June 8, 191 1] 



NATURE 



487 



plexing problem, and our knowledge regarding the 

 vehicles of infection and the part plaj'ed by animals, 

 insects, and man in the spread of plague do not at 

 present assist us in its solution. 



From the information available it would seem that 

 the early infected centres suffered severely, while those 

 that were infected later suffered but little. Possibly 

 their immunity was because they were infected later 

 in the season, for the disease towards the end of 

 February and beginning- of March began everywhere 

 to lose its strength and power of diffusion which 

 could not be attributed to preventive measures. This 

 is no new phenomenon with pneumonic plague, and 

 it is one which is well worthy of close investigation. 

 This occasional self-limitation of pneumonic plague 

 independent of active measures in no sense justifies 

 the conclusion that preventive measures are unneces- 

 sary and useless in this form of plague. On the 

 contrary, measures taken earlier would have further 

 curtailed the outbreak. Prompt and early action is 

 important and urgent, because no one can tell when 

 a pneumonic plague is self-limiting and may confine 

 itself to a few villages, or when it may have the 

 force of a pandemic and spread if unchecked from 

 ■country to country. 



While much attention has been directed to the 

 mortality in Manchuria from the pneumonic variety 

 of plague, the ravages of the bubonic form in India 

 have not been noticed, and yet the mortality of the 

 latter far exceeds that of the former. Since i8g6, 

 when the disease was imported into Bombay, there 

 have occurred in India seven million deaths from 

 plague. The mortality varies in different years. 

 Some years it is greater and in others less, but never 

 since the disease appeared in the country has any 

 vear been free of mortality. Two provinces have 

 been affected more than the others. One is the 

 Punjab, with a population of onlv twenty millions, 

 the other the United Provinces of Agra and Oudh, 

 with a population of forty-seven millions. 



The plague deaths in these two provinces during 

 the past twelve years have been as follows (statistical 

 abstract relating to British India from 1899 to 

 1909) :— 



1S95 iqcjo iQot 1902 iqo3 



Punjab 255 572 14,959 171.302 205,462 



United provinces of 



Agra and Oudh ... 7 135 9,778 40,223 84,499 



In the Punjab the plague mortality increased from 

 255 in the year 1899 to 396,357 in 1904; then it 

 declined for two years. In 1907 it rose to the 

 enormous number of 608.685, and in 1908 and 190Q 

 fell to a comparatively low figure. In the United 

 Provinces of Af^ra and Oudh the mortality increased 

 from 7 in the year 1899 to 383,802 in 1905 ; there was 

 then a decline for one vear, a rise to 328,862 in 1907, 

 and a further decline in iqo8 and 1909. Both in the 

 Punjab and the United Provinces the deaths in 1910 

 have again risen, and the upward tendency is being 

 continued in 191 1. particularly in the United Prov- 

 inces, as is shown by the following statement of 

 the plarue mortality in January, February, and 

 to the week ending March 25th : — 



Total 



148,000 



281,000 



In the first three months of loii the deaths from 

 plague in India were 281,000. and in the United 

 Provinces 148,000, which are respectively nearly five 



NO. 2 1 71, VOL. 86] 



times and more than twice the mortality from the 

 disease in China from October to March inclusive. 



With this mortality in China and India it is difficult 

 to realise that only twenty years ago plague was con- 

 sidered to be practically an extinct disease. True, it 

 lingered in some of its old homes, but to such a small 

 extent that it was hoped that even in these it would 

 finally disappear. Now the whole position has 

 changed. The slow but wide dissemination of the 

 disease since it first attacked Canton in 1893 '1"^ 

 Hong Kong the following year, and which has' been 

 followed by the infection of many countries in different 

 parts of the world is one of the most remarkable and 

 sinister events of the age. Its importance hitherto 

 has not been connected with its mortality, for with 

 the exception of China and India the deaths from the 

 disease have been few, but it lies in the fact that 

 every year the sowing of infection among susceptible 

 and subterranean animals becomes more extensive, 

 and that countries which have for hundreds of years 

 been free of plague infection are no longer in that 

 position. 



The danger lies in the disease among animals 

 being permitted to acquire a firm foothold wherever 

 it may be, for the infection in such circumstances 

 is difficult to eradicate. The insidious manner in 

 which the infection gets imported into a country, the 

 ease with which human cases have been hitherto dealt 

 with, and the apparent difficulty the disease has in 

 spreading, or even maintaining' its hold, are apt to 

 lull the suspicions of even the most wary. Thus with 

 no immediate results forthcoming^ it is not surprising 

 for it to be assumed that the twentieth-century 

 civilisation has, so far as the West is concerned, 

 deprived plague of its powers. It was to advancing 

 civilisation the disappearance of plague from Europe 

 was attributed, regardless of the fact that a similar 

 disappearance had taken place in the East, and that 

 recessions and long periods of rest from plague are 

 matters of history. Plague, when it broke out in 

 Bombay, had not been there for 184 years. Until 

 then Bombay had prided itself on its sanitation, with 

 its immense waterworks and drainage ; and its ex- 

 ternal appearance was that of a fine and thriving 



iqo4 1Q05 i5o5 iQo; 190S 1909 1910 



396,357 334.891 91.712 608,685 30,70s 35,655 152.387 



179,082 383,802 69,660 328,862 22,878 39,394 139,328 



city. But plague was the most informing- sanitary 

 inspector it ever had, and revealed the actual housing 

 condition of the people, and it is just as likely, in 

 due time and under favourable conditions, to 

 visit the crowded and verminous slums of the 

 ■cities of the West, where the " awakening of the 

 insects" in the houses is as regular in season as th.it 

 I in China. 



The disease is one which essentially affects the 

 very poor, whose condition still make the cities of 

 Europe vulnerable. It has always been called the 

 poor man's plague. The one great advantage the 

 West possesses over the East, which it did not 

 possess in former times, is the power of trained 

 organisation. It is on intelligent organisation based 

 on scientific knowledge rather than on any great 

 advance in the housing of the very poor in Europe 

 that reliance will have to be placed to combat the 

 disease and to secure safety from any great epidemic. 

 In the meantime, in addition to systematic and con., 

 tinuous measures against infected animals in places 

 where the disease has been imported, .special atten- 

 tion requires to be directed everywhere against ver- 

 minous houses and verminous people. 



W. J. Simpson*. 



