In addition to following the great international highway of Suez, the disease has insidiously spread to the countries of East Africa. Mauritius and Madagascar, with the adjoining mainland of Mozambique and Lorenzo Marquez, have become more or less infected, and, if reports are to be credited, it has also appeared in one of the Boer towns and also on the Ivory Coast in Western Africa. Last fall the disease reached South America. It apparently was first recognized at Santos, in Brazil, during October, although early in September, according to reports, a peculiar disease, causing swelling of the glands and death within forty-eight hours, was reported at Asunçion, the capital of Paraguay. At the present time Rio Janeiro is infected. The sanitary condition of these South American cities is far from being the best, and, consequently, there is but little hope that the disease will be eradicated or even held in check. With South America more or less thoroughly infected, it is evident that the United States, as well as Europe, are now threatened from all sides. The gravity of the situation is seen in the fact that already last November two cases of the plague were found in New York harbor aboard a coffee ship from Santos. Several cases have also developed on ships bound from the latter city for Mediterranean ports. The United States is threatened not merely from the East Atlantic and South Atlantic, but also from the Pacific. As a matter of fact, the danger to our Pacific ports is greater, owing to the direct communication with the Orient. It has been already indicated that Hong Kong has continued to be infected ever since 1894. On several occasions it disappeared during the winter months, only to reappear in spring. With the more or less constant prevalence of the plague at this great seaport, it necessarily will lead directly or indirectly to a dissemination of the disease along the entire Pacific. Already it has prevailed at Amoy, and has even extended to other Chinese ports as far as Niu-Chwang. For several years it has already persisted on the island of Formosa. Japan was invaded last fall at Kobe and at Osaka, and although it disappeared during the winter, yet only a few weeks ago it has reappeared at the latter city. Sidney in Australia, and Noumea in New Caledonia, are also infected at the present time. Manila, Honolulu and San Francisco have successively become infected. In all these places the disease, with but very few exceptions, has attacked the native or Oriental population. The extinction of the plague in the Hawaiian Islands since the end of March is a splendid demonstration of what energetic, vigorous measures can accomplish. The presence of the plague since March 8 in Chinatown, in San Francisco, is readily recognized as a most serious condition, especially after the courts have granted an injunction restraining the health officers from carrying out the necessary vigorous preventive measures.