GEO GRA FHIC DISTRIB UTION OF B UB ONIC PL A G UE 1 09 



they live, but also to the fact that the}^ seldom wear shoes and stock- 

 ings, and thus are ver}' liable to infection through insignifiqant wounds, 

 scratches, or abrasions, both of the feet and hands. In this connec- 

 tion it is well to call attention to the fact that in former epidemics 

 physicians have suffered severel3% and that whatever immunity they 

 enjoy is due to the observance of sanitar}^ precautions, the importance 

 of which has become apparent as we have acquired a more exact 

 knowledge of tlie etiology of the disease. It is said that more than 

 half the French ph3^sicians in Cairo perished from plague during the 

 Eg3'ptian epidemic in 1843, and in the Russian epidemic, having its 

 principal focus in the town of Vettianka, in the year 1879, three 

 physicians and many of the nurses who cared for the sick succuml)ed 

 to the plague. 



The appearance of plague in Bomba}^ in 1896 is usually ascribed to 

 importation from Hongkong. The first cases occurred in the montli 

 of August, but it was not until December that the death rate became 

 alarming, the mortality for the last week in this month being 1,384. 

 In .January the mortality was nearly 5,000 and in February 4,600, 

 although by this time the population of the city had been diminislied 

 by about one-half by the flight of its inhabitants. In March there 

 was a notable reduction in the number of deaths, and this continued 

 during April and May, and in August the disease had almost disap- 

 peared ; but early in 1898 there was a recrudescence of the epidemic, 

 and in November of that year the total mortality had reached 26,423. 

 The disease extended throughout the Bombay Presidency, following, 

 as a rule, the lines of railway. In this way it reached Surat and 

 Baroda, on the northern line ; Poona, Karad, and Miraj, on the south- 

 ern; Calcutta and Nasik, on the eastern, and Sholapur and Hydera- 

 bad, on the southeastern. The total mortality in the Presidency of 

 Bombay up to the latest reports (November 11, 3 899) has been 

 164,083. At the same date bubonic plague was prevalent to a greater 

 or less extent in China, Egypt, .Japan, Formosa, Madagascar, the Straits 

 Settlements, Persia, Portugal, the Argentine Republic, and Brazil. 

 Quite recently cases have occurred at Honolulu, in the Hawaiian 

 Islands, and at Manila, in the Philip[)ines. The disease has also 

 been introduced into New Caledonia, and from there to Sydney, 

 Australia. What the future history of this disease may be in coun- 

 tries where, owing to a dense and ignorant population, modern san- 

 itary measures are difficult to enforce, no one can say ; but, as stated 

 at the outset of this i);4)(;r, sanitarians have little apprehension with 



