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which occupied much time, it was discovered that other suspected cases had occurred in adjoining houses and had gone home and died in their villages in China. It was a locality also in which an infected rat had been found some time before. The block of buildings to the extent of some 20 houses were closed and the inmates were temporarily housed by the Government in a new set of buildings. On examination of the block after its abandonment, 23 dead rats were discovered and the houses themselves were found to be rat-ridden in floors, ceilings and walls; a rat could pass

from one end of the block to the other through these rat runs.

25. It is important to thoroughly grasp the fact that plague spreads slowly at first whether among rats or human beings. It is no doubt influenced by the wea- ther, so are armies, which seldom mobilise or carry on active operations in the depth of winter, and it is during a mobilisation of plague, which is a slow process at first but very rapid afterwards, that effective work can be done to destroy it. When an epidemic once gets beyond a certain stage none of the measures which were useful at the beginning will influence the duration of its destructiveness. Measures such as the vacating of a whole block, on account of rat or human plague will prove succesful if applied promptly and at an early stage, but cannot be recommended later on because of their impracticability.

26. The abandonment of the block is a mere temporary measure and of little permanent value unless the rats in the block are destroyed and the houses made rat- proof. In many of the old houses I have examined, I find the footings of the walls consisting of loose rubble stones so that rats are able to pass easily under the floors from house to house, and in old houses with hollow walls to pass up to the ceiling and often by this means into the rooms of the upper storeys. The filling up of the rat runs in the footings with glass and cement and a three or four-inch layer of cement on and at the sides of the footings and on the floor are necessary to render the ground floors safe.

27. As in the vacating of large blocks, which is quite feasible and useful at the commencement but which is impracticable later on, so it is with the isolation of contacts. After a certain stage, it is impracticable to provide for contacts and keep them under observation. The vacating of the house is the chief measure. When this is done promptly it has been ascertained that the number of contacts falling ill afterwards forms but a small percentage. If arrangements are made for the disinfection of the clothing and effects of the contacts and they are thoroughly examined by a medical man, they can be allowed to go to certain districts, pro- vided it was not a case of pneumonic plague which, at the highest computation, forms a very small percentage of the plague cases. In such a case the contacts from the floor should be provided for.

The system until lately practised of vacating a floor for six hours only during the fumigation should, therefore, be replaced by a complete vacation of the building in all cases.

28. If a case of plague occurs in a house a medical inspector with an inter- preter should immediately visit the house and make as careful an enquiry as possible into its history and the manner in which it was probably caused. If it is a case of pneumonic plague the inmates of the floor should be treated as contacts and isolated for 10 days. If not a case of pneumonic plague the clothes and effects of the inmates of the floor should be disinfected by steam and they should be permitted to leave. If it is possible to get them to report themselves for ten days at the Sanitary Office of the district in which they reside, it is useful; if not possible then the risk run is after all small. The house itself should then be vacated; and by the house I do not mean the one room which may contain half a dozen families, but the whole building; and a bye-law should be passed without delay to