EDITORIAL. 185 



that the natives of the Philippines largely eat with their fingers from a 

 common dish and this custom conduces to the spread of the disease. 

 Owing to their defective habits of personal hygiene, many of the natives 

 have their fingers infected. It is easy to see that their fingers may carry 

 millions of microbes. Flies which cany the faecal deposits on their feet 

 can take the infection into the markets and thus spread the disease. Any- 

 one who goes into a large military camp in the field will notice that the 

 closets at meal times are frequently free from flies. At meal hours the 

 insects transfer themselves to the tables. This is a fact, and therefore it 

 seems to me that flies in the Philippines also leave the faecal deposits at 

 times in order to reach the more refined food of the natives. In spite of 

 the general use of distilled water, the wells being closed after the begin- 

 ning of the outbreak of 1902, little difference in the number of cases 

 was observed. The disease ran its course. I believe the cases now present 

 in the Islands to be sporadic, and that cholera is now endemic. 



Dr. Clements, Bureau of Health: It seems to me that the burden of 

 proof in regard to the presence or absence of cholera in the Philippines 

 is upon the man who believes that cholera has disappeared. The great 

 world center of cholera is in the Ganges Valley. I have never been there, 

 but it would seem that the conditions in that region are climatically the 

 same as in this Archipelago. The people are of a comparatively low 

 order of civilization, with very primitive ideas of domestic hygiene 

 living on low, filled lands, no winter breaks the seasons and a very 

 large population is crowded into the area. We are practically certain 

 that cholera never disappears from the Ganges Valley. Therefore I 

 believe that those who maintain that the disease has disappeared from 

 the Philippines must prove this to be the case. Cholera in my belief 

 has been here all the time since it was first introduced. The native 

 in some respects has a fairly good clinical eye. The lowest class of 

 natives know smallpox and measles just as 'well as we do and these 

 infections have native names. On the other hand, cholera and some 

 other diseases which have been brought into the Archipelago in the 

 early times of Christian occupation are known to the natives only by the 

 Spanish designation, which to my mind is evidence that cholera was 

 introduced since Spanish settlement and was unknown previously. I 

 desire proof that it has ever disappeared after having been once introduced 

 into the Philippines. I have done probably as much field work in con- 

 nection with cholera as any other man in the Islands. I have been all 

 over the Archipelago and mild cases of a disease which is exactly like 

 cholera, except in the percentage of mortality, appear every year. I have 

 been told this in every place I visited. 



In regard to the epidemic of 1902 I think that some of the remarks 

 which have been made here in reference to the probability of variability in 

 the strains of pathogenic organisms are correct. It is very possible that 



