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plague cases. There are few if any authentic instances where the disease has been communicated to such patients after their admission into the ward of a plague hospital.
The experience in Hongkong is the same. WILM reported the rareness of the disease amongst those engaged by the Sanitary Authorities to carry out the removal of plague cases and the disinfection of plague infected houses.
I have also observed the relative insusceptibility of the attendants on plague cases in the Kennedy Town Infectious Diseases Hospital.
In wards full of plague cases of all types of the disease, the air, if it were a fertile ground for the dissemination of the infecting attendants, medical men, etc., who, beyond washing their hands in dilute Jeye's fluid, take practically no other precaution.
The report of the various Commissions, and in particular the Indian Plague Commission, are strongly against the air as a spreader of plague infection.
They state: Plaque does not spread in a hospital. It has been stated in India that the ward of a plaque hospital is one of the safest places during an epidemic.
Again plague patients have been treated successfully in well ventilated rooms of their own residences without any extension of the disease to the other in- mates of the house.
The importance of the spread of plague by air is apparently insignificant.. That such a thing does occur is true. Generally speaking, primary pneumonic plague is mainly spread by drop infection. Septicemic plague is in all probability rarely spread by dust or air.
Pneumonic plague cases ought to be strictly isolated. Septicæmic plague cases may be isolated, provided there exists a well equipped Infectious Diseases Hospital.
The reports made by THOMPSON on the treatment of plague in Sydney are confirmative of the foregoing. In hospitals in the tropics. there would appear to be little chance of the spread of a disease like plague through the air. With open doors and windows, etc., the chances of such a mode of infection are reduced to a minimu1n. In such free air there is an enormous dilution of the infectious material and this is supplemented by air currents producing energetic mixing and rapid transport of pathogenic germs.
Further, pathogenic bacteria soon disappear from the air. They adhere to floors, walls, trees, etc., and die as the result of various well known extraneous and deleterious influences.
Even although these germs are in the vicinity of man, they can rarely be inspired by him owing to the weak suction power of his inspiratory stream, com- pared with the much greater velocity of the wind-driven infectious material.
Until quite recently our ideas in regard to the bacterial content of the air, and its role in infection, were much exaggerated.
Recent investigations, particularly those made by FLÜGGE'S school, have clarified our opinions in regard to this medium and considerably reduced the importance of air as a medium of infection.
WILLIAM HUNTER.
Water and Water Supplies in Plague.
Plaque would appear not to be spread by water. Opinions are widely divergent as to the length of life of the B. pestis in water.
In ordinary tap water, I have kept the organism alive for 15 days at the room temperature during the cool season of the year.
In distilled water, which in itself is bactericidal, it dies in about 3 days.
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