excited and rendered irritable by a sensitive protein. After removal of the cause and suitable treatment, these factors fail to produce attacks and the intestinal disturbances are relieved.

Hay-fever cases, due to the pollen of willow, alder, oak, birch, maple, apple, chestnut, grasses, rose, ragweed, goldenrod, cockle-bur, sunflower, can all be treated with pollen protein to which the patient is sensitive.

There are asthmas brought about by the inhalation of the protein of horse dandruff, dog, cat, rabbit, and guineapig dandruff, chicken feathers, and from various birds and fur-bearing animals. We can treat these by avoiding such inhalation; for instance, in case of sensitiveness to feathers of the pillow, by elimination of the feather pillow.

Blacksmith, age twenty-six; was subject to attacks of asthma, brought on when near a horse or driving a horse. If a small amount of horse's perspiration touched the patient's skin, within five minutes there would be redness and wheals. This case was treated with horse dandruff protein, so that he could be around horses without any attacks of asthma.

Superintendent of bakery, age forty-eight; began working at sixteen in a bakery. At eighteen years of age, when working with flour, he would be subject to attacks of sneezing, watery nasal discharge, lacrimation, itching of eyes, ears, nose, and throat. These attacks increased in frequency and severity for ten years. Then he would have attacks of asthma, which occurred at intervals and increased in frequency and severity. When forty-three years of age he could only work part of the day in the bakery. At forty-six, on entering the bakery, there would almost instantly be brought on severe attacks of asthma. This case gave positive reaction to wheat, rice, and corn; negative to oat, barley, and rye. By omitting wheat, rice, and corn from his diet he could work in the bakery without being subject to attacks of asthma. In this case sensitive protein entered through both the respiratory and gastro-intestinal tract. By omitting these articles from the diet the system was able to take care of the amount entering through the respiratory

tract.

Oil dealer, age forty-six; suffered from asthma for three years. Reaction positive to wheat, negative to rye, oats, corn, and rice. Omitted wheat from diet, and in two weeks reported he felt better than for three years;

no attacks. Two weeks later, no attacks. Following this for two days he ate six slices of wheat bread, which brought on the worst attack he had ever experienced.

Housewife, age forty-five; asthma for twenty years. Skin test made, and all the proteins that gave positive reaction were eliminated. After being free from asthma for three months, the patient was instructed to eat plenty of lamb, which gave positive reaction on testing. One lamb chop was eaten, and six hours after she had an attack of sneezing, watery nasal discharge, itching eyes, ears, nose, and throat continually for two hours. Frequent attacks for the next two hours. Forty-eight hours later two lamb chops were taken, and in six hours she experienced severe attacks of asthma lasting two hours. followed by frequent attacks of sneezing, with watery nasal discharge for eight hours; twenty hours later eczema appeared over the entire body. Avoiding lamb soon cleared up the condition. This case was later given lamb protein, subcutaneously, at weekly intervals, beginning with a small dose and gradually increasing the dose according to local reaetion, until she was desensitized to lamb, giving no skin reaction. Since then she has been able to eat lamb without any disturb

ance.

Female, age five; at two months of age eczema all over the body, which continued to her present age. The skin was indurated, thickened, scaly and rough. The smallest amount of egg in the mouth caused immediate swelling of the tongue and the mucous membranes of the mouth and lips. Beef broth made the eczema worse. When at the seashore, if she should go near fish there would occur acute exacerbation of eczema. The patient gave positive reaction to wheat, egg, beef, haddock, and mackerel. These foods were eliminated from her diet and she was desensitized with wheat protein, and later with egg and beef. The skin became soft with very few scales, and resumed normal texture. The patient is now able to eat wheat, egg, and beef.

Female, age twenty-eight; has always known that some of the vertebrate fish, such as haddock, cod, mackerel, and salmon, would produce attacks of sneezing, nasal discharge, dry sore throat, redness and swelling of the face. Within the last five years halibut and fillet of sole produced the same symptoms. This lady, on eating any of the fish, knows that these symptoms will occur in one hour.

All are aware of disturbances caused by strawberries and tomatos with some individuals.

In bacterial protein sensitization we can use the same skin test with the different bacterial proteins to determine which is the sensitive protein. No pains must be spared in searching for and removing every disease focus which serves as a focus of protein absorption. More than one avenue may serve as a source of absorption. The focus or foci may be found in the nose or accessory sinuses, tonsils, gums, teeth roots, gall-bladder, and appendix. After these foci are cleared one may have a chronic bronchitis, which can be cleared up by treatment with sensitive bacterial protein.

Female, age forty-two; eczema about the face and back of ears for six months. Test

gave reaction to staphylococcus pyogenes aureus. I advised an X-ray of teeth, which showed abscesses at the roots of the upper left

second molar. The tooth was extracted, the abscess cavities cleaned, and in ten days the eczema disappeared.

I have seen a few cases of cancrum oris patients which gave positive skin reactions to some foods. On avoiding these foods there was relief from the cankers. These are the cases which, when the dentist has attended to the teeth, are followed by severe outbreaks of cankers, for which the dentist is severely criticized by patient and friends, and in which he is accused of being unduly rough, or of using unclean instruments, while he is no doubt innocent, the contributing factor being present within the patients themselves, and ready for an explosion on the slighest provocation.

[See also Discussion, as reported under "Proceedings of Societies," this issue.]

P

REVIOUS reports of these clinics have been made as follows: DENTAL COSMOS, Cosmos, August 1910, October 1911, November 1912, May 1914, and July 1915.

The clinic at the Philippine General Hospital, which I succeeded in establishing in August 1912, has assumed large proportions. This clinic is now operated as the clinic for the School of Dentistry of the University of the Philippines, of which I am the director. The school was opened in 1915, and we adopted then the regular four-year course, hence our first graduates will receive their degrees in April 1919. At present the school has twenty-five dental students, and the classes will number about forty for the academic year of 1918-19. As the number of students increases and a larger

number perform their practical work in the clinic, the higher class of work will increase. For the present, as is seen by the report, the largest amount of the service consists of emergency cases, that is, treatments and extractions.

Since the establishment of the clinic at the Philippine General Hospital (which is a public institution), the one at St. Paul's, the first one I founded thirteen years ago, has not been as active as in former years, but is still satisfactorily serving the poor in that section of Manila known as the "Walled City."

The clinic at Bilibid Prison, which I opened in 1906, was until lately supplied by my assistant from the St. Paul clinic, but recently the prison authorities have established a more regular and constant service, of which I have no record; hence

the dental work done in the prison far exceeds that shown in this report.

The largest gain in dental service since my last report was made in the public schools. In former years I maintained an irregular service in one of the schools, which could not be made permanent and efficient. Three years ago, I succeeded, with the aid of the then Secretary of the Interior, the Hon. Winfried T. Denison, in having a law enacted creating the Board of Dental Hygiene, which was authorized to collect funds for the purpose of establishing dental clinics in the public schools. It was much easier to get the law passed than to get the funds. Still, I was able to collect enough to open one clinic in the Meisic primary school, with over 3000 pupils probably the largest single unit of a primary school anywhere to be found-which has been very successful, and is now established on a permanent and solid foundation, having been recognized as a necessity to such an extent that it now receives the financial support of the city.

In connection with that school I have also established a toothbrush drill. This was made possible through the generosity of the Florence Manufacturing Company, donating toothbrushes, and the Colgate Company, which donated tooth paste. During the past year only one hundred pupils, fifty each of boys and girls, have been admitted to the class. All of them are eager to enter it. The drill takes place every morning during a recess, and the improvement in the health and general demeanor of the children, and their application to the work of the schoolroom, has been so marked that the teachers of these pupils have noticed it and commented on it. I hope with the beginning of the coming school year to greatly increase the work in this direction.

Being unable to continue the clinic through the Board of Dental Hygiene, which depended on the uncertainty of begging money and aid (made more difficult on account of the needs of the great war), I succeeded in interesting the school authorities in the matter, with the result that the clinic will be continued by the city schools, and in July

one dentist will be added. I have also seen by the report of the Director of Education that the appointment of a dentist in each province is recommended, and this, no doubt, in course of time, will take place.

Familiar with the various plans recommended for the conduct of dental clinics in public schools, I was in some doubt which policy to adopt. I have reached the conclusion that the preservative service entailing hopeless expense-unless it could be made universal is of comparatively limited value; second, that the emergency service, coupled with the instruction, is of considerable value. Previous to the establishment of the clinic, in the fifty-odd rooms of this one school, there were from three to five pupils in each room at the very moment suffering with toothache (this, of course, is exclusive of those who remained at home on account of the same trouble). This means that from 150 to 250 children were at school in a condition of inefficiency, causing loss of time to the teacher, loss to the student, and loss to the citizen whose money supports the schools. This has all been remedied, and, by giving an opportunity for the children. to get immediate relief, it has increased the attendance at the school. This service I consider to be highly valuable.

By the use of local anesthesia, I have encouraged my assistant to follow up the extraction of diseased roots and unsalvable teeth as much as possible, being satisfied that while the dental service is meager, this line of work probably. yields the most in good results. The record shows that one-fifth of all the service consists of extractions.

But working along on a small scalefilling a few cavities while thousands of new ones are forming, extracting a small number of disease-breeding stumps and teeth while hundreds of others are rapidly passing into the same stage-sometimes makes one feel discouraged, when it is known that, were the means at hand, such an immense service for the general good could be accomplished. I am therefore, as a result of practical experience and observation, deeply convinced of the great value of prophylaxis

-prevention rather than cure.

This is so convincingly illustrated in the toothbrush drill that it is impossible to escape conviction. The thoroughness in cleaning the teeth; the steady, dogged regularity, finally not only cleanses the teeth, but improves the diseased condition of the gums, and indeed retards the pus production about teeth and roots which should either be cured or removed.

In the "other institutions" listed in the accompanying table are included. pupils in private eleemosynary institutions, such as St. Luke's Hospital free clinic for the poor, Girls' Orphanage, School for the Deaf and Blind, and Home of the Holy Child. In these the service is purely temporary.

The total in these various institutions now foots up over 75,000 distinct dental operations, performed for nearly 30,000 patients, of whom one-third consists of females and two-thirds of males, while all but about 500 were Filipinos.

Aside from the actual results of the operation of these clinics, it is gratifying for me to note the extension and influence of this propaganda. I am certain that its extension in the schools has been made secure. Recently a large commercial firm, an employer of considerable labor, has made arrangements for dental service for its employees. Several years ago I brought this to the attention of one of our largest tobacco concerns, placing the argument on a basis of sanitation-that is, that it is possibly injurious to have operatives about the weed whose breath is germladen. Had I the time, no doubt this matter would be seriously taken up by owners of factories and employers of labor. With the exception of the dental clinic at the Philippine General Hospital for which compensation is included in my service for the university, this work all has to be done without remuneration, and it is too much for anyone to do, hence I am gradually passing, on the work to someone who will be paid for it, as is now the case in the public schools.

Recently, the Philippine Constabulary, which is our insular police, also created

five positions for dentists; but they have been appointed with too low a grade, that is, only second lieutenant, and difficulty has been found in filling the posts thus created. I think it is contemplated to increase the rank, and of course the pay. The Philippine National Guard also has a dental corps, modeled somewhat after the same corps in the United States army, or rather, as it was a few years ago. It provides for the appointment of one dentist to every 1000 of the enlistment, with the grade of first lieutenant. I have been commissioned a captain in the medical corps, and assigned to organize, instruct, and supervise the dental corps, somewhat like Major Logan in the medical corps of the United States army. These are signs of permanent progress for the dental profession in the Philippines.

We have been made to feel the effects of the war in the increase of the prices of dental goods and supplies, due largely to the decreased shipping facilities on the Pacific. This has unfortunately resulted in a large influx of goods of Japanese manufacture. Efficient as they are in many lines, the Japanese have not improved in the manufacture of dental goods over what they were nearly twenty years ago, when I lived and practiced dentistry in Japan and knew their goods very well. There is too much energy lost in making imitations of and copying outwardly goods of American manufacture, and so far they are expert

but it ends there! Still, for want of American goods we have been compelled to purchase these imitations for some of the clinics on which I have

reported in this paper. I have just been informed that the Japanese intend putting two grades of goods on the market an inferior product, that is to say the present product, and a superior product which is to command a higher price.

We feel assured that the recently opened dental depot of Mr. Louis Xiques, formerly of the S. S. White Company's branch in Buenos Aires, will greatly improve our present most deplorable

service.