11
35. It will be noticed that in most of the towns the increase in fever
nortality-rate is uniform ; but there are a few places where the rise is sudden
and corresponds with the year of introduction of canal irrigation, after which
;he mortality remains high.
V.—EPIDEMIC
36. The towns of Multan and Sialkot were badly affected as shown by
and
Notes on Multan, Sialkot and Anmrit- August. September ear towns.
August, September and O
16.20, 4965 and 107.48 per mille at Multan and
12.85, 37.34 and 53.36 per mille at Sialkot. The respective figures for 1908
for Multan were 21.50, 20.17 and 50.71 ; and for Sialkot 7.86,27*91 and
51.40. Sialkot suffered heavily this year, much more than in the epidemic of
1908 but not nearly as much as in the epidemics of 1890, 1892 and 1900.
Multan has never been visited by an epidemic of such severity. There had been
a considerable amount of cholera at Multan and some in Sialkot, but it had
ceased to have much effect on the death-rate in September. In Amritsar the
fever ratio which was 17.65 in August reached
3.82 in September and
108.89 per mille in October, while in 1908 the figures for August, September
and October were respectively 25 59, 78.00 and 266.25, whereas the average
for the previous five years was 41.84. It will be noted that the epidemic was
much less in severity than that of 1908, and still more so than that of 1892.
A reference has already been made to the increased death-rate under
the head of respiratory diseases at Amritsar, there was also a tendency, which
too had its effects upon the fever death-rate, to ascribe the increased mortality
to cholera. An examination of blood films in cases reported under both these
heads by my first assistant of the Malarial Bureau, Bawa Harnam Singh
Phalla, invariably discovered the presence of malaria parasites (Plasmodium
Falciparum). A large proportion of the mortality at Amritsar occurred amongst
infants, and as the lower classes (amongst whom the increase was most notice-
able) give their children raw milk it is very probable that the bowel symp-
toms that were in many cases the immediate cause of death were due to the
-addition to it of impure water.
37. To gauge the extent of the intensity of malaria and in order to
discover its increased incidence in towns during 1917, the following factors
have been utilized :—
(1) Provincial epidemic figures.
(2) Increase of spleen-rate taken after the fever season in Punjab
towns over that taken in June 1917.
(3) Increased number of fever cases attending dispensaries in the
year under review as compared with the figures from 1908
upwards.
4) Comparison of the provincial fever-death-rate per mille from
September to December inclusive for the 5 years ending 1916
with that of the districts of the Punjab for the year 1917.
(5) Infantile mortality rate in 1917.
38. (1) The Epidemic figure.—The epidemic figure for the year 1917
has been found by dividing the fever mortality figures for November by the
average number of fever deaths for the months of April, May, June and July—
the months of non-epidemic mortality. The month of November was chosen
as the virulence of malaria was highest in that month as shown by the pro-
vincial fever mortality figures.
39. The epidemic figure was above 5 in many of the towns and rural
areas showing that (1) an epidemic of malaria visited them and that (2) the
autumnal recrudescence was conspicuously high.
40. The towns and rural areas, showing the epidemic figure as 5 or
over it, are given below in a tabular form