The following factors contribute to the prevalence of the disease (tuberculosis)
in the Islands (Philippines):
( a ) Poor housing. (not our problem) Housing was a problem even before the war.
During the Pacific battles more than 300,000 homes were destroyed
as a result of fighting and bombings so that the problem is now
much more acute. Whole families have to double up, not in houses,
but in makeshift sheds, shacks, and lean-tos (the barong-barong)
without sanitary facilities. In the razed areas of Manila and its
suburbs, it is not uncommon to find three or four families squeezed
into a shed measuring four by five yards, which leaks like a sieve
during the rainy season and which is as hot as an oven during
the summer months. Thus, spread of infection by close and con-
tinued contact is supremely easy. The War Damage Commission
could do a lot to aid in rehabilitatlon by hastening the settlement
of claims although the results will be limited by the fact that an
individual claimant cannot get more than $500.00.
It must be mentioned here that whole communities have been
wiped out in some areas, the majority of their inhabitants mas-
sacred or maimed. I n Manila virtually every federal building has
been demolished, century-old historic buildings gutted, and some
churches, museums, and libraries burned down. There is no ques-
tion but that there is a dearth of public buildings and private
dwellings in the entire young republic today.
(b) Malnutrition. (filipino traditional diet is malnourishing) Even before the war it was an admitted fact
that the Filipino race was so undernourished that every year
beriberi killed more infants than did respiratory diseases. During
the forty months of Japanese occupation not only did no imports
reach the Philippines due to the blockade but the countryside
llgewtse was stripped to feed and maintain upwards of one million
unwelcome guests (the Japanese Imperial Army had no quarter-
master supplies to speak of). The Japanese saw to it that their
troops lived off the fat of the land, not caring whether the civilians
starved. Hence, avitaminosis reared its head, and malnutrition
contributed to the death of thousands.
Even now when nutrition is better, the high cost of living (the
purchasing value of the peso is only one-fifth of its prewar level)
is still taking its toll. Statisticians are agreed that for the next
few years llving costs wffl remain higher than the prewar level.
(c) Parasitism. (my boy definitely has this) Intestinal parasitism infests about 70 per cent
of the population. Ascariasis. Schistosomiasis, hookworm disease.
tineasis, and amebiasis form the bulwark of Philippine parasites
that choose man for their host. The ascarids, hookworm, schisto-
somes and strongylids, as they pass through the lungs in their
life cycle, may cause some injury to the pulmonary tissue on their
way to their respective habitat in the human body. Whether in
this manner they predispose the lung to subsequent lodgment of
the Mycobacterium tuberculosis has not yet been fully ascertained.
I t is a fact, however, that widespread parasitism in the Islands
not only contributes to the production of secondary anemia but so
lowers the resistance of the human host that either latent tuber-
culous foci or other intercurrent diseases may readily break out.
(d) Dust and Fly problem. (we got this) These two are peculiar to the tropics
-as is the mosquito problem. Tropical dust is the most abundant
in the world. Most Philippine highways were concrete or asphalted
before the war, but the Japanese did no maintenance, and thous-
ands of heavy U. S. Army vehicles have pulverized the best of the
asphalted roads during the past two years. The dust of the high-
ways, carried away by tropical winds, gets into your eyes, your
nostrils, and into your every pore. Hence, respiratory diseases
enjoy a Roman holiday during the dry months, thereby activating
many a quiescent tuberculous focus.
As for flies, they can be found in droves every day of the year.
With garbage and sewage disposal extremely inadequate since the
end of the war, fwd, milk and water contamination plays a con-
siderable role in the spread of infectious dlseases.
(e) Economic conditions. (we can still afford paleo diet and hire a few maids and a driver) In addition to inadequate housing, the
traditional low wages prevaliing in the Orient and inflated prices
of fwd and all other commodities contribute to a low constitutional
resistance resulting in malnutrition. Mlipinos were never m l ik
drinkers, for, in a large majority of cases, fresh milk produces
either diarrhea or tympanism.
As examples of these low wages, the common laborer earns an
average of $1.50 a day; physicians in the health service in charge
of a county receive not more than $75.00 a month; clerks and
teachers about $65.00 a month. Is it any wonder then that the
children are so undernourished that they are easy prey to tuber-
culosis and other contagious diseases?
I t must be stated here, in passing, that World War II's aftermath
w i l l be felt in the Islands for the next decade. While vital statistlcs
for the whole Philippines is incomplete, tuberculosis incidence in
the city of Manila, according to the Philippine health bureau, has
risen from the pre-war figure of 9.07 per cent to 21.84 per cent,
or an increase of 251 per cent. Last year there were 2.144 deaths
due to tuberculosis in Manila, or a city incidence of 280 deaths per
100,000. At the war's end in 1945, 11,258 cases were found by the
health bureau in the same city out of 51,550 fluoroscopic and x-ray
examinations, or an incidence of 21.84 per cent.
From
The Tuberculosis Problem in the Philippines
MIGUEL CANIZARES
Chest 1948;14;759-765
DOI 10.1378/chest.14.5.759
The online version of this article, along with updated information and
services can be found online on the World Wide Web at:
http://www.chestjournal.org/content/14/5/759.citation
