116 The Philippine Journal of Science ms 



part of the world. This is due to the natural immunity to 

 infection and resistance to disease as exhibited by the Oriental. 

 Nature produces rather remarkable results in the way of pro- 

 tection, and a full appreciation of that fact is of extreme im- 

 portance to the sanitarian working in the Far East. 



Let us first consider a few of the more-important food and 

 water-borne diseases, of which the most important is cholera. 

 This very serious disease must be considered as being and having 

 been endemic in Siam for the last one hundred years. Although 

 it is recorded as present in Java as far back as 1629, the first 

 extensive epidemic outside India seems to have begun in 1817, 

 and by 1820 had extended to China, having traveled via Burma, 

 Singapore, and Manila. It does not seem remotely possible 

 that this part of the country could have escaped the disease 

 at that time, although in the literature Siam is not mentioned 

 as suffering from cholera until 1906 as the result of the severe 

 epidemic that started in India in 1900. 



Topographically, climatically, and hygienically, Siam is an ideal 

 spot for the propagation of cholera. A vast part of the country 

 occupies an alluvial plain consisting of black, muddy, water- 

 logged clay extensively polluted with decomposing matter. The 

 sanitation is very bad, and practically all water supplies are 

 unfit for domestic use with the exception of that from the 

 modern plant in the City of Bangkok proper, completed in No- 

 vember, 1914, the influence of which is shown in the table of the 

 vital statistics of the recent epidemic. The practice of using 

 untreated fresh human faeces for fertilizing purposes is common 

 throughout the country and the distribution of foodstuffs is quite 

 uncontrolled. From the foregoing it is evident that more-ideal 

 conditions could hardly exist for the spread of an acute epidemic 

 disease like cholera. 



In studying the history of the last epidemic in the City of 

 Bangkok during the period between December 7, 1919, and 

 September 20, 1920, some interesting facts are presented. Re- 

 ferring to the table we find that the east side of the river is 

 supplied with a pure water and the west side of the river with 

 an impure water. The morbidity and the absolute mortality 

 rates are significantly lower on the east side as compared with 

 the west side, yet we find that the case mortality is higher on 

 the east side than on the west. It might be argued that the 

 greater number of cases would account for this, but in my opin- 

 ion the reason is to be found in the fact that the people on 

 the east side, having for the past few years used a perfectly 



