cases have also developed on ships bound from the latter city for Mediterranean ports.

The United States is threatened not merely from the East Atlantic and South Atlantic, but also from the Pacific. As a matter of fact, the danger to our Pacific ports is greater, owing to the direct communication with the Orient. It has been already indicated that Hong Kong has continued to be infected ever since 1894. On several occasions it disappeared during the winter months, only to reappear in spring. With the more or less constant prevalence of the plague at this great seaport, it necessarily will lead directly or indirectly to a dissemination of the disease along the entire Pacific. Already it has prevailed at Amoy, and has even extended to other Chinese ports as far as Niu-Chwang. For several years it has already persisted on the island of Formosa. Japan was invaded last fall at Kobe and at Osaka, and although it disappeared during the winter, yet only a few weeks ago it has reappeared at the latter city. Sidney in Australia, and Noumea in New Caledonia, are also infected at the present time.

Manila, Honolulu and San Francisco have successively become infected. In all these places the disease, with but very few exceptions, has attacked the native or Oriental population. The extinction of the plague in the Hawaiian Islands since the end of March is a splendid demonstration of what energetic, vigorous measures can accomplish. The presence of the plague since March 8 in Chinatown, in San Francisco, is readily recognized as a most serious condition, especially after the courts have granted an injunction restraining the health officers from carrying out the necessary vigorous preventive measures.

A few words should be given here to the overland dissemination of the disease. Europe is not merely threatened by infected ships which may come from China, India, Eastern Africa or South America. The overland routes from China and India are fully as grave a source of danger. Indeed, as will be presently shown, these are the routes along which the great epidemics of cholera and plague have always traveled in the past.

One of these great caravan routes leads from Lahore in Punjab through Afghanistan into the Russian province of Turkestan, where it meets the Trans-Caspian railway. This railway begins at Samarcand in Turkestan, and passes through Bokhara, Merv, Askabad and ends at Uzun Ada on the Caspian Sea opposite Baku. Early in 1899 an outbreak of the plague occurred near Samarcand, undoubtedly brought up from India. The precautions taken to prevent the spread were entirely successful, and although no accounts have been officially published as to the means employed, nevertheless it will be seen that the radical procedure employed by Loris Melikoff some twenty years ago was again resorted to. Inasmuch as the entire village was said to be afflicted it was surrounded by troops, and no one was allowed to enter or leave. The village and all that it contained was destroyed by fire. With this route open continually it is evident that fresh importation must be expected sooner or later.

Apparently a new plague focus, independent of that in Yunnan and Hong Kong, has been recently discovered in Manchuria. The plague seems to have existed in this province for more than ten years under the name of Tarabagan plague, and is believed to be spread by a rodent, the Arctomis cobuc, which is subject to a hemorrhagic pneumonia. The presence of such an independent endemic focus in Manchuria indicates the possibility of the spread of the disease by caravan to Lake Baikal, and thence by the Siberian railroad to Russia. Indeed, the epidemic of pneumonic type which began July, 1899, at Kolobovka, in Astrakhan, while it may have been imported from Persia, might also owe its origin to the Mongolian focus.

Russia, however, is not the only country endangered by the overland transmission of the disease. There are commercial highways which lead from Northwestern India through Baluchistan and Persia to the Caucasus, and through Turkey to Constantinople. Grave danger threatens from this source, and more especially from the cities along the Persian Gulf. Two important cities here are already infected, namely, Bushire, in Persia, and Bassorah on the Tigris, in Turkey. It would appear as if Turkey and Persia would escape with difficulty from a visitation of this dread disease.

Such, then, is the geographical distribution of the present outbreak of the plague. This, an apparently extinct disease, has suddenly reappeared and given evidence of its power to spread death and desolation. Fortunately, however, modern sanitary precautions are quite able to restrict its progress, provided they be applied at the proper time and place. Filth and overcrowding, protracted wars and famine, have been the powerful allies of the plague in the past. Through their aid this disease has made a deep impression upon the pages of history. It may not be out of place, therefore, to turn from the present outbreak of the disease and trace its grewsome past.

In ancient writings references are found which would seem to indicate the existence of the plague at a very early date. The Bible contains several such references (Deuteronomy, Chapter 28, paragraph 27. Samuel I, Chapter 5, paragraphs 6, 9). The latter especially deals with the plague which attacked the Philistines after they took the ark. The rôle of rats in the dissemination of the disease is, as some believe, apparently referred to in the trespass offering of “five golden emerods and five golden mice.” The return of the ark, together with this trespass offering, brought also the plague, “because they had looked into the ark of the Lord, even he smote of the people fifty thousand and threescore and ten men.” Poussin’s painting of this Philistine plague, exhibited in the Louvre, shows several dead rats on the streets. It is evident that the susceptibility of the rat to the plague had been noticed even at this early date. The plague of boils visited upon the Egyptians as related in Exodus (Chapter 9, paragraphs 9 and 10) has also been taken to indicate the pest of today, but neither of these scriptural references can be said to be sufficiently definite.

The Attic plague, which ravaged the Peloponnesus 430 years before Christ, has been accurately described by an eye-witness, the historian Thucydides. His narration may be considered the earliest exact record of an epidemic. Like all the great epidemics of subsequent ages, it was ushered in by the overcrowding, the misery and the famine consequent upon prolonged wars. The combustible material was there, and all that necessary was the spark to begin the work of death and devastation. It is noteworthy that the origin of the pest was traced by Thucydides to Egypt or Ethiopia, from whence it spread gradually overland to Asia Minor and thence by boat to Athens. The nature of this first great historic epidemic is and will remain uncertain. There are those who consider the Attic pestilence as one of bubonic plague, but the fact that in the very careful description of the disease no mention is made of buboes and the statement that death occurred from the seventh to the ninth day would indicate that the disease was something else. Buboes are characteristic, it is true, of the plague, but it should be remembered that outbreaks of the pneumonic form, with little or no glandular enlargement are not uncommon. Death, however, in the case of plague is very common on the second or third day, and is less liable to occur in more protracted cases. These facts lead to the commonly accepted belief that the Attic pest was not the bubonic plague. It may have been typhus fever, possibly smallpox.

The great pestilence which devastated Rome and its dependencies in 166, Anno Domini, is known as the plague of Antoninus or of Galen. This prolonged epidemic was brought to Rome by the returning legions from Seleucia. It was not characterized by buboes, and