4
The districts showing the lowest fever death-rate were Simla (10.69),
Montgomery (10.99), Ferozepore (11.05) and Ludhiana (11.92).
It is not, however, desirable to attempt to draw many conclusions from
a consideration of the figures for one year only. The sole deduction which it is
thought may be legitimately drawn from a scrutiny of the fever death-rates
for the year 1913 is that the mortality from malaria tended in many cases to be
higher in those districts which are not subject to severe epidemics as compared
with districts containing the main " epidemic areas." This fact is demonstrat-
ed in the map attached to this report (Appendix C) in which the areas involved
in the extensive 1908 epidemic are shown in red, whilst the fever mortality
per 1,000 of population for each district has been entered in green. It should,
however, be clearly understood that during the year under review there has been
no epidemic of malaria in any part of the Province, and that five years have
elapsed since the occurrence of the last epidemic.
It may therefore be tentatively concluded that the circumstances favour-
ing a high degree of malarial endemicïty are not solely those which favour the
occurrence of fulminant epidemics. Conversely, the deduction may be made
that in areas subject to these epidemics conditions exceptionally favourable
to the endemic form of the disease are not necessarily present to a marked
degree during epidemic free periods. As further observations, which support
and extend these conclusions, have been embodied in a research which will
shortly be published, it is unnecessary to make further reference to this sub-
ject here.
Finally, in Chart III the fever mortality during each month of the
year under review is depicted.
A scrutiny of the chart shows that a slight decline in mortality took place
in February as compared with the previous month, thereafter the fever mor-
tality remained steady during March and April, but was followed by a slight
but distinct rise during May. In June there is a decrease in mortality which
is continued throughout July and August, with the result that the two latter
months were the healthier from the point of view of malaria than any others
months during the year. The chief feature of the chart, however, is the com-
paratively marked nature of the increase in fever mortality during the month
of October, and its maintenance until the close of the year. For the present
it must suffice to state that the above represents the monthly distribution of
fever mortality in a year when endemic malaria was less conspicuous than usual
and when epidemic malaria was almost entirely absent. For, until ail the
known factors influencing malaria have been collected and studied over a
series of years it will not be possible to draw final conclusions in regard to the -
year under review.
This report is therefore of an ad interim nature, and it must be regarded
merely as indicating the lines on which more comprehensive reports will be
based in future.
IV.—Epidemic malaria in 1913.
There is fortunately little to be said in regard to epidemic malaria during
the year under review, for, as has already been mentioned, no outbreak of ful-
minant malaria has taken place in the Province since the severe epidemic of
1908. In fact the sum of the fever mortality for the months of October and
November for the past five years is only slightly in excess of the same figure
for the year 1908.
Major Christophers has shown that by means of the use of " epidemic
figures " it is possible to ascertain the occurrence of epidemic malaria, to measure
its severity and to map out with a considerable degree of accuracy its local
(distribution. As it will be frequently necessary to refer to these epidemic figures
it will be convenient here to explain the manner in which they are calculated.