14 



the owners have volunteered or been persuaded to clean up. The 

 large plantation dairies have nearly all been tested and many 

 private owners have seen the necessity for eliminating the danger 

 of infection through tuberculous milk. A new era will undoubt- 

 edly begin with the enforcement of the 



Sanitary Code of the Territorial Board of Health of August 



i8, ipi3. 



This code requires the testing for tuberculosis of all cows in 

 the Territory whose milk is sold for human consumption. While 

 it leaves out the private owner and protects the family cow 

 against the test, it will, nevertheless, be of immense support in the 

 work of eradication. Had this code been promulgated a few 

 years ago, the Territory would, in my opinion, have been free of 

 tuberculosis by this time. But late is better than never, and I 

 have great hopes that the new code will prevent any such delays 

 in the work as that already described. The Territory is now 

 actually in the fight against this dangerous though preventable 

 disease, and the authority which the code lends to those upon 

 whom the actual work of eradication falls cannot be over- 

 estimated. 



Infantile Mortality from Tuberculosis. 



In my paper before the Association last year I mentioned the 

 apparent decrease in the number of deaths among infants under 

 five years of -age, which appears to have occurred in .the City 

 and County of Honolulu coincidentally with the elimination of 

 the tuberculous infection from the market milk. This decrease 

 seems to be accentuated through the latest report of the Regis- 

 trar General, if I interpret the figures furnished me correctly. 

 In this connection it may be mentioned that similar observations 

 have been made in other countries, notably England, where the 

 health authorities in Leeds and Manchester both agree that a 

 notable decrease in infantile tuberculosis has occurred in direct 

 proportion to elimination of the tuberculous cow. The Manches- 

 ter method, which consists in tuberculin testing and removal from 

 the dairies of the reactors, in constantly widening circles or by 

 definite districts, is accepted as most practical in many parts of 

 England, and the results have been most gratifying, especially 

 where eradication has gone hand in hand with pasteurization. 

 This means that where, for economic reasons, all reactors can- 

 not be destroyed at once, they are segregated and their milk 

 pasteurized before it can be used for human consumption. Board 

 of Health statistics from Leeds, Manchester and other cities 

 where practiced, have shown so decided a decline in the mortality 

 of children under five years of age that it exceeded that of many 

 smaller but wealthy municipalities where social uplift clubs and 

 anti-tuberculous leagues claimed the reduction due to the better 



