450 The Philippine Journal of Science 1922 
1919, has nearly circumnavigated the earth, proceeding east and 
west from the eastern Mediterranean area and arriving at Bom- 
yay and possibly Saigon in an easterly journey from the region 
of Gallipoli and, in a westerly direction at Manila, probably 
by way of France and the United States. It is this last case 
that will be reported in this paper. 
This case was presented by an American, a chemist by profes- 
sion, 32 years old and a resident of Georgetown, Illinois. He 
spent the years 1915-4916 as a member of the technical staff of 
the Bureau of Science, Manila, and then returned to the United 
States, almost immediately proceeding to Trenton, Ontario. 
He lived there for about a year, and, so far as he had knowledge, 
was not in contact with any person who had returned from the 
war zones, or who had ever been in the eastern Mediterranean 
region or in Egypt. At Trenton, his meals were prepared by 
a Chinese cook. 
During the years 1918 to 1920, he occupied a position at the 
Government smokeless-powder plant at Nitro, West Virginia, 
a war settlement situated about 24 kilometers from Charleston. 
During that time he made one or two short trips to New York. 
The sanitary conditions at the powder plant he describes as 
excellent. He bought food supplies from the Government 
stores. He purchased green vegetables from local produce 
dealers, but knew nothing of the sanitary conditions at the farms 
or the antecedents of the farm hands. He employed no servants 
and all the meals were:cooked by members of the family. 
The personnel of the powder plant included laborers from 
many parts of Europe, and, he thinks, men from the eastern 
Mediterranean area. He also came in contact with men 
returned from the war zones in France, but never messed with 
them. 
The patient sailed from San Francisco for the Philippines 01 
November 19, 1920. He went ashore in Japan, but ate only 
one meal ashore. This was a dinner at a tea house in Kobe. 
None of the others who were at this meal were in Manila at the 
time the case came to my attention, so their stools could not be 
studied. He arrived in Manila on December 19. 
Inquiry into the previous medical history of the patient failed 
to reveal anything of note except an attack of typhoid fever in 
1910. This was the only intestinal trouble from which he ever 
had suffered. His bowels always had been regular, and he had 
suffered neither from constipation nor from diarrhea. His wife 
