The sanitary condition of these South American cities is far from being the best, and, consequently, there is but little hope that the dis- ease 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 communica- tion 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 al- though 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 in- fected. 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 Fran- cisco, 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 Kussian province of Turkestan, where it meets the Trans-Caspian railway. This railway begins at Samar- cand in Turkestan, and passes through Bokhara, Merv, Askabad and