IN INSULAR POSSESSIONS.

HAWAII.

Examination of Rodents.

Rats and mongoose have been examined in Hawaii as follows: Honolulu, week ended November 8, 1913, 459; Hilo, week ended November 1, 1913, 2,372. None was found plague infected.

PHILIPPINE ISLANDS.

Status of Cholera.

In Manila cholera has been notified as follows: Week ended October 18, 1913, 20 cases, with 14 deaths; week ended October 25, 1913. 19 cases, with 12 deaths.

The majority of the new cases are no longer being found among the shipping population. With few exceptions cholera is occurring in widely scattered sections of the city. It is very rare to find more than one case in any particular district. At times cholera also makes its appearance in towns where it is impossible to trace the origin of the disease. For instance, on October 15, 1913, a case of cholera suddenly appeared at Novaliches, which is an isolated town. about 10 miles from Manila, in the person of a child 9 years of age. The history of the family showed that none of them had been out of Novaliches for more than two weeks. The only food which they ate which was imported into the town was rice and fish. A most careful house inspection was made of Novaliches and not another case could be found, so that it would seem to be fair to assume that there was no general food infection. The child died the next day and upon the return from the funeral the father was seized with cholera. He died the succeeding day and before he could be buried the mother of the child was seized with cholera and died two days later, the diagnosis having been confirmed bacteriologically. The two last cases were of course in all probability contact infection, but there is no satisfactory explanation for the original case.

An exception to isolated cholera cases in Manila occurred in the houses located on premises Nos. 700-714 Calle Camba, in the San Nicolas district. This is practically one large two-story tenement house and is occupied entirely by Japanese, most of whom are fishermen. Fecal disposal is by tight vaults. Cholera occurred on these premises on October 8, 10, 11, 15, and 25, with a total of 5 cases.

Disinfections have been made repeatedly in these houses and special attention was given to the vaults. One vibrio carrier, but not a true cholera vibrio carrier, was found among the contacts of these cases on October 11.

Sporadic cases similar to those described at Novaliches have also occurred at Bacoor, in Cavite Province, and at Paranaque, San Felipe Nery, and Pasig, in Rizal Province. A death suspicious of cholera occurred in a tuberculous prisoner at Bilibid, but the organism could not be recovered, and the death was finally ascribed to chronic nephritis and pulmonary tuberculosis. Two hundred prisoners who were contacts of this patient were examined, but no vibrios were found in any of them. In other instances groups of 20 to 30 persons have been examined from different blocks in Tondo and San Nicolas, and in two instances true cholera vibrio carriers were found.

Cholera Carriers.

From the table which follows it will be seen that there is much reason to believe that there are many cholera carriers in the city of Manila. Cholera perhaps does not become epidemic; first, because the organism is apparently not very virulent; second, because the disposal of human excreta has been improved since the last outbreak of cholera; third, because of the promptness with which the cases are discovered and disinfecting measures carried out; and, fourth, because the modern sewer system, with the sanitary plumbing, which is now gradually coming into use in all sections of the city.

In order to deal with the vibrio problem, general disinfection of vaults and privies in the more crowded sections of the city has been carried out.

The following table is appended to show the number of contacts of each case of cholera that were examined, with the vibrios and the true cholera vibrios found in each.

The table also shows that of 59 toilet facilities reported upon only 18 were of the modern type. In other words, in 69 per cent of the buildings the disposal of human excreta was unsatisfactory. This fact is in all probability intimately associated with the spread of cholera.

FOREIGN REPORTS.

CHINA.

Dengue-Amoy.

Dengue was reported prevalent at Amoy November 3, 1913.

Cholera-Plague-Hongkong.

During the week ended October 6, 1913, 5 cases of cholera and 4 cases of plague with 4 deaths were notified in Hongkong. During the same period 2,476 rats were examined at Hongkong for plague infection. Of this number, 1 was found to be plague infected.

Plague-infected Rats-Shanghai.

During the two weeks ended November 1, 1913, 488 1ats were examined at Shanghai for plague infection. Of this number, 6 were found to be plague infected.

Status of Plague-Plague-Infected Rats-Yokohama.

To November 12, 1913, 19 cases of plague were notified in Yokohama. The disease has been confined chiefly to coolies working on the water front. The total number of rats found to date to be plague infected was 78.

JAVA.

Status of Plague.

Plague has been notified in East Java as follows:

During the week ended November 5, 1913, 10 cases of cholera with 9 deaths were notified in Roumania, making a total from the beginning of the outbreak to date of 5,666 cases, with 2,918 deaths. On November 5, 1913, 49 cases remained under treatment.

RUSSIA.
Plague.

During the period from September 26 to October 19, 1913, 56 cases of plague with 51 deaths were notified in Russia, the cases being distributed in 4 localities in the Don territory. The disease was of the pneumonic form.

TRINIDAD.

Yellow Fever on Vessel.

A case of yellow fever was notified November 28, 1913, on steamship Peter Hamre, at Trinidad.

ZANZIBAR.

Examination of Rats-Zanzibar.

During the two weeks ended October 14, 1913, 2,083 rats were examined at Zanzibar for plague infection. None was found plague infected.