?III
The Civil Surgeon concludes that, in view of the suspicion with which all measures
taken by Government for dealing with plague are viewed by the people, it would be well to
withhold assistance until it is asked for.
(i)    The Civil Surgeon of the district, Assistant Surgeon Mirza Ashgar Ali, and three
                                               Hospital Assistants of the  district, did plague
Staff and establishment.              duty in addition to their ordinary duties, with
one Hospital Assistant specially detailed for plague duty in the district.
MOOLTAN DISTRICT.
58. The following account of plague in the Mooltan District is extracted from the
report of Captain Ainsworth, I. M. S., the Civil Surgeon. It will be noticed that Captain
Ainsworth is doubtful as to the nature of the disease in the village of Umarpur :-
The symptoms he describes however are such as have been observed in the pneumonic
type of plague (the pain between the shoulders possibly due to pulmonary inflammation) as is
the high rate of fatality, 84.62 per cent. The facts that the disease did not spread widely
or that mortality among rats was not observed, are not opposed to the conclusion that the
disease was pneumonic plague, and these conditions have been found to be associated with un-
doubted outbreaks of this type of plague in India and elsewhere, while the circumstances that
plague was prevalent in the adjoining villages of the Baháwalpur State favour this con-
clusion.
At no time during the year under report did plague obtain a firm foothold in the
Mooltan District.
On the 15th May a true case of bubonic plague occurred in Mooltan City. It was an
imported case from Wan Rádharám, Lahore District. The case and contacts were
isolated in an old disused building some distance from the city. The house in which the
man had been living was evacuated and disinfected. Strong solution of the phenyle was
the disinfectant employed. After the patient's death, the contacts were kept isolated for
ten days and their clothing, bedding, &c., disinfected before discharge. The house occupied
by the patient and his attendants was subsequently disinfected, beds and bedding used by
the patient were burnt and clothing disinfected. The man remained under the treatment of
his own hakim. His family willingly submitted to segregation and disinfection measures,-but
would   not consent to inoculation.
The disease did not become epidemic; no other case occurred.
In March a report was received that the Shujabad Tahs'l was infected with plague and
that at Umarpur, a village near Jalálpur, 6 cases with 5 deaths had occurred. Baháwalpur
State at this time was declared to be plague-infected, and as Umarpur is near the Baháwalpur
boundary it was thought probable that the disease had spread across. Umarpur was
certainly infected from Uch in Bahâwalpur.
The first case to occur at Umarpur was a Maulvi who used to receive students from
Uch. The Civil Surgeon visited the village and saw two or three cases. None of these were
typical of plague, and throughout the epidemic in these parts no cases with buboes or
pneumonia were noticed, and there was no mortality among rats. The symptoms observed
pointed rather to some cerebral or cerebro-spinal affection, e.g., high fever with pain in the
head, upper part of neck and between the shoulders, backache, vomitting, restlessness,
delirium, and in- some cases convulsions. The disease did not spread with rapidity of
plague. In Umarpur 3 cases occurred in two weeks in a population of 944. There were no
imported cases. The Maulvi who was first attacked had not been away from the village for
Weeks. No cases occurred among the students' who visited him from Uch. There was no
panic among the villagers. They were advised to vacate their houses and live in chappars
which were erected for them, and inoculation was offered.
The disease however subsided and none of these measures were acted on. A
hospital in charge of a Hospital Assistant was equipped near the village. Other cases
of the same disease occurred in Jalálpur itself and in a small basti near. These were
imported cases from Baháwalpur State. In the Civil Surgeon's opinion this epidemic was
probably epidemic cerebro-spinal meningitis, and not plague, but it was impossible at the
time to settle it by bacteriological examination. The villagers at Umarpur are Syads and
averse to any such measures.
(a)    The following measures were taken to prevent plague reaching Mooltan. All
passengers by rail from the south were inspect-
Precau ionary measures.                                            ed at Khánpur.    Fairs which should have been
held in this district in March and April were stopped by order of the Deputy Commissioner.
Notices were issued to all Hospital Assistants, Thánadirs and Tahsáldars to report any
suspicious cases at once. Inoculation was not practised to any extent. Only 7 inoculations
were performed during the year; probably there would be no difficulty about inducing the
people to accept it if the matter were urgent.
The subjoined table gives details of plague occurrences in the Mooltan District during the year.