Fig. 1.
MAP OF THE STATE OF NEW YORK SHOWING THE SANITARY DISTRICTS

The Maritime District includes the four counties of New York City and comprises about half the population of the state. Its population is almost entirely quartered under distinctly urban conditions, in some parts with a congestion not equaled in any other city of the country. It would naturally, therefore, have a high death-rate, and that it is no higher than it is makes it a matter for congratulation. And yet the rate in New York City is higher than in the other principal large cities of the world. For example, the rates for the five-year period 1900-1904 in Berlin averaged 18.3, in Paris 18.2, and in London 16.9, New York being 19.4 for the corresponding period. The excess in New York is due in part to local conditions and in part to a less active oversight in matters of public health. Similarly, the Hudson Valley District, which embraces the large cities along the Hudson, has a higher death-rate than the state average, whereas the other six districts have low rates, chiefly because of the large proportion of agricultural land and small towns. The last district should be noted particularly, since its rate is remarkably low and its number of cities very small, compared with the area included. The conclusion may be properly drawn, therefore, that statistics confirm the general impression that life in the country is healthier than life in the city.

Accuracy of death-rate records.

One factor must be considered, however, since it plays an important part in drawing conclusions from these kinds of statistics, and that is, the accuracy of the records. In a city in which every one must be buried in a public cemetery, and when the physician, the undertaker, and the sexton all have to keep records which must agree, it is not easy for any burial to occur without the fact being recorded and later registered in the Census Office at Washington. But in the country, a person may be killed by accident, for example, and buried in a private lot without the undertaker recording it at all. The result is that the total number of deaths seems fewer and the death-rate seems smaller than the facts warrant, so that a false idea of the healthfulness of the community obtains. That errors of this sort have existed in the past can be seen by examining the death-rates for New York City and those for regions outside that city for the past ten years:—

Table III. Death-rates in New York City and Elsewhere in New York State, 1898-1908

New YorkOutsideDifference
189820.414.55.9
189919.614.94.7
190020.615.05.6
190119.915.14.8
190218.614.14.5
190317.915.22.7
190418.517.31.2
190518.315.82.5
190618.415.72.7
190718.516.42.1
190816.815.51.3

The decrease in the city rate is to be expected, since with greater knowledge of sanitary matters, more precautions against disease would naturally be taken. But it is not likely that the country is becoming more careless, although the tendency to concentrate population even in rural hamlets may have an effect. It is rather more likely that the reports are made more carefully and that the records are more complete now than formerly. The apparent increase in the number of deaths in rural communities is, therefore, due to greater attention in reporting deaths rather than to any real increase in the number.

If the difference between the rural community death-rate and the rate in all the cities of more than 8000 population in New York State be shown, the difference between the city rate and the country rate is even less than that shown in the table, being only 0.7 deaths in 1000 for 1908. This shows that the boasted superiority of the country over cities is not very great; that it is marked only in the case of a very large city like New York; that, as the size of the city decreases, the difference disappears, and that the country rate in the United States is high when compared with the general rate of other countries like Denmark or even England, where the general rate includes the large cities.

Effect of children on death-rate.