90 HEISEB. 



introduction into the mouth of contaminated food or drink, and that 

 almost absolute safety against infection can be insured by the simple 

 precaution of using sterilized water and cooked food, would result in 

 its early disappearance, but when it is remembered that the climate 

 is favorable for the development of the cholera organism through- 

 out the four seasons of the year — in other words, that there is no winter 

 season which would at least stop the disease for a time — that a large por- 

 tion of the people are ignorant and inaccessible, that much superstition 

 exists, that one of the most popular beliefs is in the supposed injurious 

 character of boiled water, that the cost of fuel is comparatively high, 

 making sterile water and cooked food difficult for the masses to obtain, 

 that the majority of the people cling tenaciously to the mode of living 

 which has been customary with them for hundreds of years, that food is 

 conveyed to the mouth with the fingers from a receptacle used by all the 

 household, that over GO per cent of the population are afflicted with intes- 

 tinal parasites, that, with the possible exception of the supply for a few 

 hundred thousand out of a total of seven million, the drinking water 

 is obtained from shallow surface wells, that physically the people are 

 weak and unresistant, and that funds and skilled physicians needed to 

 combat this condition are very limited, it will not be so difficult to under- 

 stand the continued presence of cholera in the Philippines. If better 

 results or the complete eradication of the diseases are to be hoped for, 

 additional methods beyond those which have heretofore been used in any 

 part of the world will need to be made available. In order that such 

 methods may be determined upon in a scientific manner, it will be 

 necessary to make further advances in the study of the cholera organism, 

 both from a morphological and epidemiological standpoint. The follow- 

 ing deductions based upon observations of the cholera during the past 

 five years are submitted with the hope that some progress may be made 

 in this direction. 



PAST EPIDEMICS IN THE PHILIPPINE ISLANDS. 



It will perhaps be recalled that the first case of cholera, recognized as 

 such since American occupation, occurred in March, 1902. It is difficult 

 to determine satisfactorily whether any cases of the disease had occurred 

 between the epidemic of 1888 and of March, 1902. This is a question, 

 however, which has given rise to considerable discussion. Physicians 

 who were resident in the Philippine Islands prior to American occupation 

 claim that cholera has been continually present for many years, but it is 

 generally held by Americans that becaiise no record exists of a micro- 

 scopic confirmation of such eases, the diagnoses are open to doubt. In 

 view of the foregoing, it is of course evident that this question can never 

 be definitely and satisfactorily settled. Certain it is, however, that 



