1 84 EDITORIAL. 



DISCUSSION ON THE PAPERS BY DR. VICTOR G. HE1SER 

 AND DR. HARRY T. MARSHALL. 



Colonel L. M. Maus, deputy surgeon-general, United States Army: It 

 affords mc much pleasure to have occasion to express myself in regard to 

 the practical conditions involved in the spread of cholera, as I had 

 abundant opportunity during the early part of the epidemic in 1902 to 

 study some of the channels of the dissemination of the disease. The 

 history given by Dr. Heiser in regard to its origin agrees exactly with 

 my own ex23erience ; it seems to be as nearly a correct one as we could 

 find it to be at that time. A ship's cargo of cabbage came to Manila at 

 the time mentioned and as the health office of Hongkong had notified 

 us of the occurrence of the disease in that city, the Marine-Hospital 

 Service was enabled to reject the shipment, which was dumped into the 

 bay, but notwithstanding, several heads reached the beach at the Parola 

 district and cholera developed. I remember the first case distinctly. 

 It was sent to the San Juan de Dios Hospital ; several others -soon fol- 

 lowed. A number of the members of the medical profession capable 

 of making an accurate diagnosis were present. Cultures were taken 

 from the bowels on the same night and the vibrio was observed under 

 the microscope, but the final diagnosis was not completed until twenty- 

 four hours later. The fact that the cases showed the cholera vibrio 

 to be present and the further fact that there had been no cholera in 

 the Islands up to that time, proved that the disease was imported. 

 As you all know, the provinces were thoroughly supplied with medical 

 officers when the epidemic of 1902 appeared, so that at that time, if 

 there had been any disease in the Archipelago similar to cholera it 

 would have been reported at once, and for that reason I am willing 

 to say that cholera was not present in the Islands at the time of the 

 outbreak in 1902. I believe therefore that the disease in this epidemic 

 was imported de novo. It was brought from Hongkong, and spread 

 from the Farola district. 



The vibrio of cholera secretes a very virulent toxin. In the course of 

 successive generations of the organism, the infections become milder. 

 It should be noted that the vibrio which was introduced at the 'beginning 

 of the epidemic in March, 1902, was of the most virulent character. 

 I believe the infection spread largely from faecal matter through the 

 intervention of flies. Typhoid was stated to be a water-borne disease. 

 In 1898, 300,000 soldiers went to the Spanish-American War, and the 

 medical officers had some knowledge of the results which appeared 

 during the campaign. A large percentage of the troops was infected 

 with typhoid, and we found the soldiers to acquire the disease not only 

 by means of the drinking water, but also by the spread of the organism 

 through the intervention of flies, and I believe cholera to be dissemi- 

 nated in the same way, by flies contaminating the food. It is well known 



