62 EDITORIAL. 



Dr. Van R. Hoff : i think I heard a gentleman say the other day that 

 the epidemic was losing its virulence as the vibrio was taking atypical 

 forms ? 



Dr. R. P. Strong: Avirnlent strains of the cholera organism some- 

 times undergo a change in morphology in laboratory artificial media. The 

 spirillum isolated by Pfeiffer in 1894 which has been grown in various 

 laboratories for about 14 years, usually no longer shows the typical comma 

 form, but after frequent passages of this strain through guinea pigs its 

 morphology becomes more typical of cholera. This organism, however, 

 gives the typical serum reactions with cholera serum. By morphology 

 alone, as I have stated, we do not attempt to identify an organism. We 

 would not attempt to identify the plague or the typhoid fever bacillus by 

 its morphology alone. It is by the combination of all the reactions that 

 we identify bacteria and particularly by the serum I'eactions which are 

 most specific of all. 



Dean C. Worcester, Secretary of the Interior of the Philippine Com- 

 mission, Manila: You have spoken of the disease kno^vn as cholera nos- 

 tras. Wliat is this disease caused by? 



Dr. R. P. Strong: Many observers believe that the etiology of the dis- 

 ease is still obscure. Some cases have been thought to be due to meat 

 poisoning, to septicine poisoning, or to intestinal infections with certain 

 of the proteus bacilli or with Bacillus Botulinus. In 1900, when Doctors 

 Flexner and Barker were in Manila, several cases died from this disease 

 and were autopsied in the Army morgue. From these after a careful study 

 a strain of the proteus bacillus was isolated. I also remember one epidemic 

 in which 10 or 15 soldiers were attacked on the same day with symptoms 

 of cholera nostras. The symptoms were supposed to have been caused 

 from eating some spoiled hash served at the mess hall. No cholera spirilla 

 were found in the stools of these cases. These attacks obviously had 

 nothing to do with Asiatic cholera. 



Dr. Van R. Hoff: Eef erring to the distribution of cholera in the city, 

 there seem to be so many foci and it is widespread. Doctor McLaughlin, 

 how do you account for that? You have a simultaneous outbreak in 

 Malate, Intramuros, and Tondo, all separated and in various parts of the 

 city. Could you trace any relationship between any of these different 

 outbreaks ? 



Dr. Allan J. McLaughlin: No ; no connection can be traced. The most 

 plausible explanation is the bacilli carrier. Many of these infections 

 are most puzzling. One case appears in Tondo, and another in Paco, 

 and the ease in Paco has no connection whatever which can be traced to 

 Tondo. 



Dr. R. P. Strong: I would like to ask Doctor McLaughlin if Doctor 

 Gilman has not reported cases of cholera to the Bureau of Health ever 

 since last January? 



