Page:Popular Science Monthly Volume 62.djvu/357

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PREVENTIVE MEDICINE.
351

was about 40,000. The disease also extended westward from Constantinople through Austria and Bohemia.

In 1720 Marseilles suffered a severe epidemic, probably as a result of the introduction of cases on a ship from Leghorn. The mortality was estimated as being between 40,000 and 60,000. From Marseilles as a center it spread through the province of Provence, but did not invade other parts of France. In 1743 a severe outbreak occurred on the island of Sicily. A destructive but brief epidemic, which is estimated to have caused a mortality of 300,000, occurred during the years 1770 and 1771 in Moldavia, Wallachia, Transylvania, Hungary and Poland. At the same time the disease prevailed in Russia, and in 1771 caused the death of about one fourth of the population of the city of Moscow.

Early in the nineteenth century (1802) bubonic plague appeared at Constantinople and in Armenia. It had previously prevailed in the Caucasus, from which province it extended into Russia. In 1808 to 1813 it extended from Constantinople to Odessa, to Smyrna and to various localities in Transylvania. It also prevailed about the same time in Bosnia and Dalmatia. In 1812 to 1814 it prevailed in Egypt, and, as usual, was conveyed from there to European countries. During the same year it prevailed extensively in Moldavia, Wallachia, and Bessarabia. In 1831 it again prevailed as an epidemic in Constantinople and various parts of Roumelia, and again it appeared in Dalmatia in 1840 and in Constantinople in 1841. Egypt, which for centuries had been the principal focus from which plague had been introduced into Europe, continued to suffer from the disease until 1845 when it disappeared from that country.

The last appearance of oriental plague in Europe, until its recent introduction into Portugal, was the outbreak on the banks of the Volga in 1878-79. The disease had previously prevailed in a mild form in the vicinity of Astrakhan and was probably introduced from that locality. An interesting fact in connection with this epidemic is that in Astrakhan the disease was so mild that no deaths occurred, and that the earlier cases on the right bank of the Volga were-of the same mild form, but that the disease there increased rapidly in severity and soon became so malignant that scarcely any of those attacked recovered. This is to some extent the history of epidemics elsewhere, and not only of plague, but of other infectious diseases, such as typhus fever, cholera and yellow fever. In all of these diseases the outset of an epidemic may be characterized by cases so mild in character that they are not recognized, and during the progress of the epidemic many such cases may continue to occur. These cases are evidently especially dangerous as regards the propagation of the disease, for when they are not recognized no restrictions are placed upon the infected individuals, although they may be sowing the germs broadcast.