1974 deaths. Japan itself has had a certain amount of imported
plague, but not on a large scale. Speaking generally, the disease
has persisted and spread in the Far East since 1894, but Precise
information is lacking, except with regard to Hong Kong.
W. J. Simpson in his Report on the Causes of the Plague in
Hong Kong (1903) reports the endemicity of the plague in that
colony to be maintained by (a) infection among rats often
connected with infectious material in rat runs or in houses, the
virus of which has not been destroyed, (b) retention of infection
in houses which are rat-ridden, and (c) infected clothing of people
who have been ill or died of plague. He considers the outbreaks
are favoured by the seasonal heat and moisture of the spring
and early summer, and the movement from place to place of
infected rats or persons. He also believes that human beings
may infect rats. In 310 cases of plague examined by Simpson
56% were bubonic, 40% septic and 4% pneumonia.
In 1896 plague appeared in the city of Bombay. It was certainly present in August, but was not recognized until the 23rd of September, and the diagnosis was not bacteriologically confirmed until the 13th of October. This fact should be remembered when failure to recognize the disease on its first appearance occurs elsewhere. The origin of the Bombay invasion is shrouded in obscurity. It is not even known when or in what part of the city it began (Condon, The Bombay Plague). Several theories have been put forward, and importation by sea from China is the theory which has met with most acceptance. The native form of plague, known as mahamari, is confined to the southern slopes of the Himalaya. It is described above, but that account may be supplemented by some earlier references unearthed by the Bombay Gazetteer (vol. iv.). Ibn Batesta notices two destructive pestilences in the 14th century, and Ferishta one in 1443, which he calls ta’un, and describes as very unusual in India. At the end of the 16th century there was a pestilence following a prolonged famine, and in the 17th century two violent epidemics are recorded under the names ta’un and waba. In the second of these, which occurred in the Ahmedabad district of the Bombay Presidency in 1683–89, buboes are distinctly described. In the 18th century several pestilences are recorded without description. It is at least probable from these notes that even before the undoubted outbreak, which began in Cutch in 1812, India was no stranger to epidemic plague. To return to Bombay and 1896: the infection spread gradually and slowly at first, but during the first three months of 1897 not only was the town of Bombay severely affected, but district after district in the presidency was attacked, notably Poona, Karachi, Cutch Mandvi, Bhiwandi and Daman. The number of cases and deaths reported in the presidency, exclusive of the city, in each year down to the end of 1899, was as follows:—
| Year. | Cases. | Deaths. | Case Mortality. |
| % | |||
| 1896 . . . | 367 | 273 | 74·3 |
| 1897 . . . | 49,125 | 36,797 | 74·7 |
| 1898 . . . | 90,506 | 68,061 | 75·2 |
| 1899 . . . | 131,794 | 101,485 | 77·0 |
| Total | 271,792 | 206,616 | 75·8 |
The corresponding figures for Bombay city are:—
| Year. | Cases. | Deaths. | Case Mortality. |
| % | |||
| 1896 . . . | 2,530 | 1,801 | 71·1 |
| 1897 . . . | 11,963 | 10,232 | 85·7 |
| 1898 . . . | 19,863 | 18,160 | 91·2 |
| 1899 . . . | 19,484 | 15,830 | 81·3 |
| Total | 53,840 | 46,023 | 85·4 |
The total for the presidency, including the city, in four years was 325,632 cases with 252,549 deaths in a. population of 26,960,421 (census of 1891). The population of the city is 821,764, but during the earlier plague period large numbers fled, so that the foregoing figures do not give the true plague incidence according to population. Moreover, concealment was extensively practised. The most striking fact brought out by the tables just given is the large and steady increase year by year in the presidency, in spite of all efforts to arrest the spread of infection. It has gone on since 1899, and it has not been confined to Bombay, but has extended over the whole of India. In 1897 it had already penetrated to Rajputana, the Punjab, the North West Provinces and the Central Provinces. In the following year Bengal, Madras, Haidarabad and Mysore were invaded. Not all these provinces suffered alike, but on the whole plague steadily strengthened its hold on India generally, and hardly relaxed it in any part. The most noteworthy details available are as follows, taken from the plague mortality returns published June 1908. In the Punjab from 179 deaths in 1897 the mortality reached a maximum of 334,897 in 1905, in Agra and Oudh they rose from 72 in 1897 to 383,802 in 1905, and in Madras Presidency from 1658 in 1899 to 20,125 in 1904.
The most striking figures, however, are those for Bombay and Bengal which are given below as well as the total mortality in India.
| Year. | Bengal Presidency (including Calcutta). | Bombay Presidency (including Bombay City). | All India. |
| 1896 | — | 2,219 | 2,219 |
| 1897 | — | 47,710 | 47,974 |
| 1898 | 219 | 86,191 | 89,265 |
| 1899 | 3,264 | 96,592 | 102,369 |
| 1900 | 38,412 | 33,196 | 73,576 |
| 1901 | 78,629 | 128,259 | 236,433 |
| 1902 | 32,967 | 184,752 | 452,655 |
| 1903 | 65,680 | 281,269 | 684,445 |
| 1904 | 75,438 | 223,957 | 938,010 |
| 1905 | 126,084 | 71,363 | 940,821 |
| 1906 | 59,619 | 51,525 | 300,355 |
Outside China and India plague has caused no great mortality in any of the countries in which it has appeared, with the exception perhaps of Arabia, about which very little is known. But some of the outbreaks are interesting for other reasons, and require notice. The first case is the singular occurrence of three deaths at Vienna in October 1898. The earliest victim was an attendant named Barisch, employed in the pathological laboratory of the Vienna General Hospital, and told off to look after the animals and bacteriological apparatus devoted to the investigation of plague, cultures of which had been brought from India. by the medical commissioners sent by the Royal Academy of Science in 1897. Barisch was drunk and out all night on the 8th of October, on the 14th of October he fell ill. Plague was suspected, but Dr Müller, who attended the man and had studied the disease in India, would not admit the diagnosis on clinical grounds, nor was it bacteriologically established until the 19th of October. Barisch died on the 18th of October. On the 20th one of the nurses, and on the 21st Dr Müller, fell ill. Both died of pneumonia plague, from which also Barisch had undoubtedly suffered. A second nurse and a sister of mercy had feverish attacks, but no further case occurred. Barisch was shown to have been careless in the performance of his duties, and to have disregarded instructions; and the inference is that he conveyed the infection to his mouth, and so to the lungs, from the bacteriological specimens or inoculated animals. The melancholy incident illustrates several points of interest: (1) the correctness of the bacterial theory of causation, and the identity of the bacillus pestis as the cause; (2) the infectious character of the pneumonia type of disease; (3) its high fatality; (4) the difficulty of diagnosis.
The next occurrence of special interest is the appearance of plague in Portugal in 1899, after an absence of more than 200 years. Its origin is shrouded in obscurity. Oporto, the seat of the outbreak, had no connexion by sea with any place known to be infected, and all attempts to trace introduction ended in speculation or assumption. The most probable theory was that soldiers returning home from infected Portuguese possessions in the East brought it with them, but this does not explain the selection of Oporto and the escape of other places. The earliest
