60 EDITORIAL. 



reported as suspicious and later prove to be cholera are included in the 

 report as cholera cases, and those in which the diagnosis eventually is 

 negative are reported as not cholera. 



Dr. Richard P. Strong, chief of the Biological Laboratory, Bureau of 

 Science; professor of tropical medicine, Philippine Medical School: A 

 great deal has been said before the society about the examination of 

 suspected cases of cholera which have occurred before the beginning of 

 the actual epidemics in Manila and in which the bacteriologic examination 

 for cholera has been negative. I think we have lost sight of the fact 

 that we have in Manila an endemic disease known as cholera nostras. 

 I have observed cases of this disease with more or less frequency in the 

 Islands for the past ten years. There have been one or two outbreaks 

 of this malady in the Army and cases are met with from time to time 

 in the natives every year. This disease is well known in other portions 

 of the world, for example in Europe and the United States. It obviously 

 has nothing to do with Asiatic cholera, although its symptoms may some- 

 times closely resemble those of true cholera. I performed autopsies on a 

 number of cases of cholera nostras in 1900 in Manila, when Doctors 

 Flexner and Barker of the Johns Hopkins University were out here. At 

 that time we searched very carefully for Asiatic cholera, but we never 

 found cases of this disease. Some of the patients died at the old First 

 Eeserve Hospital and were carefully examined bacteriologically. Prom 

 the intestines of some of these proteus bacilli were isolated. I think the 

 cases that the Bureau of Health reports as suspected cholera from time 

 to time, when Asiatic cholera is not present in Manila, are frequently 

 those of cholera nostras or of ptomaine poisoning. Obviously, in these 

 instances we can not find the organism of Asiatic cholera, it is not present, 

 and the disease has an entirely different etiology. 



The successful bacteriological diagnosis of Asiatic cholera depends upon 

 the number of cholera organisms in the stool at the time of the examina- 

 tion and the care with which the bacteriological examination is performed. 

 Occasionally, after a patient has been in the hospital for from forty-eight 

 to seventy-two hours it may be impossible to make a bacteriologic diag- 

 nosis of cholera from the examination of the dejecta, for the reason that 

 such patients may have been sick for several days before they entered the 

 hospital and the cholera organisms frequently disappear almost entirely 

 from the stool by the fifth or sixth day from the onset of the disease. 

 If the case has succumbed to some late complication of the disease, or 

 the autopsy was not performed imtil forty-eight hours or a few days after 

 death, it may also be impossible to make a bacteriologic diagnosis of 

 cholera. However, all this has nothing to do with the diagnosis during 

 the acute symptoms of the disease, nor does it depend upon a change of 

 morphology in the organism, or upon a change in its serum reactions, or 

 upon the changes it produces in culture media ; it simply depends upon the 



