2
From this the spontaneous fluctuations to which the fever mortality is
subject in the Punjab can be easily judged. The statement also shows that
fever in the province underwent a steady decrease from 1908 to 1912 ; but
was followed by a slight rise in mortality during 1913 and 1914, which, again
subsided very definitely during the year under review when the fever mortality
rate was practically half that of 1908, the year of the last great epidemic.
The distribution of fever mortality in different areas with the monthly
fever mortality for each district of the province is given in the table in Appen-
dix B.
A glance at the table in Appendix B shows that the districts
with a high fever mortality are Muzaffargarh with 20.34, Mianwali 20.10,
Amritsar 18.18, Attock 18.13, Rawalpindi, Kangra, Multan, Hoshiarpur and
Gujranwala 17.95, 17.41, 17.31, 16 93 and 16 89 per mille. The districts show-
ing the lowest fever death-rate per mille were Simla (7.69 , Gurgaon (9.49),
Gujrat (10.76) and Shahpur (1095.) A reference to the fever mortality records
of the previous year shows that the fever mortality ratio per mille was highest
in Muzaffargarh with 25.45, Karnal 23.07, Gujranwala 22.17, Attock 21.56.
Rawalpindi 21.03, Ambala 20.12, Multan 19.78 and Rohtak 19.40 ; and the
lowest in Simla 8.46. Ferozepore 12.73, Ludhiana 12 95 and Gurdaspur 14.41.
The fever figures in 1913 were highest in Karnal 24.80, Ambala 24.43,
Rawalpindi 23.38, Muzaffargarh 21.95, Mianwali 20.68 and Attock 19.86.
From a comparison of the fever figures for the last three years—years
practically free from a malaria epidemic—it will be seen that the fever-rate
has been constantly high in Muzaffargarh, Rawalpindi, Attock, Mianwali,
Multan and Gujranwala.
Although it is not fair to draw any hasty conclusions after studying
the fever mortality figures of the districts of the Punjab for only the last
three years, one must, it is thought, conclude that the districts enumerated
above include some endemic centres.
In map I given in Appendix G a comparison is made of the fever death-
rate per mille for 1915 with that of 1914 for all districts.
A study of Chart III shows that there was a very distinct fall in fever
mortality from October 1914 to February 1915 ; thereafter there was a slight
rise in March 1915 with a similar fall in April followed by a very distinct and
abrupt rise in May. After May there was a steady fall and a decrease in mor-
tality up to September, followed in its turn by a constant rise to the end of
December, which became more marked in the latter month, and the fever
mortality reached its highest pitch in December. The chief feature of the
chart is the distinct rise in fever mortality in the autumnal months—October
and November—and that of December, which shows that the bad fever months
were October, November and December instead of the usual autumnal months—
September, October and November. This may be attributed to the fact that
the monsoon was scanty and ended early, and that the effects of the coldest
months of the year were later in affecting the health of the people. The short
but distinct rise in May, which was also to be noticed in the charts of 1913
and 1914 may be due to :—
(1) a slight recrudescence of malaria every year at the end of April
and in the month of May.
(2) some of the plague deaths were no doubt returned as fever deaths
by the chaukidars ; the plague mortality was at its highest in
May.
Maps No. II, III, IV and V are appended in Appendix C to show the
spleen-rates of different towns taken in June and November of 1914 and 1915,
i.e., before and after the fever season.