23
5f. The number of cases here shown does not include all attacks among inocu-
lated persons, but only those of which particulars could be verified. The circumstances
which prevented the record of the necessary details concerning all cases among inoculated
persons will be noticed later.
52. It should be mentioned that this statement includes 1,246 cases with 450 deaths
in the Jullundur District, 177 cases with 65 deaths in the Hoshiárpur District, 31 cases
with 14 deaths in the Gurdáspur District, and 13 cases with 5 deaths in the Siálkot District
Consideration of effects of inoculation.
" Campaign " of 1900. Difficulty in arriving at con-
clusion.
53. There remains for consideration
the result of the inoculation operations carried
on during the hot weather of 1900.
It may be said at the onset the attempt to form a conclusion as to the result of these
operations is beset by very considerable difficulties.
In the first place, as will have appeared from what has already been written, the
conditions which prevailed during the epidemic of 1900-01 differed very considerably from,
those of previous epidemics in the Jullundur and Hoshiárpur Districts.
54. The most important differences were the abolition of restrictions upon com-
munication between the inhabitants of infected and uninfected villages and the great
diminution in the strength of the staff and establishments on plague duty. This diminution,
as has already been mentioned, being most marked with regard to the most important
element—the superior officers.
Experience has overwhelmingly proved that the chief factor in the spread of
plague is human intercourse, and with the removal of restrictions which had hitherto been
imposed upon intercourse between the inhabitants of infected and uninfected villages, the
conditions for the spread of the disease became more favourable than formerly. Thus the
increase in the conditions favourable to the spread of plague was accompanied by a
diminution in the staff for dealing with the disease,
55. A second difficulty in estimating the result of the inoculation operations now
under consideration lies in the fact that owing to the diminution in the staff and establish-
ment on plague duty, it was not possible to obtain the same detailed information
regarding plague occurrences as was the case in former years. There is little reason to
doubt that the statistics for the epidemic of 1900-01 are very nearly accurate as far as
regards the number of plague cases and deaths. In order, however, to judge of the efficacy
of inoculation, as shown by the incidence and fatality of plague among the inoculated and
uninoculated, it is necessary to know the condition of each patient, as regards inoculation,
or at any rate this knowledge is necessary with regard to a large proportion of the
population. The difficulty in obtaining the. information with regard to persons attacked
with plague during 1900-01 has been very great and is largely responsible for the delay
in the submission of this report.
In earlier epidemics, where there was at least one Hospital Assistant in charge of
each infected village, and where, moreover, Medical Officers saw nearly every case of plague,
it was possible to obtain prompt and accurate information and to record at the time of
his attack whether a patient had been inoculated or not, with details of the operation.
The register of plague patients—hospital registers as they were then called—were in most
cases complete and accurate.
56. During the year under report, however, as soon as plague began to spread
rapidly, it became necessary to place several villages in charge of a Hospital Assistant or
even of a Compounder.
It was thus impossible to mention with the same accuracy as formerly the records
concerning plague patients, nor could Medical Officers exercise the same supervision as in
former years. In the case of several villages no registers of plague cases were maintained
during the outbreaks of the disease, but were compiled afterwards from enquiries made on
the spot by Hospital Assistants and Assistant Surgeons, when the subsidence of the
epidemic permitted of more attention being devoted to this subject, When the names of
patients had been obtained it was necessary, for purposes of the present enquiry,
to ascertain whether they had been inoculated or not. This involved very serious labour.
It was necessary in fact to search in the inoculation registers for the name of each patient.
The extent of this work may be appreciated when it is considered that it involved a
scrutiny of over 300,000 of entries in the inoculation registers of the infected villages,