UNSOLVED HEALTH PROBLEMS. 175 



night for generations past, their habit of chewing betel nut which has 

 made the custom of expectorating in public and private a universal and 

 we sometimes fear an incurable habit. Added to this is their utter 

 resignation to the disease as & thing incurable and inevitable. Therefore, 

 not only have we the ordinary preventive and curative measures against 

 tuberculosis to organize and enforce, but we must devise ways of cooking 

 and preparing native products into a suitably nourishing and popular 

 dietary, and then educate the masses not only to the ways of adopting 

 these reforms, but also to an earnest desire for them. They will have 

 to be first cured of their superstitions, which is as great a task as convert- 

 ing them to a new religion ; hoiises will have to be opened at night, betel 

 nut chewing gradually abolished, and then a gigantic antispitting 'crusade 

 begun, and, last of all, comes the Herculean task of rousing them out of 

 their inertia and convincing them that not only is tuberculosis curable, 

 but that they are responsible for the spread of the disease and able to 

 themselves accomplish the cure. 



Cholera. — Cholera is still with us in spite of the active measures which 

 ' are constantly being taken to eradicate it. Although we have so far been 

 successful in promptly suppressing outbreaks whenever they appear, 

 yet it is constantly occurring in sporadic form over widely separated 

 sections of the Islands. The puzzling question is this : When no possible 

 connection with any previous ease is discoverable, where are the cases of 

 cholera contracted that appear so spasmodically over these widely separ- 

 ated regions? "Whether it is lying dormant during the periods of time 

 when no cases are reported is yet to be determined. Some years ago the 

 writer drew attention to the fact that logical deduction indicated that 

 there was a morphological change in the cholera organism which made 

 it difficult to recognize at certain stages. Eesearch work done in the 

 meantime strengthens this view. There is also a strong probability that 

 cholera carriers are responsible for some outbreaks; yet the fact remains 

 that the disease appears frequently at places in which its origin can not 

 satisfactorily be proved. 



Plague. — Plague at present is a stranger to the Philippines. Meas- 

 ures for its eradication were begun in 1900, but it was not until the 

 heretofore-described scheme of dealing with rats was used that the 

 disease disappeared. Since April, 1906, no cases have been found in 

 human beings, and no cases in rats since 1907. 



However, on account of the close proximity of China, where plague 

 seems to appear every year, special precautions are constantly taken at 

 our ports in order to prevent the reintroduction of this disease. The 

 question of course is how safely to accomplish this with a minimum 

 amount of annoyance and loss to the shipping interests and to the 

 traveling public. The present plan is to fumigate all vessels from 

 infected ports twice annually and to keep the interisland vessels free 



