EXTENSION.--To the eastward, from China, it spread to Japan, the Philippines, Australia, the Hawaiian Islands, Alaska, California, Mexico, Peru and the western coast of South America. To the westward, it invaded India, Mauritius, Egypt, Suez ports, Eastern, Central and South Africa, Mediterranean ports, Great Britain (Scotland), the West Indies and Brazil. In the last twenty years plague has caused millions of deaths, and, during a single week in April, 1907, it destroyed more than 75,000 lives in India, a number about equal to the deaths of a year in London during the Great Plague of 1665. In contrast with India the rest of the world has suffered little during the present world-epidemic, but this loss, while relatively small, is enormous when translated into lives and dollars. The figures for India are simply huge. MORTALITY.--The official lists of _deaths_ in India for the last twenty years include some in which the number of _reported_ deaths per year exceeded one million, and it has been estimated that the actual number of persons dead from the plague during this period approximates 8,000,000. It is gratifying to note a marked decrease in the total mortality in the reports of the last few years, but so long as the annual death list, year after year, was measured by hundreds of thousands, rather than thousands, the situation could not be considered as anything but grave. WIDESPREAD DISSEMINATION IN RECENT YEARS.--Without going into statistics deeply we may consider also the list of countries, states and islands from which plague cases have been reported officially during the last few years. My purpose is to invite attention to the continued existence of various plague foci, any one of which might serve to extend the infection further, were governmental quarantine and public health supervision relaxed. During August, September, October, November and December, 1909, plague cases occurred in India, Mauritius, China, Japan, Egypt, Turkey, Russia, British East Africa, the Azores, Venezuela, Ecuador, Peru, Chili, California (two cases), and the Hawaiian Islands. During the first half of 1910 no very marked variation in the distribution of plague occurred, cases being reported from practically all of the foreign countries just named. A year later the situation, so far as the distribution of plague cases is concerned, was not greatly changed, as may be seen from the following tabulation, which I have abstracted from the _British Medical Journal_ of September 16, 1911. _India._--Deaths from plague in India during the first six months, 604,634. Most prevalent (1) United Provinces, 281,317; (2) Punjab, 171,084; (3) Bengal, 58,515; (4) Bombay Presidency, 28,109. Deaths in July, not included above, 8990. _Hong Kong._--April 24 to August 21, 255 cases, 194 deaths.