From Long-Cheou the plague descended the Canton River and reached Naning-Phu. From thence it followed overland to the seaport Pakhoi, some hundred and fifty miles distant. A few months later, in February, 1894, it reached Canton, either by descending the river from Naning-Phu or by boat from Pakhoi. That the plague at Canton, in 1894, had not lost any of its old-time destructiveness is seen in the fact that it is estimated to have caused not less than one hundred thousand deaths in Canton in the short space of two months.
From Canton the plague spread to Hong Kong in April, 1894. It was during the existence of this epidemic that the first bacteriological studies of the disease were made and resulted in the discovery of the plague bacillus. In the fall of 1894, the disease died out in Hong Kong, but it reappeared in 1895 and 1896. Considering the fact that Hong Kong is one of the most important maritime centers, it is not surprising to find that in the spring of 1896 the plague was carried by shipping to the Island of Formosa. It is quite certain that about the same time the plague was carried from Hong Kong to Bombay. At all events, the existence of this disease was recognized in Bombay in September, 1896, by Doctor Viegas. Previous to this date, the mortality in Bombay was abnormally high, undoubtedly due to the very unsanitary condition of the overcrowded city.
The existence of famine in India, together with the filthy, overcrowded condition of the population, enabled the plague to gain a firm foothold in a relatively short time. Indeed, there can be no doubt but that the disease was well established at the time it was first recognized. It is no wonder, then, that in spite of the most stringent precautions, it spread like wildfire, so that in a short time the weekly deaths from the plague rose to nearly 2,000. In the face of such a relentless enemy, it is but natural that a large proportion of the population 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. The sanitary condition of these South American cities is far from being the best, and, consequently, there is but little hope that the disease will be eradicated or even held in check. With South America more or less thoroughly infected, it is evident that the United States, as well as Europe, are now threatened from all sides. The gravity of the situation is seen in the fact that already last November two cases of the plague were found in New York harbor aboard a coffee ship from Santos. Several 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.