????A DISTRICT.]                                       237
Plague measures in Poema City are differentiated from those in the other large towns
of the Presidency by a striking characteristic ; the rigid enforcement of the production of a
certificate of the cause of death before disposal of a dead body. Doubtless this measure
conduces to the detection of plague, but the sustained violence of the recent epidemic seems to
show that it is of little use in combating an outbreak.
It has been stated that the third epidemic began in the latter half of February 1899, the
total mortality during January was, however, every high ; but this is explained by Major
Rende :-
"(3) During January and February  1899, measles and influenza were prevalent in
epidemic form, causing a large mortality amongst the young and the very old, also their
sequels, pneumonia and bronchitis. In January 1899, the monthly mortality of the town was
385, and for the sake of comparison it will be convenient to take January 1896, which was
a year free from plague, at least the early portion of it. In January 1896, the monthly
mortality was 259, but this excluded still-born children, of whom 24 are included in the Janu-
ary 1899 statistics ; this would lower the number in the latter year to 361.
The mortality of children under five years of age during January 1899 was 208, whereas
in the corresponding month of 1896 it was only 59. The deaths in this class alone would
more than account for the increased mortality, not reckoning the 24 still-boras which are
included in the 1899 statistics.
(4) A plague epidemic does not take its start amongst persons of this age, but com-
mences in the vigorous adult class, who move about seeking work, and are therefore more
exposed to zones of infection. It is quite inconceivable that undetected plague could have
existed in the town and not be detected by the medical officers on corpse-inspection, as it
must be remembered that these officers were specially skilled in the work, and it was largely
owing to the thoroughness with which this work was carried out that cases of plague had been
detected and limited in their spread in the preceding ten months. To suppose that an
epidemic of plague can exist in the town with a selective agency for children under 5 years
of age, and showing none of the objective features of the disease, would certainly revolutionize
our present knowledge of the disease. If additional data are necessary to dispel the suspicion
that the increased mortality we suffered from in Poona during the early months of this year
was due to plague, they could be found in the immunity from plague in the Cantonment and
neighbouring villages.
( 5 ) If the excess mortality had been due to plague, it would mean that over a hundred
deaths in the month were unrecognized, and that no precautions were taken ; and this non-
recognition of the disease would surely have led to an outbreak in the neighbouring Canton-
ment and villages.
(6)    For a clear comprehension of this subject it has been necessary to devote some
space to the subject ; it is a matter of considerable  importance,  as an increased death-rate
in a town which is   exposed to plague infection is  usually   the danger  flag  preceding an
epidemic ; but with a reliable death registration, this signal of danger would be recognised
on the first imported case of the disease coming into the town.
(7)     During the month of February, after the town had been infected with plague,  the
mortality amongst children was less ; whereas the mortality amongst adults was  greatly in
excess, this excess being due to plague."
Of the origin and gradual  spread   of the   outbreak,  Major  Reade   gives the following
description :-
"The present outbreak of plague commenced early in February, and can be traced to an
imported case from Bombay, the illness for several days being concealed. The servant
of a Bhatia merchant came from Bombay, but it is not known whether he was ill at the time
of his arrival or in the incubation stage of the disease. Just before his death, he was removed
from his master's house, 638 Sadáshiv Peth, to 191 Shukrawár Peth, where he died of plague
on February 12th. On examination of the corpse the death was pronounced to be due to
plague. On the 13th of the same month the daughter of the Bhátia merchant died of plague
in her father's house in Sadáshiv Peth.
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