174 HEISEK. 



believed to be a safe one. It is an established custom to use such 

 night soil for fertilizing vegetables, and it is believed that the consump- 

 tion of raw vegetables thus fertilized has had much to do with the spread 

 of amoebic dysentery, cholera, hookworm, and other intestinal diseases. 



Smallpox. — Smallpox, once so formidable a proposition to us, has at 

 least been reduced to insignificant proportions. Over 6,000,000 persons 

 have been vaccinated by the Bureau of Health within the past five years. 

 The unvaccinated are in remote regions where as yet it has been found 

 impossible to convey vaccine in a potent condition. 



The ordinary glycerinized lymph at present in use will not keep for 

 more than seven to ten days at the temperature which prevails here. 

 As many of the sections to be reached are in traveling time from two to 

 three weeks away from the point to which ice can be sent, or where cold 

 storage is available, it is obvious that a vaccine is necessary which will 

 retain its potency for a longer period of time than any now obtainable. 

 Vaccine in powdered form has been tried, also dry points, but the per- 

 centage of success is so small and clanger of infection so great that their 

 use is restricted. 



The acute phase of this problem then is either to manufacture a more 

 effective vaccine or to find a way of transporting it successfully. Obser- 

 vations point to the conclusion that ordinary cowpox vaccine is not as 

 effective among the dark as among the white skinned races. The writer 

 has personally observed that out of more than 100 cases of smallpox or 

 varioloid among white people not one case occurred in a person who had 

 been vaccinated within five preceding years, while there have been many 

 cases of smallpox among Filipinos of whose successful vaccinations within 

 one preceding year there could be little doubt. 



It has been interesting to observe a demonstration of this at Bilibid 

 Prison, where all prisoners are vaccinated upon admittance, and regularly 

 once a year or oftener thereafter. Yet smallpox has made its appearance 

 there each year, and many cases have occurred in persons who show the 

 typical pits accepted as characteristic of previous attacks of smallpox. 



Tuberculosis. — Tuberculosis is another of our problems. We estimate 

 that it claims as many victims as in other portions of the globe, and 

 it will require the same activity here as elsewhere to hold it in check. 

 The introduction of out-patient tuberculosis dispensaries, the construction 

 of shacks in the mountains, the opening of night camps near Manila, 

 arrangement for the hospitalization of the helpless sick and prophylactic 

 instruction in the public school, the usual methods in fact that are 

 employed elsewhere, are now under way here ; but the tuberculosis problem 

 has its peculiar and complicating features in the Philippines, namely, .the 

 unsuitable dietary of the people, their peculiar superstitions concerning 

 the contraction of the disease, their almost unshakable fear of night air 

 as a poisonous thing, a fear which has kept their houses tightly closed at 



