454 WHITMORE. 



All important factor in the prevalence of tuberculosis here is the 

 insanitaiy condition under which the people live. The majority of 

 houses are greatly overcrowded, and at night all doors and windows are 

 closed and the house is made as tight as it is possible to make a native 

 bamboo stinicture. No precautions are taken to prevent contagion and 

 it is not uncommon for ten to fifteen people to live and sleep in a small 

 house of one room; sometimes from one to five of these people have 

 tuberculosis and are coughing and spitting about the house so that all 

 the inmates are constantly exposed to infection. Underfeeding also 

 predisposes to the disease by lowering the resistance of the individual, 

 but it can probably be truly said of the Philippines that "without the 

 house, tuberculosis would not exist." 



In 100 autopsies at the Philippine Medical School tuberculous lesions 

 were found in 35. 



The Bureau of Health of Manila is taking energetic steps to prevent 

 the spread of tuberculosis. Overcrowding is prohibited, light and venti- 

 lation have been provided for, antispitting ordinances have been passed, 

 and an active educational campaign is being carried out through the 

 public schools and the daily press. It is also proposed to open a free 

 dispensary in the city of Manila for tuberculous cases, and to erect one 

 or more "tent colonies" for the open-air treatment of tuberculosis. 



I am informed by the chief veterinarian of the Bureau of Agriculture 

 that tuberculosis is very rare among the cattle in the Philippines — so 

 rare as to be almost unknown, and also that tuberculosis is unknown 

 among the carabaos, pigs, and goats. Furthermore, the natives drink 

 little milk and eat little butter, and what milk they do drink is mainly 

 derived from carabaos and goats. Still, surgical tuberculosis in man 

 is by no means uncommon. In 1,400 surgical cases in St. Paul's 

 Hospital, Manila, there have been 30 cases of joint tuberculosis, 37 cases 

 of bone tuberculosis, and 32 cases of cervical and axillary gland tuber- 

 culosis. Among 732 patients in the University Hospital of this city 

 there have been 5 cases of bone tuberculosis and 18 of cervical and 

 axillary gland tuberculosis. 



In the dispensary at the University Hospital for the year July 1, 

 1908, to June 30, 1909, there were 6,G50 cases, of which 1,882 were 

 surgical. Of 84 cases of chronic bone and joint disease 30 were in- 

 stances of tuberculosis of the bones and joints. Of 92 cases of ade- 

 nitis, 63 showed tuberculous lesions of the cervical and axillary glands. 



Summing up the available .(reliable) statistics on surgical tuber- 

 culosis in Manila, we obtain 187 cases of bone, joint, and gland tuber- 

 culosis out of a total of 4,014 surgical cases; i. e., a percentage of 4.65. 

 This is certainly not a lower percentage than is found in Europe and 



