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the list for the same quarter of the year. The total death-rate per mile per annum
is, however, comparable with the death-rate from any town in the Presidency or
in any other part of India.
The Cholera figures.—The bare cholera figures in any report are not of great
value unless certain facts as to the origin of the disease are explained. Thus,
although it is undoubtedly true that cholera is spread chiefly by a polluted water,
there is no doubt whatever that other methods of transmitting the disease do
exist. Enteric fever epidemics occasionally arise from the wholesale pollution
of a pi pe wat er-suppl y; but recent researches have shown t hat t he i ndi vi dual , i n
the shape of what is known as a" Carrier, " is responsible for a very large percent-
age of cases, pollution of a water-supply of a town with Ehrlich's bacillus being
fortunately of rare occurrence. In like manner cholera may be spread by the whole-
sale pollution of a water-supply, or by pollution of the water-supply of a portion
of a town, the rest remaining free from the disease. The virus of the disease may
also be disseminated by flies.
It is well known amongst those who have had large experience of cholera
epidemics that, if the disease be introduced into any town provided with a proteeted
water supply, the malady seldom spreads beyond the members of the household
into which the virus has been introduced. In towns where the water-supply is not
protected, but consists of ill-constructed wells, tanks, etc., it is usual to find that the
organism, sooner or later, is carried into these sources of drinking water and that an
epidemic results. Examples of this will be pointed out in the cases given in the
table XV (a).
Reference to the table will show that a considerable amount of cholera was
present in the 18 towns possessing protected water-supplies. But if these
figures are read in conjunction with the remarks column, it will be observed that
the large proportion of cases were " imported," that is, the deceased was infected
outside the town where the deaths occurred. These various outbreaks of cholera
can be divided roughly into certain well defined groups according to the method
of introduction and the circumstances obtaining in the various towns :-
(a) Instances in which the cases have been for the most part imported from
outside. Amongst these the striking examples are Conjeeveram, Vellore, Coonoor,
Ootacamund, Nellore and Tirupati. In these places cholera has been frequently
introduced from outside, but practically no indigenous cases have occurred within
the towns limits. In the case of Conjeeveram the principal factor in the introduc-
tion of the disease is the number of pilgrims, beggars and mendicants who visit the
temple in this town. The water-supply is satisfactory on the whole and fairly
adequate in quantity. The cases of cholera are found amongst the pilgrim class.
It should be noted that, when cholera is confined to imported cases only, there is
not a simultaneous rise in the dysentery and diarrhœa figures.
(b) Instances in which pilgrims are largely responsible for the introduction
of the disease but, owing to serious deficiency in the quantity of water available in.
the town, the inhabitants of certain parts are obliged to make use of unprotected
sources of drinking water. Amongst this very important group of cases Madura
stands easily first. The town is a great pilgrim centre. It is on the direct road
from a very . important place of pilgrimage, namely, Rámésvaram. Unfortu-
nately several of the outlying and poor parts of the town are not supplied with the
pipe water. The consequence is that when pilgrims introduce the infection
into the town, the disease becomes epidemic in all quarters where wells and
tanks are used as sources of drinking water. There is no reasonable ground for
incriminating town supply for in two out of the three analyses, the quality of
the water has been exceedingly good. Further, the study of the incidence of
the disease in the various parts of the town entirely confirms the truth of this
statement. Very much of the same remarks apply to the following towns:
Trichinopoly, Dindigul, Cuddapah, Guntúr, Vizagapatam and Gudiyáttam. In
all these places the actual quantity of water is seriously deficient, causing the
inhabitants to have recourse to all sorts of doubtful supplies for drinking
purposes, in time of scarcity. In Vizagapatam particularly the parts of the
town that had no pipe supply provided nearly all the cases of cholera. In
Cuddapah the water-supDly during the 3 months June to August practically failed
with the result that an epidemic of cholera broke out ; many cases however were
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