In the latter year the disease was reintroduced.
Rats become infected with it, and fleas transmit it from them to human beings.

It was probably brought in by pestiferous rodents hidden inside packages of vegetables, as it appeared in a district where crates of vegetables are opened in large numbers, and did not appear in the vicinity of the piers, although shore rats are abundant there, and if diseased rodents had landed from shipping, would promptly have become infected,--a thing which did not occur.
At about the same time plague also appeared at Iloilo, where it was eradicated with a total of nine deaths.

At Manila there have been up to the present time [504] fifty-nine deaths, and scattering cases continue to occur at considerable intervals.
Had plague not been promptly and effectively combated, it would unquestionably have spread rapidly, causing untold misery and heavy property losses.
As I have previously stated, at the time of the American occupation smallpox was by many people regarded as an almost inevitable ailment of childhood.

It proved necessary to secure the passage of legislation forbidding the inoculation of human beings with it to prevent misguided Filipinos from deliberately communicating it to their children, not because they did not dearly love them, but because they regarded infection with it as a calamity sure to come sooner or later, and desired to have it over with once for all.
We have performed more than ten million vaccinations, with the result that the annual deaths from this disease have decreased from forty thousand at the outset to seven hundred for the year just ended.

There is now less smallpox in Manila than in Washington.
In the six provinces nearest Manila it was killing, on the average, six thousand persons annually.