miles and a population of 17,064,413 (1941 census). The State is divided into 16 districts and is bounded on the east and the south by Madras Province and on the west by Bombay Province. Previous writers on cholera (Rogers, 1928; Russell and Sundararajan, 1928) have expressed the view that the epidemics of cholera originat- ing in Bengal Presidency passed through the Central Provinces, invaded Hyderabad State and continued their onward course into Madras Presidency. Further, it is generally believed that there are two main routes (Map I) of local spread of cholera infection, viz. (1) through Shri- sailam (Kurnool District) and (2) through Pandharpur (Sholapur District). The out- breaks of cholera during the concluding Mahasivaratri Jatra at Shrisailam are believed to affect a considerable number of pilgrims from Hyderabad State. This jatra is indeed regarded as a signal for the increase of cholera incidences in Gulbarga, Mabubnagar, Raichur, Nalgonda, Karimnagar and Medak districts. However, even though an epidemic dose break out in the general population, it ordinarily runs a mild course during the months of March, April and May. On the other hand, the Pandharpur Jatra in Sholapur District (Bombay Province) is regarded as a more potential source of danger, because infection on a large scale is carried CHOLERA IN HYDERABAD STATE along the Palki routes through the districts of Aurangabad, Bhir, Parbhani and Osmanabad. R. D. l.m.&s. d.p.h. &Hy. (Cal.) By MEHTA, (Hyd.), As a result, outbreaks of cholera occur in these Medical Statistician, Bureau of Epidemiology, Public districts during the months of July to October. Health Department, Hyderabad-Dn. The statistical data analysed in this paper Introduction.?Hyderabad State is the largest are those that were collected recently from State in India with a total area of 82,698 square different sources by the Bureau of Epidemiology. MAP JI OF HVDtRmnvMYDEXMfiD State.J797& ,y-t Jrrrt^^w j/iKgfVISTmet flowpflni?s.^;n!
PftNDHRR ? ?u-v !/??'! W??w- L. , /?*?)" '' J ?o) \\/' '- ?'? J j .vaga^ 7^
< /, ^/g^O>&r RlflkznclRtFtUlNCL
HIVLB.S&IULAS ....---, w? i>/sr
It is difficult to assess the absolute reliability A straight line has been fitted by the usual of the data. In any case there is no reason to method of least squares to depict the long-term believe that they possess a reliability lesser than trend. the figures relating to other parts of India which have been studied by previous workers. Trend ofuf cholera mortality in Hyderabad State, 1904-1948. Trend of cholera mortality.?Table I shows the annual rates of cholera mortality per 100,000 of population for each year from 1904 to 1948. The equation of the trend line is of the form Y = a -f- bx. Population Table I /oqoco
Showing the annual rates of cholera mortality per Pc.r 1904 to 1948 100,000 of population from Rati.
Rate Rate Dlrjh Year per Year per 100,000 100,000
\94?
1904 9.6 1927 60.4 I Y L- n? *r Ss 1905 5.0 1928 ! 31.0 1906 85.6 1929 3.2 1907 9.1 1930 1 127.4 Table II summarizes the values of the two ' ' ' ' 190S 18.7 1931 37.3 constants a and b which measure ! respectively 1909 21.1 1932 0.5 the mean incidence and the rate of increase 1910 0.7 1933 32.5 (+) or in rate. 1911 16.5 1934 32.5 decrease (?) mortality 1912 9.3 1935 68.6 1913 10.0 1936 58.7 Table II 1914 44.4 1937 58.4 1915 15.9 1938 54.8 1916 11.4 1939 24.7 Serial Name of 't' 1917 19.4 1940 65.2 number districts 1918 56.4 1941 58.1 1919 104.9 1942 40.0 1920 0.4 1943 34.0 1 Adilabacl 37.6 2.2 2.75 1921 43.3 1944 2.4 2 Parbhani 48.9 1.9 2.71 1922 25.9 1945 146.9 3 Aurangabad 38.3 1.4 2.80 1923 9.0 1946 5.8 4 Nanded 42.8 1.4 1.75 1924 25.5 1947 22.0 5 Osmanabad 53.3 1.3 1.00 1925 0.2 1948 40.3 6 Bhir 42.1 1.2 2.40 1926 0.1 7 Atraf-e-Balda 17.9 1.2 4.00 ; 8 Gulbarga 27.4 1.0 1.43 9 Nizamabad 38.5 0.9 1.28 10 Bidar 33.2 0.7 1.16 Where Y relates to the annual rates of 11 Mabubnagar 24.2 0.6 1.50 12 Medak 32.9 0.5 0.38 cholera and x stands for time mortality 13 Nalgonda 30.9 0.3 0.43 measured in a"year as unit with the origin chosen 14 Raichur 43.9 0.2 0.22 ' ' at the year 1926. In this equation a measures 15 Karimnagar 21.6 0.2 0.50 ' ' the mean level of incidence and b the of 16 Warangal 21.5 0.3 0.75 ' ' slope' ' the trend line. The values of a and b are 34.4 and 0.72 This value of ' ' respectively. positive b (-f- 0.72) means an upward slope of the trend In order to test whether the increase or line which indicates that, if at all, the incidence decrease possessed any statistical significance of recorded cholera has been on the standard error of each estimate of the the increase. ' slope has been worked out and the value of t' is 1. It is not unlikely that the trend may in ' also given in table II. If the value of t' some measure be due to an improvement in the exceeds 2.0 the slope can be considered to recording of cholera mortality statistics. possess statistical significance. With the excep- 2. If, however, there has not been any tion of Warangal District for which a negligible material improvement in the registration of vital degree of decrease has been recorded, all the statistics the one conclusion to be drawn from districts show a tendency towards increase the chart is that cholera has so far problem in varying measures. The highest rate of failed to receive due attention. increase in incidence has been in Adilabad (2.2) Similar trend lines were fitted to the series of followed by Parbhani (1.9), Aurangabad (1.4), annual rates of cholera mortality for individual Osmanabad (1.3), Bhir (1.2) and Atraf-e-Balda district. (1.2). Dec., 1950] CHOLERA IN HYDERABAD STATE : MEHTA 571
It is pertinent to remark that all these are specially from June continuing to September. contiguous districts lying in the north-west Cholera incidence is at the highest pitch in section of the State ancl are largely inhabited by August. Maharastrians. seasonal for indivi- ' ' Average mortality figures The a values shown in table II provide a dual districts are presented in table III. It measure of the mean incidence of the disease in may be noted from these figures that in the individual districts. These values have been districts of Raichur and Gulbarga and also shown by different degrees of shading in Map II partly in Medak, Nanded, Bidar and Nizamabad for the purpose of studying the geographical the shooting up of cholera mortality starts distribution of incidence. The areas of high earlier, i.e. in the month of May, while in most incidence also lie generally in the north-west. of the other districts this condition is attained Seasonal distribution of cholera in the during the months of June and July. State.?The graph shows the seasonal variation in cholera mortality in the State. The MAPMAPUof Hop HYDLMMT)HYDE/toMB minimum mortality occurs from December SjnT?^SjnT?- to February followed by a considerable rise Showing,Showing 7hL MtfiN 7hl ml ah CmLLRQcmuzn HdRJRUTyNcmjouTy Grrph Showing Average SeasonrlMortalitvSeasonrl Mortalitv of Cholera Of OP ?ltFLREHTj>lST&lctS3lSf&lcfS In HVDERRBRDHVDERRBRD5TRTE 5TRTE During 1904-48. it# DlPPEEENJ' iSinviUOyj ?3d OOO'OOI WOliUTHdOd
FtB Mar. Ap? Mav June July Aucr Sept Oct: Kov-
Table III
Showing the average seasonal mortality rates per 100,000 of population in different districts during 1904 to 1948
Name of ' Jan. Feb. Mar. June ! Dec. district April May j July Aug. Sept. Oct. Nov.
Raichur 3.4 i 7.3 23.7 30.2 78.9 106.1 136.4 61.0 45.8 29.8 22.7 11.3 Osmanabad 4.7 2.4 3.3 19.1 42.4 24.4 88.2 199.1 70.9 65.2 29.2 12.7 Warangal 9.5 i 8.4 8.3 20.0 24.3 31.0 39.9 53.9 40.6 6.4 7.9 7.3 Nalgonda 19.5 12.8 40.7 28.1 32.3 42.5 54.1 68.2 54.8 19.5 13.7 11.1 Medak 6.7 13.3 14.1 19.6 41.8 45.0 59.8 93.3 53.6 19.2 11.8 4.5 Aurangabad 2.1 0.8 11.2 31.8 20.7 28.9 95.9 180.9 139.8 41.1 16.1 9.2 Parbhani 0.5 0.4 2.2 6.6 35.1 53.5 127.1 172.0 146.8 50.2 19.8 6.0 Beed 0.4 0.6 0.0 6.4 19.3 47.4 98.4 179.9 129.7 72.2 23.5 6.3 Nanded 1.3 1.1 12.6 19.1 56.1 90.1 74.8 139.0 114.8 27.0 8.4 2.3 Gulbarga 4.4 3.0 4.9 9.0 110.6 67.6 76.7 91.1 72.9 22.9 17.7 6.5 Bidar 1.5 1.3 2.0 4.2 47.5 49.7 78.6 102.2 96.3 34.0 18.2 3.4 Nizamabad 1.1 1.4 12.3 19.6 59.9 94.1 117.9 116.7 31.4 9.1 5.1 2.1 Adilabad 2.2 1.3 8.9 13.1 28.4 28.6 67.0 159.6 146.1 37.7 6.3 1.1 Karimnagar 0.5 2.8 6.6 21.5 23.4 24.9 54.6 69.9 56.7 10.5 4.7 2.0 Mabubnagar 5.0 2.2 9.2 17.8 23.6 43.5 38.7 60.8 47.3 21.5 15.8 19.7 Atraf-e-Balda 6.4 1.7 1.7 11.2 23.9 33.5 31.1 42.9 45.9 9.2 17.7 5.0 Hyderabad City 2.5 1.7 35.0 21.1 12.1 28.3 179.2 157.8 16.3 5.8 1.0 1.0 Hyderabad State 4.6 4.0 10.5 17.9 42.3 49.4 79.4 108.3 76.9 27.4 14.1 6.9 572 THE INDIAN MEDICAL GAZETTE [Dec., 1950
One explanation of an earlier occurrence of disease particularly in Raichur and Gulbarga may be that the devotees of Shiva live in these two districts and carry infection home from Shrisailam fair (Shivaratri) held usually in the month of March. People of Maharashtra districts of north-west visit Pandharpur fair in the month of July and the peakedness of seasonal figures during that period in the districts may be attributable to the importation of infection from that festival centre.
Conclusion The statistics of cholera mortality for Hyderabad State have been studied for a period of 45 years (1904 to 1948). The recorded statistics indicate that the incidence of the disease has remained uncon- trolled. The Maharastra districts in the north- west not only show high incidence of the disease but also indicate a relative worsening of the cholera situation with the progress of time. The effect of fairs particularly at Pandharpur and Shrisailam on the mean incidence of cholera and its seasonal distribution has been indicated.
The study was carried out in the Statistics Section of the All-India Institute of Hygiene and Public Health. The help received from the staff is gratefully acknowledged. I must particularly thank Messrs. A. Bose and Govind Narain for the computational help they have rendered and to Shri Jiban Ghosh for the preparation of charts.
REFERENCES
Rogers, L. (1928) .. Indian Med. Res. Mem., No. 9. Thacker, Spink and Co., Calcutta. Russell, A. J. H., and Ibid., No. 12.; StWDARARAJAN, E. R. (1928). [The reader who feels that his epidemiological horizon has not been widened much by the paper may have the satisfaction of knowing that the soundness of the symbols and mathematics therein has been confirmed by our statistical experts.?Editor, I.M.G.]