Entitled: "Stricken with fever - more deadly than Filipino bullets - 1st Reserve, Hospital, Manila, Philippine Islands." Malaria, typhoid, dysentery, and yellow fever plagued American troops, who were fighting in the tropics for the first time in US history. The Philippine-American War (1899-1902) was an armed conflict between the USA and Philippine revolutionaries. The conflict arose from the struggle of the First Philippine Republic to secure independence from the United States following the latter's acquisition of the Philippines from Spain after the Spanish-American War. Fighting erupted on February 4, 1899, and quickly escalated into the 1899 Second Battle of Manila. On June 2, 1899, the First Philippine Republic officially declared war against the USA. The war officially ended on July 4, 1902. The war and occupation by the USA would change the cultural landscape of the islands, as people dealt with an estimated 34,000 to 220,000 Philippine casualties, disestablishment of the Roman Catholic Church, and the introduction of the English language in the islands as the primary language of government, education, business, industrial and increasingly in future decades among families and educated individuals. Cropped stereograph card photographed by Underwood & Underwood, 1900.