and she departed. The next woman, ushered in after the expected bell had been sounded, was a native of Fez. She was a servant in the family of a Moorish gentleman (?), who, when the doctor was calling on his wife, in company of a young English girl, then and there expressed his wish to marry the latter. The elder lady ventured to point out that he had already a nice wife of his own, but this was considered no impediment to his proposal. He could divorce her, he said. So easily and lightly can the marriage bond be broken in a barbarous country like Morocco. Our young countrywoman fortunately did not understand the conversation, or she might have felt somewhat embarrassed under the circumstances. Another woman and her little daughter were the next to enter the consulting room. They were extremely poor and none too clean. The sad-looking child was suffering from swollen glands. The mother seemed to be fond of her, and said that the little girl was her only child and she thought she was about to die; but the doctor was able to reassure her, and they left cheered. The next woman admitted had a gentle face with a sweet expression. She sat down on a stool by the doctor, and spoke to her in a confiding way. She wished to procure medicines for a very suffering daughter, whom the doctor had already attended. The patient who followed was a very curious-looking woman with a gloomy expression of face. Her raven-black hair fell in plaits; her haïk being thrown back, I could see that her neck and arms were all tattooed. She was badly marked with smallpox; indeed, the disease had almost deprived her of the sight of one eye. The other was now giving her much trouble, and she had come a threedays' journey in order to see the doctor. After she had been treated a more cheerful person entered, though there had been much in her past history to cause her depression. She had probably been injured for life by the barbarous treatment she had received at the hands of a jealous wife. On the occasion when I saw her, her mouth was troubling her, for she lamented that her flesh was mounting and leaving her teeth naked.' She was much gratified by receiving a toothache remedy. A little girl, a child-servant, appeared with a very inflamed finger, but it was too dirty to be properly examined, and she was dismissed with the native attendant, who was told to wash it for her. A grandmother then brought in a very handsome boy with magnificent black eyes, very becomingly dressed in a white 'gelab' (cloak), with its pointed hood drawn over his head, a bright pink caftan' (a long indoor garment) being visible beneath it. The woman seemed devoted to this child and kissed him affectionately. Happily there did not appear to be very much the matter with this attractive little fellow, and the granny with her precious charge soon made way for a sweet-faced woman with a very sad history. Her husband, who, unlike many Moors, was very fond of his wife and had refused to divorce her because she had no son, was then lying in prison. He had happened to live in a house next door to one in

which a murder had been committed. Though guiltless, he was seized, and efforts had been unavailing to release him, as, unfortunately for him, he had some property which, in the iniquitous country of Morocco, could be squeezed' out of him. A friend who was accompanying me had to leave early, so we could not hear particulars about the next patient. However, I trust enough has been said to prove that the suffering women of Morocco are sorely in need of aid, and perhaps this can be afforded in no better and more practical way than by the establishment of medical missions. It is needless to say that the doctors work under great difficulties. I have alluded to that of lack of funds; another consists not only in the acquirement of a very hard language, but also in the right understanding of the patients' descriptions of their maladies. I will give one which might puzzle even a very expert physician in his diagnosis of the case. It is as follows: 'My head is imprisoned, it is all contracted. Sometimes I have no eyes. I am dead, and cannot raise myself off my bed.' 'Something got into my head, whether from my ears I do not know; it then went down into my chest, then journeyed into my breast, from there to my stomach; it then went into my legs. Please, I want some medicine to take away the pain from my head, and for the illness to go out of my feet.' The woman was suffering from a cold in her chest and neuralgia.

There is one branch of the work for suffering women and children in Tangier which has scarcely been touched as yet-that amongst patients of a higher social grade. In some ways the poorer native women are better off than their richer sisters. The work done by females is often arduous and unfitted for women, but at any rate it is better for them to labour than merely to exist, alternately eating and sleeping. The idleness and indifference engendered by the total lack of interest is lamentable. The doctor, on one occasion, hearing that a child was ill, made her way to the house where a richer Moorish woman resided, but failed to obtain admittance. She was put off with the message, 'The child is better,' but in a day or two the little one was no more. However, with time and patience the medical missionaries will doubtless overcome prejudice and gain access to houses where as yet they have failed to enter. They have done much, and the natives are beginning to realise this, judging from a remark I recently heard. Passing by the market-place in company of the doctor, we heard a woman, in the loud, guttural tones of unmusical Arabic, saying some such words as these: When a man falls we walk over him, but the Nazarenes pick him up.' To 'raise the fallen' is the blessed office the brave workers of the medical mission have been endeavouring to effect. They have had considerable success. Would that English men and women, going amongst people of different race and creed, could oftener be known as accomplishing so noble a task !

M. J. MEATH.

FIGHTING THE

BUBONIC PLAGUE IN INDIA

THE first historical mention of Plague is of an outbreak in Lybia, in the third century before Christ. Again, we read of bubonic Plague in the Great Plague of Justinian, in 542 A.D. In the fourteenth century the Black Death' appeared in Southern Italy, 1346-47, and spread over Europe, reaching England in 1348, where it appears to have remained for five or six years. A second epidemic occurred in 1361, and a third in 1368. In the fifteenth, sixteenth, and seventeenth centuries, outbreaks in Great Britain are recorded. The Great Plague of London in 1665, in which 70,000 persons died, was the last English epidemic of Plague. Plague occurred frequently in European countries up till 1841. In Russia it is endemic, sometimes of a mild type, but more often virulent.

In India, Plague has probably existed since 1815, from time to time in a sporadic form and under many names in various parts of the country, with no reliable information as to mode of origin. In the autumn of 1896 a severe outbreak occurred in Bombay, which was preceded by an epidemic among rats of a fatal, but hitherto unknown, disease. From Bombay, Plague was carried to many upcountry districts, and the Presidency has practically not been free of the disease since August 1896, despite the many precautions taken by Government.

Plague is a highly infectious disease, due to the presence of a micro-organism in the blood, discovered by Kitasto in 1894. There are two distinct types: (1) bubonic, in which the glands become enlarged in one or more groups; (2) pneumonic, in which pneumonia is apt to be the chief symptom, and is of the gravest import. There is considerable fever in Plague, and the most common cause of death is heart failure, as a result of the high temperature. There is often much mental disturbance, which may go on to violent delirium, when the patient not infrequently roams about if not carefully watched. Such are the cases which one may come upon in the road, and it was not uncommon in Bombay and Poona, during the epidemic, to see a man fall to the ground a few yards in front of one, and to find on reaching him that he was dead.

Convalescence in Plague was slow, and, unfortunately, one attack is not protective against a second. We had several cases in hospital of a recurrence in less than six months.

In order to gain some idea of the methods adopted to meet an outbreak, it will perhaps be interesting to take a town which has become infected, and mention in detail the lines on which the Plague authorities proceeded.

For this purpose Poona will serve, as it was the seat of a severe outbreak in September 1896, followed by a recrudescence in 1897, with an enormous mortality. What was done in Poona may be regarded as an indication of the lines of action adopted elsewhere, with modifications to suit the various districts affected. There was only one week in June 1897 without a reported case of Plague since the onset in 1896.

The attitude taken by the Poona Plague Committee was much like that of a general surrounded by a treacherous, but invisible foe, bent upon entering and destroying his lines by stealth.

Early in the Bombay epidemic of 1896 the natives left that city in crowds, and undoubtedly carried the disease into Poona, among other places.

The lack of sanitary arrangements in Indian towns has much to do with the difficulty of checking an epidemic, besides furnishing an excellent nidus for micro-organisms.

In Poona City, which has usually a population of 130,000, the streets are narrow and ill-paved, with open gutters running along the sides, into which every conceivable kind of filth is thrown. The houses and shops are badly built, with few or no windows, and of course no fireplaces, which means a complete absence of ventilation during the night hours, when the door is shut, and the rooms densely packed with human beings. Although quite half of the population had fled in terror of Plague, the streets in the native parts of the city were thronged with people towards evening. Many houses and shops were sealed by magistrates' orders; and it was not uncommon to see Gone to Bombay' chalked over a shop door. This is of particular interest when one remembers that Bombay became badly infected as Poona got free of the disease.

In dealing with the natives it has to be borne in mind that an Englishman meets with innumerable difficulties on account of: (1) caste prejudices; (2) superstition and fatalism; (3) native ignorance and distrust of all sanitation; (4) the dishonesty of many native officials, combined with a perfect genius for misrepresenting Government's orders, to suit their own ends; (5) the existence among natives of a freemasonry, which enables them to conceal sick or dead friends in a truly wonderful manner. That they themselves keep the epidemic alive by their conduct never seems to occur to them.

In July 1897 there was a weekly record of about 14 cases

in Poona; August, September, and October showed increasing numbers. In the first week of November 650 cases were notified, with 460 deaths.

In all there were over 2,000 cases in November; 1,600 in December, and from then a rapid decrease in numbers, so that March 1898 virtually saw the outbreak at an end, but not without a truly appalling loss of life; of which statistics give no true record, on account of false returns given by natives of the cause of death.

Throughout the epidemic, Poona cantonment, which is quite distinct from the city and has a population of about 105,000, invariably showed fewer attacks; this was no doubt largely due to the better sanitation prevailing.

Having now seen what an active and relentless foe was in their midst, the authorities, medical, military, and civil, combined to fight it, inviting and encouraging the co-operation of the educated natives. With the apparent end of the epidemic in June 1897, the system of house to house visitation was allowed to lapse and corpse inspection by medical officers took its place. That this was insufficient the rapid strides made by the disease in the early autumn months showed. In September, when the weekly list of cases rose to 100, the Plague Committee again called in military aid, and work was carried on in city and cantonment with great activity.

The city, which was the stronghold of the enemy, so to speak, was divided into ten wards, for each of which an English officer and doctor were responsible, working with a given number of soldiers and native helpers under them.

The duties were manifold and varied, consisting of: searching for and removing to hospital all cases of Plague; transferring friends and relatives who had been in 'contact' to Segregation Camp; supervising the disinfection and white-washing of infected houses, and, when required, making a window in rooms not possessing such a luxury. A census of persons in each ward was kept by the officer in charge. On the walls of an infected house the search party' painted date, number of attacks, and deaths, for future reference. Every house was visited in turn; but there is no doubt that many cases eluded the vigilance of the soldiers.

6

The friends used to keep a look-out from the house-top for the 'search' parties, and then remove their sick from house to house till it was deemed safe to return to their own homes, after the soldiers had left the district for the day. 'Surprise' visits often brought to light such cases. Even if the patient were handed over, the clothing, such as it was, would be given to a neighbour to prevent it being disinfected. All this meant, of course, a further spread of infection. The introduction of the cordon system was the result. From the daily returns it was easy to ascertain which streets were most infected, and the next morning these were surrounded by a cordon of soldiers, thus