Report on Malaria in the Punjab, during the
year 1913.
I.—INTRODUCTION 1 .
1. The remark to the effect that there is no disease in the Punjab
comparable to malaria as a cause of sickness and mortality is not applicable to
the year under review which was unique, by reason of an appalling'visitation of
influenza in epidemic form,
2. The disastrous extent to which this world-wide epidemic took its
toll of the manhood of this Province, is indicated by the fact that the total
mortality, which usually does not exceed 700,000, during 1918 reached the
extraordinary figure of 1,565,560. But not only was influenza the dominant
disease during the year ; for ^ by reason of the fact that the epidemic took
place during the autumn at the precise* time when malaria is apt to assume
epidemic proportions, the mo tality due to the latter disease cannot even
approximately be estimated, more especially as deaths due to influenza were
(on the advice of the Sanitary Commissioner) recorded under the head of
" fevers." The symptoms of influenza are now well known and it is hoped
that in future-deaths from this disease will be recorded as such.
3. Indeed in view of the need of increasing the accuracy of the vital
statistics, it- is for consideration whether the time has not arrived for a short
and simple " nomenclature of disease ' -' to be drawn up for use in municipal
towns and rural circles. It would be well if the heading " fever " which is,
after all, only a symptom of many diseases, could be removed from *Period-
ical Returns.
4. The " fever " statistics for 1918, being so profoundly effected by
influenza, it would appear to serye no useful purpose to attempt to analyse
them from the point of view of malaria. The vital statistics which it has been,
usual to include in these reports are, however, given in the Appendices.
II.—SUMMARY OE CONDITIONS DURING- 1918.
5. As was recorded in the Annual Report for 1917 a severe epidemic
of malaria, which chiefly affected the districts in the south-west of the Province,
occurred in the months of October and November 1917. The circumstances
attending this epidemic were unfortunately not studied at the time ; but, as
eome knowledge of its distribution is essential to a proper understanding of the
conditions prevailing in 1918, a map (Map II, Appendix O) has been prepared
to depict its distribution and relative intensity as indicated by the epidemic
figure of rural circles (thanas).
6. As a result of the epidemic, the ct fever " motality in January
1918 was unusually high. Thereafter it. decreased until the month of May
when a small rise took place. During the following month it fell until, for the
first time in the year, the " fever " mortality in August and September,
was of normal proportions. In the month of October the phenomenal rise in,
the " fever " mortality associated with the onset of the influenza epidemic
commenced. In November the " fever" mortality reached the appalling
figure of 637,959. In December a conspicuous ^decline took place, but the
(t fever " deaths still numbered over 120,000. The magnitude of the epidemic
will be realized when it is stated that, whilst the average annual number of
fl fever " deaths is approximately 350,000, the deaths during the last three
months of 1918 numbered 1,006,650.
7. That this enormous mortality was in the main the result of influ-
enza there can be no doubt; but it is of importance to determine more -pre-
cisely, if possible, the contribution of-malaria towards this enormous figure.
It has been mentioned that the * f fever " mortality was unusually
high in the early months of the year long before the commencement of the
influenza epidemic ; and it magr be assumed in the light of past experience,
that this enhanced mortality was in great part a legacy of the malaria epidemic
pf the preceding autumn.