3
Gujrát 2,829 deaths were reported, in Jhang 2,597 in Karnál 1.701, and in Shahpur
585. The infection took root during 1902-03 in the Rewári Tahsíl of Gurgaon
(3,700 deaths), the Sadr Tahsíl of Ráwalpindi (455), Hissar (468), Montgomery
(228, chiefly in the Dipálpur and Gugera Tahsíls), Rohtak (220, all but 6 in
the Jhajjar Tahsíl), and the Jhelum Tahsíl of Jhelum (83).
6. The reports now under review confirm conclusions previously arrived
at regarding the course and spread of plague The outbreaks in the Punjab
are subject to regular seasonal variations and reach their climax between the
months of March and April in each year. The Chief Plague Medical Officer
suggests that there is also a period of decline in December owing to the influ-
ence of cold, but this decline has been noticed in 7 only of 30 more
serious district outbreaks (viz., those in which the number of deaths reported in
any month was 250 or more) which have occurred since the first infection of
the Province. The disease is spread from village to village chiefly by the agency
of human intercourse and infected clothes. Within villages rats play a great
part as agents in its spread, and they may spread it from one village to another
in the immediate neighbourhood, but not to another at any distance. The soil
and houses convey infection, and in places which have once been infected re-
crudescence occurs without the reimportation of infection. There is still no good
reason to believe that grain and articles of food or merchandise are carriers of
infection. There are, however, some points in connection with outbreaks in
the Punjab in the years under review which indicate that as yet we do not know
the causes which really govern the course of plague. Thus the rural areas and
small towns have been most severely visited and the larger towns have for the
most part enjoyed considerable immunity from serious outbreaks, although infec-
tion has been introduced into many large towns and although in towns we are less
able to take adequate measures to stamp it out. Townsmen are not as ready as
villagers to do what is required, evacuation in towns is impossible, disinfection
can never be made absolutely thorough, human communication is closer
than in villages, and rats are more numerous. Though imported into Delhi,
Amritsar and Lahore, the infection has not taken root in Delhi and has not given
rise to severe outbreaks in the other two cities. The immunity of these and
other large towns may perhaps be due to the fact that their streets and houses
have paved streets and floors, and that a large proportion of their inhabitants
live on upper storeys. Another remarkable fact is that the outbreaks in different
districts have differed in severity during the same year to an extraordinary
extent. It is also extraordinary that the severity of the disease has varied in
the same district from year to year so much as it has done, for instance, in
Ludhiána and Gujránwála. The extent to which precautionary measures were
adopted in different districts and different years does not afford a satisfactory
explanation of the variations noticed. Evacuation is the measure which has had
the greatest influence on plague in the Punjab, and it is true that the people of
Ludhiána in 1901-02 and of Gujránwála in 1902-03 were less inclined than the
people of some other districts to resort to this measure, but other districts
which suffered in those years less than Ludhiána and Gujránwála, as for instance
Lahore and Siálkot, also neglected evacuation, and in the years when Ludhiána
and Gujránwála escaped more lightly evacuation was not more commonly resorted
to in these districts than in the years of their severe visitation.
7. In the absence of more definite information regarding the points
noticed in the last paragraph, Sir Charles Rivaz thinks that it would serve no
good purpose for him to discuss them. He, however, remarks that the fact that
the Punjab outbreaks were mostly village outbreaks afforded peculiar opportunities
in this Province for the effective application of precautionary and preventive
measures. That these opportunities have not been more fully utilized is deplor-
able. But during the years under review it has been quite impossible to
compel the general adoption of proper measures. The peasantry have indeed
exhibited a sturdy independence under the calamity with which they have
been visited, and the absence of panic among them, except in a few cases,
is a matter on which they are entitled to pride themselves, but their calm-
ness and stolidity have been founded on fatalism and have amounted to an
unwillingness to accept advice and a refusal or evasion of measures which would