing the extinction of
other species? Going forward I hope these questions and hopefully many of the answers will be kept
in mind as Krause and Mahan is written and revised. It is important work, and I would like to see
this text at the center of its progress.
It has been an honor to work with all our wonderful, committed authors and editors as well as the
students and teachers who use the book. I am blessed, and it couldn’t have happened without you.
Thank you from the bottom of my heart. You certainly made it a great ride!

L. Kathleen Mahan
January 6, 2020
Preface
Over its 15 editions, this classic text has continued to change in response to the ever-dynamic field
of nutrition. And because it remains the most comprehensive nutrition textbook available, it is the
reference students take into their internships and careers.

Audience
Scientific knowledge and clinical information is presented in a form that is useful to students in
dietetics, nursing, and other allied health professions in an interdisciplinary setting. It is valuable as
a reference for other disciplines such as medicine, dentistry, child development, physical and
occupational therapy, health education, and lifestyle counseling. Nutrient and assessment
appendices, tables, illustrations, and clinical insight boxes provide practical hands-on procedures
and clinical tools for students and practitioners alike.
This textbook accompanies the graduating student into clinical practice as a treasured shelf
reference. The popular features remain: having basic information on nutrition in the life cycle all the
way through to protocols for clinical nutrition practice in one place, clinical management algorithms,
focus boxes that give detailed insight on emerging topics, sample nutrition diagnoses for clinical
scenarios, useful websites, and extensive appendices for patient education. All material reflects
current evidence-based practice as contributed by authors who are experts in their fields. This text is
the first choice in the field of dietetics for students, interns, educators, and clinicians.

Organization
This edition follows the Conceptual Framework for Steps of the Nutrition Care Process. All
nutritional care process components are addressed to enhance or improve the nutritional well-being
of individuals, their families, or populations. The chapters flow according to the steps of assessment,
nutrition diagnosis, intervention, monitoring, and evaluation with the separation of the pediatric
medical nutrition therapy (MNT) chapters into their own section to assist with that specialty
practice.
Part 1, Nutrition Assessment, organizes content for an effective assessment. Chapters here provide
an overview of the digestive system, as well as calculation of energy requirements and expenditure,
macronutrient and micronutrient needs, nutritional genomics, and food intake. A thorough review of
biochemical tests, acid–base balance issues, and medications promote the necessary insight for
provision of excellent care. A chapter titled “Inflammation and the Pathophysiology of Chronic
Disease” addresses the latest knowledge about inflammation as a cause of chronic disease and the
necessity of assessing for it. The final chapter in this section addresses the behavioral aspects of an
individual’s food choices within the community, a safe food supply, and available resources for
sufficient food access.
Part 2, Nutrition Diagnosis and Intervention, describes the critical thinking process from
assessment to selection of relevant, timely, and measurable nutrition diagnoses. These nutrition
diagnoses can be resolved by the registered dietitian nutritionist (RDN) or trained health
professional. The process is generally used for individuals but can be applied when helping families,
teaching groups, or evaluating the nutritional needs of a multicultural community or population. A
nutrition diagnosis requires an intervention, and interventions relate to food and nutrient delivery
(including nutrition support), use of bioactive substances and integrative medical nutrition,
education, counseling, and referral when needed.
Part 3, Nutrition in the Life Cycle, presents in-depth information on nutrition for life stages for
conception, pregnancy, and lactation. Chapters on infancy, childhood, and adolescence highlight the
importance of nutrition through critical periods of growth. A chapter on adult nutrition highlights
risk factors for chronic diseases that usually start appearing in adulthood. Finally, nutrition for the
aging adult is discussed in detail because of the growing need for nutrition services in this rapidly
expanding population.
Part 4, Nutrition for Weight Management, provides a review of nutrition concepts for the
achievement and maintenance of health and prevention of disease. Topics include weight
management, disordered eating, dental health, bone health, and sports nutrition.
Part 5, Medical Nutrition Therapy, reflects evidence-based knowledge and current trends in
nutrition therapies including integrative approaches. All of the chapters are written and reviewed by
experts in their field who present MNT for conditions such as cardiovascular disorders; cancer;
diabetes; liver and digestive diseases; renal disease; pulmonary disease; HIV; endocrine disorders
(including thyroid disease); and rheumatologic, neurologic, and psychiatric disorders.
Part 6, Pediatric Specialties, describes the role of nutrition therapies in childhood. Chapters
provide details for low-birthweight, neonatal intensive-care conditions, genetic metabolic disorders,
and developmental disabilities.
New to this edition
The chapter on food–drug interaction was eliminated this edition. Input from our educators and
readers indicated that this chapter was not as useful as in the past due to the rapid changes that
occur in the pharmaceutical industry and because computer applications are now in widespread use.
We have, however, continued to include a food–drug appendix.

• New appendices on choline, biotin, the Mediterranean diet, and the International Dysphagia
Diet Standardisation Initiative (IDDSI).
• Updated and expanded integrative nutrition approaches.
• Expanded section on pregnancy and lactation.
• The chapter titled “Planning the Diet with Cultural Competence” has a new co-author and
expanded international nutrition guidelines.
• All chapters were updated with an emphasis on cultural diversity.
• Many new authors have provided new insights to chapters on cancer; GI; HIV; neurology;
weight management; analysis of the diet; anemia; nutritional genomics; pulmonary,
psychiatric, and cognitive disorders; critical care; and intellectual and developmental
disabilities.
• New content highlight boxes on CRISPR, the Indigenous food movement, hearing
assessment, Health At Every Size, health disparities, and a tribute to Dr. George Blackburn.

Pedagogy
• Unique pathophysiology algorithms and flow charts present the cause, pathophysiology, and
the medical nutrition management for a variety of disorders and conditions. They equip the
reader with an understanding of the illness as background for providing optimal nutritional
care in a variety of healthcare settings.
• Clinical Insight boxes expand on clinical information in the text and highlight areas that may
go unnoticed. These boxes contain information on studies and clinical resources for the
student and practitioner.
• New Directions boxes suggest areas for further research by spotlighting emerging areas of
interest within the field.
• Focus On boxes provide thought-provoking information on key concepts for well-rounded
study and the promotion of further discussion within the classroom.
• Useful websites direct the reader to online resources that relate to the chapter topics;
however, links are no longer included as they can outdate quickly.
• Sample Nutrition Diagnosis boxes present a problem, its etiology, and its signs and
symptoms, before concluding with a sample nutrition diagnosis, providing both students and
practitioners with “real-life” scenarios they may encounter in practice.
• Key terms are listed at the beginning of each chapter and bolded within the text where they
are discussed in more detail.
• Chapter references are current and extensive, with the purpose of giving the student and
instructor lots of opportunity for further reading and understanding.

Ancillaries
Accompanying this edition is the Evolve website, which includes updated and invaluable resources
for instructors and students. These materials can be accessed by going to
http://evolve.elsevier.com/Mahan/nutrition/.

Instructor resources
• PowerPoint presentations: More than 900 slides to help guide classroom lectures.
• Image Collection: Approximately 200 images from the text are included in the PowerPoint
presentations, as well as more illustrations that can be downloaded and used to develop
other teaching resources.
• Audience Response System Questions (for use with iClicker and other systems): Three to
five questions per chapter help aid incorporation of this new technology into the classroom.
• Test Bank: Each chapter includes NCLEX-formatted questions with page references specific
to that chapter’s content to bring you more than 900 multiple-choice questions.
• Animations: Animations have been developed to visually complement the text and the
processes described.
• NEW! Case Studies with Answers: Ten detailed clinical case studies using the nutrition care
process.

Student resources
• Study Exercises with Answers: With more than 600 questions, these exercises give instant
feedback on questions related to the chapter’s content.
• NEW! Case Studies: Ten detailed clinical case studies using the nutrition care process.

Janice L. Raymond, MS, RDN, CD, CSG

Kelly Morrow, MS, RDN, FAND
Acknowledgments
We sincerely thank the reviewers and especially contributors for this edition who have devoted hours
and hours of time and commitment to researching the book’s content for accuracy, reliability, and
practicality. We are greatly in debt to them and realize that we could not continue to produce this
book without them. In particular, we would like to acknowledge Ronona Crowder-Woods for her help
with the Diabetes chapter, Hillary Nason on the Mediterranean Diet appendix, Amanda Fredrickson
on the Diabetes Exchange List appendix, Linden Hale on the Biotin appendix and Maya DiTraglia on
the Choline appendix. Thank you!
We also wish to acknowledge the hard work of Sandra Clark, Senior Content Strategist, who keeps
the vision, and Danielle Frazier, Senior Content Developmental Specialist, who can get the “hot off
the press” items we’d like included, and Tracey Schriefer, Senior Project Manager, who amazingly
keeps the manuscript moving forward as she juggles between us and all others. Thank you!
PA R T I

Nutrition Assessment
OUTLINE

Introduction
1. Intake: Gastrointestinal digestion, absorption, and excretion of nutrients
2. Intake: Energy
3. Clinical: Water, electrolytes, and acid–base balance
4. Intake: Assessment of food- and nutrition-related history
5. Clinical: Biochemical, physical, and functional assessment
6. Nutritional genomics
7. Inflammation and the pathophysiology of chronic disease
8. Behavioral-environmental: The individual in the community
Another random document with
no related content on Scribd:
detailed many things regarding the wild flight of himself and
Aguinaldo's party up the coast. The last words written in it
were pathetic and indicated something of the noble character
of the man. The passage, which was written only a few minutes
previously, while the fight was on and while death even then
was before him, said: 'I am holding a difficult position
against desperate odds, but I will gladly die for my beloved
country.'

"Pilar alive and in command, shooting down good Americans, was

one thing, but Pilar lying in that silent mountain trail, his
body half denuded of its clothes, and his young, handsome,
boyish face discolored with the blood which saturated his
blouse and stained the earth, was another thing. We could not
help but feel admiration for his gallant fight, and sorrow for
the sweetheart whom he left behind. The diary was dedicated to
the girl, and I have since learned that he was to have married
her in Dagupan about two weeks before. But the Americans came
too soon. Instead of wedding bells there sounded the bugle
calls of the foe and he was hurriedly ordered to accompany his
chief, Aguinaldo, on that hasty retreat to the mountains. The
marriage was postponed, and he carried out his orders by
leaving for the north. Pilar was one of the best types of the
Filipino soldier. He was only 23 years old, but he had been
through the whole campaign in his capacity as
brigadier-general. It was he who commanded the forces at
Quingua the day that Colonel Stotsenberg was killed, and it
may be remembered that the engagement that day was one of the
most bloody and desperate that has occurred on the island. He
was a handsome boy, and was known as one of the Filipinos who
were actuated by honestly patriotic motives, and who fought
because they believed they were fighting in the right and not
for personal gain or ambition."

Chicago Record's Stories of Filipino Warfare,

page 14.
PHILIPPINE ISLANDS: A. D. 1899 (March-July).
The establishment of a provisional government
in the island of Negros.

Negros "was the first island to accept American sovereignty.

Its people unreservedly proclaimed allegiance to the United
States and adopted a constitution looking to the establishment
of a popular government. It was impossible to guarantee to the
people of Negros that the constitution so adopted should be
the ultimate form of government. Such a question, under the
treaty with Spain and in accordance with our own Constitution
and laws, came exclusively within the jurisdiction of the
Congress. The government actually set up by the inhabitants of
Negros eventually proved unsatisfactory to the natives
themselves. A new system was put into force by order of the
Major-General Commanding the Department [July 22, 1899], of
which the following are the most important elements:

"It was ordered that the government of the island of Negros

should consist of a military governor appointed by the United
States military governor of the Philippines, and a civil
governor and an advisory council elected by the people. The
military governor was authorized to appoint secretaries of the
treasury, interior, agriculture, public instruction, an
attorney-general, and an auditor. The seat of government was
fixed at Bacolod. The military governor exercises the supreme
executive power. He is to see that the laws are executed,
appoint to office, and fill all vacancies in office not
otherwise provided for, and may with the approval of the
military governor of the Philippines, remove any officer from
office. The civil governor advises the military governor on
all public civil questions and presides over the advisory
council. He, in general, performs the duties which are
performed by secretaries of state in our own system of
government. The advisory council consists of eight members
elected by the people within territorial limits which are
defined in the order of the commanding general. The times and
 places of holding elections are to be fixed by the military
governor of the island of Negros. The qualifications of voters
are as follows:

(1) A voter must be a male citizen of the island of Negros.

(2) Of the age of 21 years.

(3) He shall be able to speak, read, and write the English,

Spanish, or Visayan language, or he must own real property
worth $500, or pay a rental on real property of the value of
$1,000.

(4) He must have resided in the island not less than one year
preceding, and in the district in which he offers to register
as a voter not less than three months immediately preceding
the time he offers to register.

(5) He must register at a time fixed by law before voting.

(6) Prior to such registration he shall have paid all taxes

due by him to the Government.

{384}

Provided, that no insane person shall bc allowed to register

or vote. The military governor has the right to veto all bills
or resolutions adopted by the advisory council, and his veto
is final if not disapproved by the military governor of the
Philippines. The advisory council discharges all the ordinary
duties of a legislature. The usual duties pertaining to said
offices are to be performed by the secretaries of the
treasury, interior, agriculture, public instruction, the
attorney-general, and the auditor. The judicial power is
vested in three judges, who are to be appointed by the
military governor of the island. Inferior courts are to be
established. Free public schools are to be established
 throughout the populous districts of the island, in which the
English language shall be taught, and this subject will
receive the careful consideration of the advisory council. The
burden of government must be distributed equally and equitably
among the people. The military authorities will collect and
receive the customs revenue, and will control postal matters
and Philippine inter-island trade and commerce. The military
governor, subject to the approval of the military governor of
the Philippines, determines all questions not specifically
provided for and which do not come under the jurisdiction of
the advisory council."

Message of the President, December 5, 1899

(Message and Documents: Abridgment, 1899-1900,
volume 2, page 47).

Also in:
Report of General Otis (Message and Documents,
volume 2, page 1131-1137).

PHILIPPINE ISLANDS: A. D. 1899 (May-August).

Agreement of terms with the Sultan of Jolo concerning
the Sulu Archipelago.

On the 19th of May, a detachment of U. 8. troops took the

place of the Spanish garrison at Jolo, the military station in
the Sulu Archipelago. On the 3d of July, General Otis, Military
Governor of the Philippines, issued orders as follows to
General J. C. Bates, U. S. V.: "You will proceed as soon as
practicable to the United States military station of Jolo, on
the island of that name, and there place yourself in
communication with the Sultan of Jolo, who is believed to be
at Siassi, where he was sojourning when the last information
concerning him was received. You are hereby appointed and
constituted an agent on the part of the United States military
authorities in the Philippines to discuss, enter into
negotiations, and perfect, if possible, a written agreement of
character and scope as hereinafter explained, with the Sultan,
which upon approval at these headquarters and confirmation by
the supreme executive authority of the United States, will
prescribe and control the future relations, social and
political, between the United States Government and the
inhabitants of the archipelago. … In your discussions with the
Sultan and his datos the question of sovereignty will be
forced to the front, and they will undoubtedly request an
expression of opinion thereon, as they seem to be impressed
apparently with the belief that the recent Spanish authorities
with whom they were in relationship have transferred full
sovereignty of the islands to them. The question is one which
admits of easy solution, legally considered, since by the
terms of treaties or protocols between Spain and European
powers Spanish sovereignty over the archipelago is conceded.
Under the agreement between Spain and the Sultan and datos of
July, 1878, the latter acknowledged Spanish sovereignty in the
entire archipelago of Jolo and agreed to become loyal Spanish
subjects, receiving in consideration certain specific payments
in money. The sovereignty of Spain, thus established and
acknowledged by all parties in interest, was transferred to
the United States by the Paris treaty. The United States has
succeeded to all the rights which Spain held in the
archipelago, and its sovereignty over the same is an
established fact. But the inquiry arises as to the extent to
which that sovereignty can be applied under the agreement of
1878 with the Moros. Sovereignty, of course, implies full
power of political control, but it is not incompatible with
concessionary grants between sovereign and subject. The Moros
acknowledged through their accepted chiefs Spanish sovereignty
and their subjection thereto, and that nation in turn conferred
upon their chiefs certain powers of supervision over them and
their affairs. The kingly prerogatives of Spain, thus abridged
by solemn concession, have descended to the United States, and
conditions existing at the time of transfer should remain. The
Moros are entitled to enjoy the identical privileges which
they possessed at the time of transfer, and to continue to
 enjoy them until abridged or modified by future mutual
agreement between them and the United States, to which they
owe loyalty, unless it becomes necessary to invoke the
exercise of the supreme powers of sovereignty to meet
emergencies. You will therefore acquaint yourself thoroughly
with the terms of the agreement of 1878, and take them as a
basis for your directed negotiations. …

"It is greatly desired by the United States for the sake of

the individual improvement and social advancement of the
Moros, and for the development of the trade and agriculture of
the islands in their interests, also for the welfare of both the
United States and Moros, that mutual friendly and well-defined
relations be established. If the Sultan can be made to give
credit to and fully understand the intentions of the United
States, the desired result can be accomplished. The United
States will accept the obligations of Spain under the
agreement of 1878 in the matter of money annuities, and in
proof of sincerity you will offer as a present to the Sultan
and datos $10,000, Mexican, with which you will be supplied
before leaving for Jolo—the same to be handed over to them,
respectively, in amounts agreeing with the ratio of payments
made to them by the Spanish Government for their declared
services. From the 1st of September next, and thereafter, the
United States will pay to them regularly the sums promised by
Spain in its agreement of 1878, and in any subsequent promises
of which proof can be furnished. The United States will
promise, in return for the concessions to be hereinafter
mentioned, not to interfere with, but to protect the Moros in
the free exercise of their religion and customs, social and
domestic, and will respect the rights and dignities of the
Sultan and his advisers."

{385}

Of the results of the mission of General Bates, General Otis

reported subsequently as follows:

"General Bates had a difficult task to perform and executed it

with tact and ability. While a number of the principal datos were
favorably inclined, the Sultan, not responding to invitations,
kept aloof and was represented by his secretary, until
finally, the general appearing at Maibung, the Moro capital, a
personal interview was secured. He being also Sultan of North
Borneo and receiving large annual payments from the North
Borneo Trading Company, expected like returns from the United
States, and seemed more anxious to obtain personal revenue
than benefits for his people. Securing the port of Siassi from
the Spaniards, establishing there his guards and police, he
had received customs revenues from the Sandaken trade which he
was loath to surrender. Negotiations continued well into
August, and finally, after long conferences, an agreement was
reached by which the United States secured much more liberal
terms than the Spaniards were ever able to obtain."

Report of General Otis, August 31, 1899

(Message and Documents: Abridgment, 1899-1900,
volume 2, pages 1162-1164).

"By Article I the sovereignty of the United States over the

whole archipelago of Jolo and its dependencies is declared and
acknowledged. The United States flag will be used in the
archipelago and its dependencies, on land and sea. Piracy is
to be suppressed, and the Sultan agrees to co-operate heartily
with the United States authorities to that end and to make
every possible effort to arrest and bring to justice all
persons engaged in piracy. All trade in domestic products of
the archipelago of Jolo when carried on with any part of the
Philippine Islands and under the American flag shall be free,
unlimited, and undutiable. The United States will give full
protection to the Sultan in case any foreign nation should
attempt to impose upon him. The United States will not sell
the island of Jolo or any other island of the Jolo archipelago
to any foreign nation without the consent of the Sultan.
Salaries for the Sultan find his associates in the
administration of the islands have been agreed upon to the
amount of $760 monthly. Article X provides that any slave in
the archipelago of Jolo shall have the right to purchase
freedom by paying to the master the usual market value. The
agreement by General Bates was made subject to confirmation by
the President and to future modifications by the consent of
the parties in interest. I have confirmed said agreement,
subject to the action of the Congress, and with the
reservation, which I have directed shall be communicated to
the Sultan of Jolo, that this agreement is not to be deemed in
any way to authorize or give the consent of the United States
to the existence of slavery in the Sulu archipelago."

Message of the President, December 5, 1899

(Message and Documents: Abridgment, 1899-1900,
volume 2, pages 47-48).

"The population of the Sulu Archipelago is reckoned at

120,000, mostly domiciled in the island of Jolo, and numbers
20,000 fighting men. Hostilities would be unfortunate for all
parties concerned, would be very expensive to the United
States in men and money, and destructive of any advancement of
the Moros for years to come. Spain's long struggle with these
people and their dislike for the former dominant race in the
Philippines, inherited, it would seem, by each rising
generation during three centuries, furnishes an instructive
lesson. Under the pending agreement General Bates, assisted by
the officers of the Navy, quietly placed garrisons of one
company each at Siassi and at Bongao, on the Tawai Tawai group
of islands, where they were well received by the friendly
natives. With the approval of the agreement, the only
difficulty to a satisfactory settlement of the Sulu affairs
will arise from discontent on the part of the Sultan
personally because of a supposed decrease in anticipated
revenues or the machinations of the insurgents of Mindanao,
 who are endeavoring to create a feeling of distrust and
hostility among the natives against the United States troops.

"The Sultan's government is one of perfect despotism, in form

at least, as all political power is supposed to center in his
person; but this does not prevent frequent outbreaks on the
part of the datos, who frequently revolt, and are now, in two
or three instances, in declared enmity. All Moros, however,
profess the Mohammedan religion, introduced in the fourteenth
century, and the sacredness of the person of the Sultan is
therefore a tenet of faith. This fact would prevent any marked
success by a dato in attempting to secure supreme power. Spain
endeavored to supplant the Sultan with one of his most
enterprising chiefs and signally failed. Peonage or a species
of serfdom enters largely into the social and domestic
arrangements and a dato's following or clan submits itself
without protest to his arbitrary will. The Moro political
fabric bears resemblance to the state of feudal times—the
Sultan exercising supreme power by divine right, and his
datos, like the feudal lords, supporting or opposing him at
will, and by force of arms occasionally, but not to the extent
of dethronement, as that would be too great a sacrilege for a
Mohammedan people to seek to consummate. The United States
must accept these people as they are, and endeavor to
ameliorate their condition by degrees, and the best means to
insure success appears to be through the cultivation of
friendly sentiments and the introduction of trade and commerce
upon approved business methods. To undertake forcible radical
action for the amelioration of conditions or to so interfere
with their domestic relations as to arouse their suspicions
and distrust would be attended with unfortunate consequences."

Report of General Otis, August 31, 1899

(Message and Documents: Abridgment, 1899-1900,
volume 2, page 1165).

PHILIPPINE ISLANDS: A. D. 1899-1900.

 Military operations against the Insurgents.
Death of General Lawton.

"The enlargement of the field of operations and government in

the Philippine Islands made it impracticable to conduct the
business under the charge of the army in those islands through
the machinery of a single department, and by order made April
7, 1900, the Philippine Islands were made a military division,
consisting of four departments: The Department of Northern Luzon,
the Department of Southern Luzon, the Department of the
Visayas, and the Department of Mindanao and Jolo. The
Department of Northern Luzon is subdivided into six, the
Department of Southern Luzon into four, the Department of the
Visayas into four, and the Department of Mindanao and Jolo
into four military districts. …

"At the date of the last report (November 29, 1899 [see
above]) the government established by the Philippine
insurgents in central Luzon and the organized armed forces by
which it was maintained had been destroyed, and the principal
civil and military leaders of the insurrection, accompanied by
small and scattered bands of troops, were the objects of
pursuit in the western and the northern parts of the island.
{386}
That pursuit was prosecuted with vigor and success, under
conditions of extraordinary difficulty and hardship, and
resulted in the further and practically complete
disintegration of the insurrectionary bands in those regions,
in the rescue of nearly all the American prisoners and the
greater part of the Spanish prisoners held by the insurgents,
in the capture of many of the leading insurgents, and in the
capture and destruction of large quantities of arms,
ammunition, and supplies. There still remained a large force
of insurgents in Cavite and the adjacent provinces south of
Manila, and a considerable force to the east of the Rio Grande
de Pampanga, chiefly in the province of Bulacan, while in the
extreme southeastern portions of Luzon, and in the various
Visayan islands, except the island of Negros, armed bodies of
Tagalogs had taken possession of the principal seacoast towns,
and were exercising military control over the peaceful
inhabitants. Between the insurgent troops in Bulacan and the
mountains to the north, and the insurgents in the south,
communication was maintained by road and trail, running along
and near the eastern bank of the Mariquina River, and through
the towns of Mariquina, San Mateo, and Montalban and the
province of Morong. This line of communication, passing
through rough and easily defended country, was strongly
fortified and held by numerous bodies of insurgents.

"On the 18th of December, 1899, a column, under the command of

Major General Henry W. Lawton, proceeded from Manila, and
between that date and the 29th of December captured all the
fortified posts of the insurgents, took possession of the line
of communication, which has ever since been maintained, and
destroyed, captured, or dispersed the insurgent force in that
part of the island. In the course of this movement was
sustained the irremediable loss of General Lawton, who was
shot and instantly killed while too fearlessly exposing his
person in supervising the passing of his troops over the river
Mariquina at San Mateo.

"On the 4th of January, 1900, General J. C. Bates, U. S. V.,

was assigned to the command of the First Division of the
Eighth Army Corps, and an active campaign under his direction
was commenced in Southern Luzon. The plan adopted was to
confront and hold the strong force of the enemy near Imus and
to the west of Bacoor by a body of troops under General
Wheaton, while a column, under General Schwan, should move
rapidly down the west shore of the Laguna de Bay to Biñang,
thence turn southwesterly and seize the Silang, Indang, and
Naic road, capture the enemy's supplies supposed to be at the
towns of Silang and Indang, and arrest the retreat of the
enemy, when he should be driven from northern Cavite by our
troops designated to attack him there, and thus prevent his
reassembling in the mountains of southern Cavite and northern
Batangas. This plan was successfully executed. General
Schwan's column moved over the lines indicated with great
rapidity, marching a distance of over 600 miles, striking and
defeating numerous bodies of insurgents and capturing many
intrenched positions, taking possession of and garrisoning
towns along the line, and scattering and demoralizing all the
organized forces of the enemy within that section of country.
From these operations and the simultaneous attacks by our
troops under General Wheaton in the north the rebel forces in
the Cavite region practically disappeared, the members either
being killed or captured or returning to their homes as
unarmed citizens, and a few scattered parties escaping through
General Schwan's line to the south. By the 8th of February the
organized forces of the insurgents in the region mentioned had
ceased to exist. In large portions of the country the
inhabitants were returning to their homes and resuming their
industries, and active trade with Manila was resumed. In the
course of these operations about 600 Spanish prisoners were
released from the insurgents, leaving about 600 more still in
their hands in the extreme southeastern provinces of Camarines
and Albay, nearly all of whom were afterwards liberated by our
troops. In the meantime an expedition was organized under the
command of Brigadier General William A. Kobbé, U. S. V., to
expel the Tagalogs who had taken possession of the principal
hemp ports of the islands situated in Albay, the extreme
southeastern province of Luzon, and in the islands of Leyte,
Samar, and Catanduanes. This expedition sailed from Manila on
the 18th of January and accomplished its object. All of the
principal hemp ports were relieved from control of the
insurgents, garrisoned by American troops, and opened to
commerce by order of the military governor of the islands on
the 30th of January and the 10th and 14th of February. The
expedition met with strong resistance at Legaspi by an
intrenched force under the Chinese general, Paua. He was
speedily overcome and went into the interior. After a few days
he reassembled his forces and threatened the garrisons which
 had been left in Albay and Legaspi, whereupon he was attacked,
and defeated, and surrendered. Thirty pieces of artillery, a
large quantity of ammunition, a good many rifles, and a
considerable amount of money were captured by this expedition.

"On the 15th of February an expedition, under the supervision

of Major-General Bates and under the immediate command of
Brigadier General James M. Bell, U. S. V., sailed from Manila
to take possession of the North and South Camarines provinces
and Western Albay, in which the insurgent forces had been
swelled by the individuals and scattered bands escaping from
our operations in various sections of the north. The insurgent
force was defeated after a sharp engagement near the mouth of
the Bicol River, pursued, and scattered. Large amounts of
artillery and war material were captured. The normal
conditions of industry and trade relations with Manila were
resumed by the inhabitants. On the 20th of March the region
covered by the last-described operations was created a
district of southeastern Luzon, under the command of General
James M. Bell, who was instructed to proceed to the
establishment of the necessary customs and internal-revenue
service in the district. In the meantime similar expeditions
were successfully made through the mountains of the various
islands of the Visayan Group, striking and scattering and
severely punishing the bands of bandits and insurgents who
infested those islands. In the latter part of March General
Bates proceeded with the Fortieth infantry to establish
garrisons in Mindanao. The only resistance was of a trifling
character at Cagayan, the insurgent general in northeastern
Mindanao surrendering and turning over the ordnance in his
possession.
{387}
With [the execution of these movements] all formal and open
resistance to American authority in the Philippines
terminated, leaving only an exceedingly vexatious and annoying
guerilla warfare of a character closely approaching
brigandage, which will require time, patience, and good
 judgment to finally suppress. As rapidly as we have occupied
territory, the policy of inviting inhabitants to return to
their peaceful vocations, and aiding them in the
reestablishment of their local governments, has been followed,
and the protection of the United States has been promised to
them. The giving of this protection has led to the
distribution of troops in the Philippine Islands to over 400
different posts, with the consequent labor of administration
and supply. The maintenance of these posts involves the
continued employment of a large force, but as the Tagalogs who
are in rebellion have deliberately adopted the policy of
murdering, so far as they are able, all of their countrymen
who are friendly to the United States, the maintenance of
garrisons is at present necessary to the protection of the
peaceful and unarmed Filipinos who have submitted to our
authority; and if we are to discharge our obligations in that
regard their reduction must necessarily be gradual."

United States, Secretary of War,

Annual Report, November 30, 1900, pages 5-10.

PHILIPPINE ISLANDS: A. D. 1900 (January).

Report of the First Philippine Commission.

The First Commission to the Philippines returned to the United

States in the autumn of 1899, and then submitted to the President
a brief preliminary statement of its proceedings in the
Islands and the opinions its members had formed, concerning
the spirit and extent of the Tagalo revolt, the general
disposition of the people at large, their capacity for
independent self-government, etc. On the 31st of January
following the commissioners presented a report which deals
extensively with many subjects of investigation and
deliberation. In Part I., it sets forth the efforts made by
the commission "toward conciliation and the establishment of
peace," through interviews with various emissaries of
Aguinaldo, and others, and by means of a proclamation to the
people. In Part II., it gives an extended account of the races
and tribes of which the native population of the Islands is
composed. In Part III., it details the provision that has
heretofore been made for education, and states the conclusions
of the commission as to the capacity of the people and their
fitness for a popular government. In Part IV., a very full
account of the Spanish organization of government in the
Philippines, general, provincial and municipal, is given, and
the reforms that were desired by the Filipino people are
ascertained. From this the commission proceeds to consider the
question of a plan of government for the Islands under the
sovereignty of the United States, and concludes that the
Territorial system of the United States offers all that can be
desired. "What Jefferson and the nation did for Louisiana,"
says the report, "we are … free to-day to do for the
Philippines. The fact that Bonaparte had provided in the
treaty that Louisiana should in due time be admitted as a
State in the Union, and that in the meantime its inhabitants
should have protection in the free enjoyment of their liberty,
property, and religion, made no difference in the relation of
Louisiana to the Constitution of the United States so long as
Louisiana remained a Territory; and, if it had made a
difference, it should have constituted something of a claim to
the immediate enjoyment of some or all of the benefits of the
Constitution. Unmoved by that consideration, however, the
Jeffersonian policy established once for all the subjection of
national domain outside the States to the absolute and
unrestricted power of Congress. The commission recommends that
in dealing with the Philippines this vast power be exercised
along the lines laid down by Jefferson and Madison in
establishing a government for Louisiana, but with … deviations
in the direction of larger liberty to the Filipinos. … The
result would be substantially the transformation of their
second-class Territorial government of Louisiana into a
Territorial government of the first-class for the Philippine
Islands." To this recommendation of the Territorial system of
government the commission adds a strenuous plea for a closely
 guarded civil service. "It is a safe and desirable rule," says
the report, "that no American should be appointed to any office
in the Philippines for which a reasonably qualified Filipino
can, by any possibility, be secured. Of course the merit or
business system must be adopted and lived up to; the patronage
or spoils system would prove absolutely fatal to good
government in this new Oriental territory." Further parts of
the report are devoted to the Philippine judicial system, as
it had been and as it should be; to "the condition and needs
of the United States in the Philippines from a naval and
maritime standpoint"; to the secular clergy and religious
orders; to registration laws; to the currency; to the Chinese
in the Philippines; and to public health. Among the exhibits
appended in volume 1 of the published Report are the
constitution of Aguinaldo's Philippine Republic (called the
Malolos constitution), and several other constitutional drafts
and proposals from Filipino sources, indicating the political
ideas that prevail.

Report of the Philippine Commission,

January 31, 1900, volume 1.

See, also (in this volume),

EDUCATION: A. D. 1898 (PHILIPPINE ISLANDS).

PHILIPPINE ISLANDS: A. D. 1900 (March).

Institution of municipal governments.

By General Orders, on the 29th of March, 1900, the Military

Governor of the Islands promulgated a law providing for the
election and institution of municipal governments, the
provisions of which law had been framed by a board appointed
in the previous January, under the presidency of Don Cayetano
Arellano, chief justice of the Philippines. The first chapter
of the law reads as follows:

"ARTICLE 1.
 The towns of the Philippine Islands shall be recognized as
municipal corporations with the same limits as heretofore
established, upon reorganizing under the provisions of this
order. All property vested in any town under its former
organization shall be vested in the same town upon becoming
incorporated hereunder.

"ARTICLE 2.
Towns so incorporated shall be designated as 'municipios,' and
shall be known respectively by the names heretofore adopted.
Under such names they may, without further authorization, sue
and be sued, contract and be contracted with, acquire and hold
real and personal property for the general interests of the
town, and exercise all the powers hereinafter conferred. The
city of Manila is exempt from the provisions of this order.

{388}

"ARTICLE 3.
The municipal government of each town is hereby vested in an
alcalde and a municipal council. The alcalde and councilors,
together with the municipal lieutenant, shall be chosen at
large by the qualified electors of the town, and their term of
office shall be for two years from and after the first Monday
in January next after their election and until their
successors are duly chosen and qualified: Provided, That the
alcalde and municipal lieutenant elected in 1900 shall hold
office until the first Monday in January, 1902, only; and that
the councilors elected in 1900 shall divide themselves, by
lot, into two classes; the scats of those of the first class
shall be vacated on the first Monday of January, 1901, and
those of the second class one year thereafter, so that
one-half of the municipal council shall be chosen annually.

"ARTICLE 4.
Incorporated towns shall be of four classes, according to the
number of inhabitants. Towns of the first class shall be those
which contain not less than 25,000 inhabitants and shall have
18 councilors; of the second class, those containing 18,000
and less than 25,000 inhabitants and shall have 14 councilors;
of the third class, those containing 10,000 and less than
18,000 inhabitants and shall have 10 councilors; of the fourth
class, those containing less than 10,000 inhabitants and shall
have 8 councilors. Towns of less than 2,000 inhabitants may
incorporate under the provisions of this order, or may, upon
petition to the provincial governor, signed by a majority of
the qualified electors thereof, be attached as a barrio to an
adjacent and incorporated town, if the council of the latter
consents.

The qualifications of voters are defined in the second chapter

as follows:

"ARTICLE 5.
The electors charged with the duty of choosing elective
municipal officers must be male persons, 23 years of age or
over, who have had a legal residence in the town in which they
exercise the suffrage for a period of six months immediately
preceding the election, and who are not citizens or subjects
of any foreign power, and who are comprised within one of the
following three classes:

1. Those who, prior to the 13th of August, 1898, held the

office of municipal captain, gobernadorcillo, lieutenant or
cabeza de barangay.

2. Those who annually pay 30 pesos or more of the established

taxes.

3. Those who speak, read, and write English or Spanish."

Succeeding articles in this chapter prescribe the oath to be

taken and subscribed by each elector before his ballot is
cast, recognizing and accepting "the supreme authority of the
United States of America"; appoint the times and places for
holding elections, and set forth the forms to be observed in
them. In the third chapter, the qualifications of officers are
thus defined:

"ARTICLE 13.
An alcalde, municipal lieutenant, or councilor must have the
following qualifications:

1. He must be a duly qualified elector of the municipality in

which he is a candidate, of 26 years of age or over, and have
had a legal residence therein for at least one year prior to
the date of election.

2. He must correctly speak, read, and write either the English

language or the local dialect.

"ARTICLE 14.
In no case can there be elected or appointed to municipal
office ecclesiastics, soldiers in active service, persons
receiving salary from municipal, provincial or government
funds; debtors to said funds, whatever the class of said
funds; contractors of public works and their bondsmen; clerks
and functionaries of the administration or government while in
said capacity; bankrupts until discharged, or insane or
feeble-minded persons.

"ARTICLE 15.
Each and every person elected or appointed to a municipal
office under the provisions of this order shall, before
entering upon the duties thereof, take and subscribe before
the alcalde or town secretary"—an oath analogous to that
required from the electors.

Further articles in this chapter and the next define the

duties of the alcalde, the municipal lieutenant, municipal
attorney, municipal secretary, municipal treasurer, and the
municipal councilors. The fifth chapter relates to taxation
and finances; the sixth and seventh contain provisions as
follows:

"ARTICLE 53.
The governor of the province shall be ex officio president of
all municipal councils within the province and shall have
general supervisory charge of the municipal affairs of the
several towns and cities therein organized under the
provisions of this order, and in his said supervisory capacity
may inspect or cause to be inspected, at such times as he may
determine, the administration of municipal affairs and each
and every department thereof, and may hear and determine all
appeals against the acts of municipal corporations or their
officers. He, or those whom he may designate in writing for
that duty, shall at all times have free access to all records,
books, papers, moneys, and property of the several towns and
cities of the province, and may call upon the officers thereof
for an accounting of the receipts and expenditures, or for a
general or special report of the official acts of the several
municipal councils or of any and every of them, or of any and
every of the officers thereof, at any time, and as often as he
may consider necessary to inform himself of the state of the
finances or of the administration of municipal affairs, and
such requests when made must be complied with without excuse,
pretext, or delay. He may suspend or remove municipal
officers, either individually or collectively, for cause, and
appoint substitutes therefor permanently, for the time being
or pending the next general election, or may call a special
election to fill the vacancy or vacancies caused by such
suspension or removal, reporting the cause thereof with a full
statement of his action in the premises to the governor of the
islands without delay. He shall forward all questions or
disputes that may arise over the boundaries or jurisdictional
limits of the city, towns, or municipalities to the governor
of the islands for final determination, together with full
report and recommendations relative to the same. He may, with