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THE PLAGUE AT KOLOBOVKA IN 1899.

So little has up to the present time been published concern-ing the outbreak of plague at the mouths of the Volga in thesummer of last year that a paper describing in full detail theprincipal features of the outbreak is unusually welcome.Such a paper has recently been published by Professor A. M.Levin,l who was among the first group of medical men whoinvestigated the epidemic on behalf of the Russian ImperialPlague Commission. Though Dr. Levin did not reach thescene of the outbreak until it was nearly over and was only’enabled to see three cases of the disease, he succeeded inobtaining a sufficiently complete account of the precedingcases to admit of his reconstructing the story of the epidemicfrom beginning to end. The following are the principal factswhich his inquiries brought to light.Kolobovka, the scene of the outbreak, is a village in the

Tsaref uyezd, or district, of the government of Astrakhan.It lies on the raised left bank of the river Akhtuba, theprincipal easterly mouth of the Volga. It contains some457 dvors, or courtyards, round which the dwellingsare built, and a population estimated at about 3500souls. The people are Great Russians, members ofthe Orthodox or Eastern Church, and are occupiedprincipally in agriculture and sheep-rearing. The fieldsbelonging to the peasants here are mostly situatedin the steppes at a considerable distance from thevillage; and consequently during the season of field workall the able-bodied inhabitants-both male and female-goout into the steppes, where they live for the time in small huts- or izbushki. Some of these are built half underground, andthey are scattered irregularly over the steppes at considerabledistances from each other. In the meantime the village isleft with only the old, the sick, and the children for its

population-with the exception that every few days the

villagers at work in the steppes pay a brief visit to theirhomes in the village-principally, apparently, to obtain foodsupplies.Up to July 16th (28th) of last year the health of

Kolobovka appeared to be quite normal. There was nounusual mortality and no signs of the presence of anyinfectious disease. But on the date named a deaf-and-dumbwoman, named Maria Semakina, aged 35 years, while at workin the fields fell ill with fever and cough and expectoration ofblood. She was brought back to the village and died thereon July 21st (August 2nd). It was not until the 27th ofJuly that a medical man visited the village and consequentlythere is some uncertainty about the succeeding cases; butit was gathered that on the day following this first death thewoman who kept the house where Maria Semakina lived alsofell ill with fever and spitting of blood. She died on July 25th(August 6th). On that day her son developed the samesymptoms, with the addition of pain in the chest, and diedin less than 24 hours after their onset. In the meantimeother persons had been attacked with the disease, but allwere either relations of the first patient or had attended herfuneral. Thus on July 22nd (the dates henceforthmentioned are all according to the Old Style) an old man of70 years of age was attacked with fever, vomiting, pains inthe chest, and spitting of blood, and died on the 25th.Four other persons sickened on the 25th, 26th, 26th, and30th of the month respectively, and all with practicallythe same symptoms. All these patients were of compara-tively advanced years-a fact no doubt due to the absenceof the younger villagers for the reasons explainedabove.

In all 24 persons were attacked with the disease and ncless than 23 died from it. The case-mortality was therefore96 per cent.-a figure so high that, as it is pointed out, italone seemed to point to a diagnosis of plague, few, if any,other diseases presenting so high a degree of fatality. The

rapidity of its course was equally striking. Of the 23 deaths,six occurred on the first day of illness, three on the second,nine on the third, three on the fourth, and two on the fifth,The most prominent symptoms pointed to a severe lung affec.tion. The patients complained of pain in the chest, cough,and expectoration containing a good deal of blood. ThE

sputa are described as "watery-mucous," and as coming ul1 Vratch, 1899, No. 49, p. 1441

in large quantity and with great ease. On examiningthe chest it was usually found that a few scattered dry ormoist sounds could be heard, and only in a few cases werecrepitations present and these were unaccompanied by anynotable dulness. Dr. Levin, who was a member of the firstRussian Plague Commission aent to India and had seen

many cases of pneumonic plague in Bombay, found thatthe symptoms presented by the patients in Kolobovka wereidentical with those of the pneumonic plague patients seenby him in the Indian city. The other principal symptomswere fever, marked mental disturbance, a white, furredtongue, rapid pulse, and in a few cases petechiæ on theskin. The petechiæ differed from those of typhus fever inbeing of a darker and more purple colour than those metwith in that disease.

i While the large majority of the patients developed thedisease in its pneumonic form, in a few the disease appearedin its primary bubonic form. One bad a "bubo in the rightgroin," another a "very tender enlarged gland in the rightaxilla," and a third a "rather tender swelling in the rightgroin and enlargement of cervical glands." Apparentlythese were the only three cases of bubonic plague, and theremainder, 21 in number, suffered from the pneumonic varietyof plague. The diagnosis was confirmed by the isolation fromthe tissues of some of the later patients of bacilli which gaveall the reactions of Eitasato’s plague micro-organism. The

laboratory experiments to identify the bacillus were carriedout partly in Astrakhan and partly in Fort Alexander I.-theisland near Cronstadt which, as already described in thecolumns of THE LANCET,2 has been converted into a labora-tory for the preparation of plague antitoxin.The origin of this outbreak of plague has not as yet been

satisfactorily explained and its explanation is surrounded byalmost insuperable difficulties. Just as was the case in

Oporto, in Alexandria, in Mauritius, in Madagascar, in

Bombay, and, indeed, almost in every place to which plaguehas spread in recent years, no direct importation of infectionfrom a pre-existing focus of the disease could be traced.Kolobovka lies on a high road upon which there is a. prettylively traffic to andfro between the delta of the Volga and thetown of Tsaritsyn further up the river. Among the peopleconstantly travelling on this road are many Persians andPersian Tatars who every year come in large numbers fromEnzeli to Astrakhan to seek work. Some years ago plague wasendemic in Persia, but nothing has been heard of the diseasethere for the past 15 or 20 years. Dr. Levin has made analternative suggestion as to the origin of the infection.Kolobovka, he points out, lies in the Kalmuck steppes,which extend from the left bank of the Volga to the Uralriver. The steppes are inhabited principally by LamaiteKalmucks, whose praying-places can be seen at intervals onthe banks of the Volga. From private letters from the

: Russian consul-general in Ourga, in northern Mongolia, itwas ascertained that among the pilgrims who yearly visitthe Buddhist shrines in northern and north-eastern

, Mongolia are a considerable number of Kalmucks from

l these very steppes between the Volga river and the Ural river.. There is a well-known endemic centre of plague in

eastern Mongolia. May not, it is asked, some Kalmuckrpilgrims returning from that country have brought with

them the infective material of plague ? It is impossible hereE to discuss in full the considerations which favour (or the

reverse) this view as to the origin of the Kolobovka outbreak.It can scarcely, however, fail to strike the reader that thereare very great difficulties in accepting this explanation. The

plague centre in Mongolia is removed from the Volga river_ by some 70 degrees of longitude-a distance which may bee roughly estimated at about 4000 miles. The journey from3 the one to the other would of necessity occupy many months,

and it is not easy to understand why the plague infection,0after being carried over that long distance, should havee attacked, not the Kalmuck pilgrims themselves or their

t relations, but the Christian population of a Russian village.A more plausible explanation, though one still fraught

with many difficulties, might be found in the importa-tion of infection from Russian Central Asia, where a

’ very severe outbreak of plague occurred in the late summer’ and autumn of 1898. The village of Anzob, the chief centre;.

of that outbreak, is scarcely more than 1000 miles fromKolobovka, and there is a pretty constant traffic of persons

e from that part of Russian Central Asia to Astrakhan and

p the Volga provinces. No prcof, however, of such a method of

THE LANCET Sept. 16th, 1899, p. 811.

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transportation of infection is forthcoming, and any explana-tion of the sort must for the present rest entirely on some-what fruitless speculation.To return to the facts of the Kolobovka outbreak, it is

stated that no mortality among rats or other rodents wasobserved in connexion with it. An experienced veterinarysurgeon, Mr. Tartanovski, was specially deputed to investigatethe matter, and though he examined over 3000 bodies ofsmall rodent animals he found no traces of suspicious diseasein any of them.The measures undertaken to check the epidemic were of a

radical character. The whole village was surrounded by acordon, which included also the steppes in the neighbour-hood. The circle had a circumference of about 135 versts or90 miles. The cordon was at first kept by the localinhabitants, but later by Cossack troops. The village wasdivided into sections and twice daily a house-to-house visita-tion was made in each section. All patients found wereremoved to hospital and the ’’ contacts" segregated inanother building specially set aside for them. The hut inwhich the case had occurred was closed and it and the earthround it were drenched with lime. Formalin and carbolicacid were also largely employed as disinfectants and theextent to which they were used may be gathered fromthe statement that as many as 700 litres of formalinand 150 poods (equivalent to about 6000 pounds) ofcarbolic acid were got through before the epidemic wasover. Incculation with Haffkine’s prophylactic was freelyoffered to the villagers, and though nothing in the way ofpersuasion or threats was used some 4000 persons werevoluntarily inoculated in the course of two weeks, includingthe medical, nursing, and disinfecting staffs. This practi-cally represented the entire population of the village and ofthe neighbouring steppes, with the exception of some 40persons who either declined or who were advised not to

undergo the operation on account of their age or health. Itwould have been interesting to know whether this inocula-tion of the entire community was the principal cause of, ora decisive factor in, the extinction of the epidemic, but uponthis point the article under notice throws no light.

THE WAR IN SOUTH AFRICA.

THE eyes of English-speaking people are all turned in thedirection of their thoughts, and their thoughts, it is needlessto say, are focussed on the dramatic events now taking placein a limited part of Natal. General Buller has devised a newand bold strategical scheme for the relief of Ladysmith.His forces are now on a march from which there is "no

turning back"; their progress so far has been slow but sure,and we must be content to possess our souls in patienceand await further developments. There is no concealingthe fact, however, that news of the attack on Spion Kop isawaited with keen anxiety. At the time of writmg the barefact of the position having been captured has reachedLondon, and we are in ignorance both of the cost of ourvictory and of its probable results.We are glad to notice the change of tone which is

taking place in the press and among the people generally inregard to the Government and the military autho-rities. Miscalculations and mistakes have, no doubt,occurred in the course of this campaign and it is quiteright and fitting that everything connected with the warshould hereafter be reviewed and subjected to the strictestcriticism, but it strikes us as neither just nor generous to dothis at the present moment on very incomplete informationor to shut our eyes to the extreme difficulties which have hadto be encountered or to the great and successful efforts thathave been made to overcome them. After all, it may betruthfully affirmed that never before have 120,000 troopsbeen transported in the same space of time to a destina-tion some 6000 or 7000 miles distant from this country ;there is no other Power in the world which couldhave accomplished it. Never before has an armybeen so well furnished and equipped with all therequirements of field service. We have only to com-

pare the present expedition with those of other countriesor with any previous expedition from this island to recognisethe contrast, so striking and remarkable has it been. Notonly had the Boers matured all their plans and selected

their own time for declaring war at two days’ notice, butthe great extent and the geographical and topographicalobstacles of a country, every inch of which was well knownto them, have to be borne in mind ; and the Boers had,moreover, the best and most ubiquitous intelligencedepartment in the world at their disposal-namely, spiesand people friendly to their cause distributed every-where. Even many of our hired sick-bearers in thefield deserted to the enemy. As to any attempt ata military surprise on our part it was merely a farce anda pantomime, for it almost invariably turned out that,instead of being surprised, our foes bad, on the contrary,carefully prepared some trap or ambush to surprise us,and we had consequently to buy our experience of Boertactics and wariness at a heavy cost. But the great difficulty,after all, which had to be surmounted in this campaign wasthe military situation which existed in South Africa at thetime of the arrival of our reinforcements there and theemergent political necessity which this created-namely, therelief of besieged British garrisons. The British generalsand troops found themselves, too, face to face with new andhitherto unprecedented conditions of warfare. We feel con6-dent that a calm and impartial consideration of all the circum-stances will bring about a very different view to that whichnow apparently obtains and to which our checks and want ofsuccess have hitherto given rise. It is no doubt the con-sciousness of all this on the part of the Government thatcauses the Cabinet to hail the opening of Parliament withgladness. It is easy enough to be wise after the event. TheGovernment were blamed not long ago for doing too muchand for driving the Boers into war, whereas it is now blamedfor not having acted with sufficient promptitude and for nothaving done half enough when it did act.

Troops in large numbers, field batteries, and hospital shipsare arriving at the Cape or are being sent out from this

country, and large batches of ick and wounded are returningfrom the scene of war and being forwarded on arrival toNetlev, where every preparation has been made for their recep-tion. In addition to the arrangements that have been madeat our large military stations, proffers of hospital accom-modation fcr our wounded and convalescent officers andsoldiers are being made to the War Office from all sides. Ifthere is some abatement (for which we confess we are not atall sorry) of enthusiasm in the " send off " of troops fromthis country there is no sign of it in our colonies, for atWinnipeg, Montreal, Halifax, Sydney, Melbourne, andAdelaide the embarkation of troops gives rise to greatpopular excitement.The Secretary for War has accepted the offer of Mr.

Van Alen (an American gentleman now resident in London)to provide a section of a field hospital, complete in everyrespect, for service in South Africa under the medicalsuperintendence of Captain E. Powell, R.A.M.C. A hospitalfor the Imperial Yeomanry is being fitted out and allappointments on its medical and surgical staff have beenalready filled up. These include Dr. John WichenfordWashbourn (physician and lecturer at Guy’s Hospital andphysician to the London Fever Hospital). Mr. RaymondJohnson (assistant surgeon to University College Hospitaland to the Victoria Hospital for Children), and Mr. F.Newland-Pedley (senior dental sorgeon to Guy’s Hospitaland lecturer on dental surgery in the Guy’s Hospital DentalSchool).The Portland Hospital, which arrived at Cape Town on

Dec. 26th, forms an independent section of No. 3 Hos-pital at Rondebosch and is in complete working order.It is very gratifying to read that the staff of the hospitalhave received great help from the principal medical officerand everyone connected with the Royal Army MedicalCorps, and that no difficulties of any sort have arisen. Thelabours of the medical corps in the field, along the lines ofcommunication, at railway junction depots, and at base

hospitals are very arduous, and the fearless conduct ofmedical officers in aiding and bringing away the woundedfrom the firing line at the various battlefields is, we read,in everyone’s mouth."The reported casualties in the various forces which are

now on the march or fighting their way towards Lady-smith have not so far been large considering the numbersengaged and the severity of the fighting, but these must,it is feared, reach a very much higher number when themore strongly held positions and lines of entrenchmentsheld by the Boers have to be attacked and taken. We arewriting before information has reached us concerning the