5
8. Fever.—In 1922 the mortality from fever was 885,268 as compared
with 1,070,368 in 1921, the death-rate falling to 19.0 per mille, against
23.0 per mille in previous year and the quinquennial average of 24.4 per
mille. As usual, deaths from fever represented about 75 per cent. of the
total mortality. The reduced fever mortality of 1922 was largely influenced
by the improved conditions existing in the post-monsoon period of 1921.
(a) Malaria.—Of the febrile diseases, malaria continues to be the
most important, the recorded mortality from malarial fever in 1922 being
11.6 per mille against 15.8 per mille in the preceding year. The actual rate
of death from malarious fever per mille of population has declined in every
districts of the Presidency. But although the number of deaths has shown a
decline, sickness has not diminished and a comparison of the mean fever
indices for the period of 1920-22 with that in 1912 shows a very large increase
in the prevalence of malarial fever in all parts of the Presidency. The classi-
fication of mortality returns under the different kinds of fever is still far from
accurate, and the recorded malarial death-rate is vitiated in many instances
by the inclusion of figures of mortality from pneumonia, tuberculosis, enteric
fever, kala-azar and other febrile diseases. The Director of Public Health
estimates that " ordinarily, malaria appears to be the direct or indirect cause
of from 20 to 33 per cent. of the reported fever deaths."
If to the death-rate caused by malaria be added the physical degeneration
of the people among whom it is prevalent, the imperative necessity for a
vigorous anti-malarial campaign and for utilising all the available resources
of the community for fighting the disease becomes apparent.
The Minister therefore lays great stress on the local bodies initiating the
policy of enlisting the services of all the social service organizations in this
cause, and in particular of the Central Co-operative Anti-malaria Society,
Limited, whose work has been rousing the dormant energies of the rural
population and organizing them for taking effective measure not only against
malaria but kala-azar and other diseases which present such a menace to the
rural population. Government (Ministry of Local Self-Government) will give
every possible support to the work of this important organization. The
Minister also desires in this connection to impress upon district boards the
urgent necessity of organizing the rural population of the province into union
boards, so that they may be furnished with an effective machinery for fight-
ing disease by taking preventive measures generally and in particular by
providing adequate sources of drinking water supply and maintaining the
existing water-supply against pollution.
The Director of Public Health lays great stress on a sufficient use of
quinine against malaria for both preventive and curative purposes, and
mentions the significant fact that the districts which appear to be least
malarious consumed by far the largest proportion of quinine.
Investigations made by the Director of Public Health lead to the
conclusion that interference with the natural flow of water across country
from field to field, obstruction or silting up of water-courses and any condition
which seriously diminishes the supply of water and promotes stagnation
either on the surface of the land or in the beds of streams and drainage
channels lead to a local increase of malaria. Increase of malaria in parts of
Eastern Bengal, which until recently were comparatively free from malaria,
is directly attributed to the haphazard construction of embankments which
restrict the natural flow of water. On the other hand, experiments made by
the Public Health Department in several areas of intense malaria infection,
which aim at the restoration of the natural flow of water in stagnant channels
and the flushing out of drains, ditches and insanitary tanks, have been
attended with successful results, and have definitely led to a reduction in the
prevalence of malaria. Reference was made last year to the good results
obtained from experiments carried on in the colliery area (Singaran-Toposi)
and at Meenglas in the Duars, and to the effect of the Banka Valley scheme
in reducing the spleen index in adjacent villages and improving local agricul-
tural conditions. A " flood and flush " scheme was carried out at Jangipur,
and the results recorded so far show that there has been a general improve-
ment in the health of the town. A portion of the bed of the Saraswati river
has been re-excavated in recent years, and the restoration of the flow in the