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CHAPTER XV.
THE HEALTH OF THE TOWNS SUPPLIED WITH PROTECTED WATER SUPPLIES.
A careful scrutiny of vital statistics of the towns, whose water-supply is under
examination should give valuable information as regards the correctness or other-
wise of the deductions drawn from the results of analyses obtained in the laboratory.
Accordingly a table has been made out which gives the figures for certain diseases
whose prevalence in any town is usually accepted as being more or less connected
with the quality of water-supplied. The particulars tabulated are (i) number of
cholera deaths in each quarter of the year, (ii) the deaths from diarrhœa and dysen-
tery under the age of 5 years, and (iii) the total deaths from those maladies in each
quarter. Before discussing the figures or drawing any conclusions, it is necessary
to make certain general statements about the value of the statistics generally, and
about the value of the incidence of those diseases as an indication of the use of
impure water.
As is well known to all officers who serve in India, too great reliance cannot
be placed on any vital statistics, because the patients are not in most cases seen by
any medical man, no certificate of death is given, and the diagnosis of the disease
is left to the friends of the deceased or to the village officer. It is, however, safe
to say that the natives of this country usually diagnose normal cases of cholera,
diarrhœa and dysentery fairly correctly, so that in the table the chances of error
fro this cause are not so great as might be expected. Further, inhabitants of
cities are less likely to make errors than uneducated villagers.
It will be asked by those who do not know India why deaths from enteric
fever are not included in this table The reply is, that no deaths from enteric
are ever reported. except by qualified practitioners in large towns. That cases
do exist amongst the native population is quite certain, for it is not uncommon to
hear of them from Civil Surgeons in charge of large hospitals ; but the village
chowkidars, and the friends of the patient, have not yet learnt to diagnose the
disease ; in all probability all such cases find their way into the " fever " column of
the death register. This omission detracts considerably from the value of vital
statistics generally as a collateral indication of the purity of a water-supply.
It may be stated with. a large amount of truth that the index of purity of a
given water-supply may be roughly gauged from the following returns (a) presence
or absence of cholera, (b) the prevalence of diarrhœa and dysentery in children
under 5 years, c) the presence of dysentery and diarrhœa in the community as a
whole. Unfortunately, in the table given, deaths only are available, whereas a
much more satisfactory opinion could be arrived at if total. cases and deaths were
obtained. Milder epidemics, causing few deaths, frequently exist and may be re-
ported, but the figures demonstrating the presence of these cannot be given, as
there is no notification of disease in this country. The attendance register of
hospitals may give confirmation of the presence of such an. epidemic, but the
number of people who resort to dispensaries is not sufficient to make these figures
of much use to us.
It is not maintained that a polluted water-supply is the only cause of dysenteric
and diarrhœa. There are doubtless many other conditions which influence the
spread of these maladies ; but speaking in general terms, it may be stated, that there
is a direct relationship between the purity of a watet-supply and the absence of
these diseases, though the presence of these diseases in any given town does not
necessarily mean that the water-supply is impure.
The death-rates for the quarters are calculated per 1,000 of the population
D e r a n n u m , b u t a s c h o l e r a , d y s e n t e r y a n d d i a r r h œ a , a l l h a v e a s e a s o n a l p r e v a l e n c e ,
the figures for any period less than for a whole year are not of much value in them-
selves . They form a useful basis for comparison between the diffierent towns in