CHAPTER I.
GENERAL REVIEW,
Part II.—Measures and their Results.
Since plague began in this Presidency in September 1896, no effort has been spared to
eradicate it from Bombay City and the other places where it first appeared : to check its dis-
semination and spread to other places : to prevent recrudescence or re-infection in places
where outbreaks had occurred and the disease had apparently died out. Hardly any such
effort, however, whatever its direction, has been completely successful. Bombay City, Poona,
Karachi and many others, have, year after year, in spite of the most strenuous efforts, suffered
from epidemic after epidemic ; the area of infection, which, extensive as it was at the close of
the first year, was yet clearly limited, now practically covers the entire Presidency: Hubli,
Dharwar, Satara, Surat, Nasik, Godhra, and many other large towns, in spite of every effort
to save them while as yet they were only threatened, suffered from severe outbreaks. Mea-
sure after measure has been tried to prevent infection, to minimise dissemination, to check an
incipient outbreak—has been tried, and to some extent, at least, found wanting.
The reasons for this want of succese may be found in our ignorance of the origin and
modes of spread of the disease ; in the failure of the people to comprehend its characteristics,
and the value of the measures—in the proper enforcement of which their co-operation is
essential ; and in some measures, perhaps, to the limited scope of the measures themselves.
These reasons are supported by the following evidence.
The plague measure hitherto most universally adopted and most uniformly successful has
been evacuation, i. e., the desertion of an infected locality by its inhabitants and their trans-
ference to another place. There is a great deal of evidence to show that such action has
excellent results in reducing the virulence and duration of an outbreak ; but the results have
been in a great many instances spoiled. As far as is at present known, and as far as present
evidence permits of a theory, the infection of plague appears to be an infection of locality.
That is to say, that a place becomes infected, and a person stopping in such a place is in
danger of getting plague. If this theory is true, then the good results of evacuation aro
easily understood, as it removes the people from the sphere of infection.
Where evacuation has been attended with a want of success, therefore, the reason is per-
haps to be sought in the return of the people to the infected locality either with or without
permission. This is due more to the people's failure to appreciate the clanger attending such
visits, than to their impatience of a slight temporary inconvenience.
Quite other, again, are the reasons of the powerlcssness of Railway Medical Inspection to
prevent dissemination : which arc, first, the limited scope of this measure, in that it docs not
affect people travelling by road either by carriage or on foot : and second, that the methods
by which plague is spread being unknown, it is necessarily uncertain how far railway inspec-
tion affects those methods. The theories on plague dissemination are so many and so various
that the measure that would embrace them all would indeed be a far-reaching one. Moreover,
in the incubation period, the diagnosis of plague is so difficult as to discount in some degree
the value of any inspection, however careful.
And so with other measures. It is needless to enlarge upon them here, as they are each
treated in detail in their proper places. Yet, in spite of the luck of completo success, a large
share of success has undoubtedly crowned the efforts made in many directions to combat the
progress of the disease,