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Comparing the various quarters with one another it will be observed that the
months of December, January and February give the lowest return for cholera.
The months of September, October and November give the highest and the
quarter June, July and August the next.
Dysentery and diarrhœa.–As has already been stated dysentery and diarrh
œ a f i g u r e s , t a k e n b y t h e m s e l v e s , c a n n o t b e l o o k e d u p o n a s a n a b s o l u t e g u i d e t o t h e
degree of pollution of the water-supply. Many conditions affect the spread of
these diseases, particularly overcrowding, dearness of provisions, famine, bad
sanitation generally and the presence of flies. This contention is borne out by the
fact that these diseases are prevalent in jails, where the most scrupulous care is
taken with all the sanitary arrangements and with the water-supply. Nevertheless
the figures for dysentery and diarrhœa should always be scrutinized when
considering the water–supply of any given town. The amount of dysentery
present in these eighteen towns is exactly the same as in all municipal towns.
Therefore one might conclude that the presence of a good filtered supply has had
no influence on the incidence of this malady. The conclusion is not justified,
though it is difficult to explain in every case what is the real cause of the continued
high figures. In some instances the results of analyses of the water appear to indicate
that an important factor is the unsatisfactory quality of the drinking water–supply.
But in others this cannot be urged. For instance the highest figure for dysentery
and diarrhœa is found in the town of Tirupati. The water–supply though not
extraordinarily good will compare favourably with many others in the Presidency.
There is however one unfortunate circumstance about it, namely, that it is liable to
pollution of a very dangerous character from the fact, that men have to enter
the mains to clean out roots of trees; this may be the cause of pollution but
it does not seem very likely. Out of 18 towns possessing protected water–supplies
12 have a lower dysentery and diarrhœa figure than the average of all municipal
towns. Some of these are very much lower. If a town has dysentery and
diarrhœa figure under two per mille this may be looked upon as very satisfactory.
From a comparison between the rural and urban dysentery death–rate, there can be
little doubt that the conditions of life obtaining in towns are more liable to cause
the spread of dysentery and diarrhœa than are those in rural areas. This figure for
rural areas as a whole is only 1 . 4 per mille of population, about one–third of that for
the towns. Making due allowance for the fact that errors in diagnosis are more
likely to occur in villages than in towns, it still points to the fact, that, the
overcrowding and general insanitation present in large cities have a very malign
influence on the spread of these maladies.
The relation between dysentery and diarrhœa in infants and in adults.—Table
No. XV demonstrates very distinctly an important point under this head, namely,
that in a great majority of cases, whenever the dysentery and diarrhœa rate is
higher than normal, the increase is largely to be found in deaths that occur under
the age of five—vide the cases at Gudiyáttam, Madura, Tanjore, Coonoor and
Dindigul. The only instance in which a higher death–rate from dysentery and
diarrhœa obtains amongst persons older than five years is Tirupati. All these
towns mentioned above show a great mortality amongst young children. We are
unfortunately not prepared to give any explanation in all cases. A very large
number of factors exercise an influence on the subject of infant mortality, and it
would not be fair to conclude that the quality of the water was a prime factor
in these cases, though it undoubtedly may have had some influence.Mortality amongst
c h i l d r e n i s e x t r e m e l y h i g h i n G u d i y á t t a m a n d v e r y l o w a m o n g s t p e o p l e o v e r f i v e . W e h a v e n o e x p l a n a t i o n f o r t h i s , b u t i t m a y b e p o i n t e d o u t t h a t
the water in Gudiyáttam contains a large quantity of nitrates and saline
matter. This may have some influence on the mortality of young children. In
Madura the mortality both under and over five year is high.The principal cause is
insanitary conditions as a whole, and parti cularly avery highly contaminated surface
soil due to lack of drainage. In Tanjore infant mortality is also extremely high.
The reason for this we are unable to state. Madras has a high death–rate both amongst
adults and children. There can be little doubt as to one cause of this, viz., the
extremely bad quality of the water–supply. Dindigul also has an abnormal
mortality particularly amongst children, the water in this town is fairly good but is
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