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578 should seek safety in flight. It is believed that fully 300,000 people left Bombay shortly after the plague developed. There can be no doubt but that these refugees, directly or indirectly, carried the disease to the neighboring villages, and thus contributed to the enormous dissemination of the pest throughout Western India. In the Presidency of Bombay there were reported, in less than three years, more than 220,000 cases, with more than 164,000 deaths. When it is furthermore recognized that the natives concealed the existence of the disease as much as possible, it will be evident that these figures reveal a partial but, nevertheless, a grim truth.

With Bombay and the surrounding country thus seriously infected, it became merely a question of time when the disease would be carried to other ports and countries, by vessels and by overland routes. In spite of the sanitary perfection which we may flatter ourselves on having attained in recent years, it is nevertheless a fact that the disease is slowly but steadily and, as it were, stealthily invading port after port. That the sanitary methods, however, are not at fault is seen in the fact that when an early and prompt recognition occurred, the disease has been held in check. The insidious spread of the disease is rather due to the enormous development of commerce and to the rapid means of communication with distant countries.

From Bombay the plague has spread to ports on the Persian Gulf, on the Red Sea, and has reached Alexandria. Aden, Djeddah, Port Said, Cairo, have all had outbreaks of the disease. Beirut and Smyrna have each developed straggling cases. Isolated cases have been met with in London, at St. Petersburg and in Vienna. However, only three appreciable outbreaks have as yet occurred on European soil. The first was that at Oporto in Portugal, where one hundred and sixty cases, with fifty-five deaths, have developed up to the present time. The second outbreak occurred at Kolobovka, a village near Astrakhan. Of the twenty-four cases that developed there in July and August, 1899, twenty-three died. The last outbreak is that at Glasgow, where the disease made its appearance but a few weeks ago.

In addition to following the great international highway of Suez, the disease has insidiously spread to the countries of East Africa. Mauritius and Madagascar, with the adjoining mainland of Mozambique and Lorenzo Marquez, have become more or less infected, and, if reports are to be credited, it has also appeared in one of the Boer towns and also on the Ivory Coast in Western Africa. Last fall the disease reached South America. It apparently was first recognized at Santos, in Brazil, during October, although early in September, according to reports, a peculiar disease, causing swelling of the glands and death within forty-eight hours, was reported at Asunçion, the capital of Paraguay. At the present time Rio Janeiro is infected.