It is, then, not fair to say, despite frequent but careless statements by writers on typhoid fever, that this disease is a country disease, and that it is transmitted to the city by the vacationist who finds the disease lurking in the waters of the farm well. Some years ago it was pointed out that the period of maximum development of typhoid fever is in the fall, and the conclusion was drawn that the disease was particularly prevalent then because that season is the end of the vacation period. That this is not true, or at any rate not entirely true, may be seen from the consideration of two facts, viz. first, that the death-rate in the country districts is low compared with the rates in cities, and second, that those stricken with the disease on their return to the city are quite as apt to have traveled through other cities and to have taken water from other places than farm wells.
Typhoid in small cities.
As a matter of fact, the greatest danger from typhoid fever is neither in the country nor the large city, but in the village or small city. Here the growth and congestion of population has made necessary the introduction of a water-supply, and in many cases this has not been supplemented by the construction of a sewerage system. The ground becomes saturated with filth, percolating, in many cases, into wells not yet abandoned, and the introduction of the typhoid germ brought in from outside is all that is needed to start a widespread epidemic.
Table VIII. Mortality from Typhoid Fever in the Cities of New York State, showing Total Deaths from Typhoid Fever and Deaths per 100,000 Population
| Rate per 100,000 | |||||||||||
| City | Average rate per 100,000 for ten years | 1899 | 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908 |
| Cities using unfiltered lake water: | |||||||||||
| Auburn | 23.0 | 23.4 | 39.5 | 22.9 | 9.7 | 25.8 | 28.8 | 15.9 | 12.1 | 6.0 | 46.6 |
| Dunkirk | 40.2 | 17.5 | 51.6 | 32.4 | 76.5 | 29.0 | 41.3 | 39.3 | 31.4 | 71.8 | 11.1 |
| Geneva | 29.3 | 49.2 | —- | 46.3 | 9.0 | 52.1 | 42.0 | 32.7 | 24.0 | 15.4 | 22.1 |
| Cities using unfiltered river water: | |||||||||||
| Cohoes | 84.4 | 88.3 | 113.0 | 58.4 | 133.2 | 91.3 | 103.6 | 57.9 | 57.8 | 78.2 | 62.0 |
| Lockport | 48.4 | 18.1 | 18.0 | 71.5 | 35.4 | 75.7 | 34.6 | 51.8 | 67.6 | 50.1 | 60.7 |
| Niagara Falls | 132.9 | 113.0 | 123.3 | 143.7 | 148.1 | 114.0 | 135.3 | 184.4 | 154.5 | 126.0 | 87.1 |
| North Tonawanda | 30.9 | 23.1 | 11.0 | 32.3 | 10.5 | 41.1 | 30.2 | 39.3 | 19.3 | 47.2 | 54.6 |
| Ogdensburg | 54.6 | 87.8 | 39.5 | 31.4 | 62.3 | 61.7 | 68.9 | 53.1 | 67.3 | 47.1 | 26.8 |
| Oswego | 49.4 | 22.6 | 45.0 | 22.4 | 17.5 | 53.5 | 62.3 | 84.1 | 58.0 | 66.0 | 62.2 |
| Rome | 22.7 | 26.1 | 6.5 | 12.2 | 25.2 | 18.6 | 24.5 | 42.3 | 28.2 | 17.0 | 26.4 |
| Tonawanda | 30.1 | 13.5 | 13.4 | 13.3 | —- | 26.0 | 38.4 | 25.3 | 50.6 | 25.0 | 95.6 |
| Cities using filtered river water: | |||||||||||
| Albany | 28.7 | 87.0 | 40.3 | 21.1 | 30.2 | 19.7 | 18.5 | 19.3 | 20.3 | 20.0 | 10.9 |
| Binghamton | 22.2 | 25.5 | 42.8 | 52.4 | 27.1 | 9.7 | 9.6 | 12.0 | 9.1 | 18.2 | 15.2 |
| Elmira | 41.0 | 33.6 | 47.6 | 25.4 | 39.7 | 80.0 | 51.6 | 28.8 | 44.7 | 28.0 | 30.7 |
| Poughkeepsie | 46.5 | 25.1 | 45.7 | 41.1 | 20.3 | 44.2 | 59.7 | 43.3 | 39.4 | 112.0 | 34.5 |
| Rensselaer | 61.9 | 107.3 | 93.7 | 61.6 | 91.2 | 31.8 | 89.4 | 37.3 | 18.6 | 58.3 | 30.0 |
| Watertown | 71.9 | 85.7 | 101.4 | 35.6 | 64.7 | 71.0 | 211.0 | 23.6 | 50.0 | 37.1 | 39.0 |
| Watervliet | 57.5 | 105.7 | 77.0 | 55.6 | 62.3 | 55.2 | 61.8 | 47.9 | 47.7 | 20.4 | 41.1 |
| Cities using well or spring water: | |||||||||||
| Corning | 46.4 | 27.7 | 54.2 | 43.2 | 24.9 | 48.0 | 46.1 | 30.0 | 43.1 | 69.0 | 78.2 |
| Cortland | 29.2 | 55.8 | 33.2 | 116.2 | 10.1 | —- | 9.2 | 26.6 | 8.7 | 24.6 | 7.9 |
| Fulton | 33.2 | 25.0 | — | 24.0 | 11.8 | 93.2 | 34.8 | 22.6 | 56.5 | 22.0 | 42.5 |
| Ithaca | 51.7 | 7.8 | 45.6 | 44.6 | 7.3 | 357.0 | 27.9 | 13.7 | 6.8 | — | 6.4 |
| Olean | 19.5 | 21.6 | 10.5 | 20.8 | 30.7 | 30.3 | 20.0 | —- | 20.0 | 19.1 | 22.1 |
| Jamestown | 28.9 | 40.5 | 39.3 | 25.5 | 4.1 | 24.1 | 62.7 | 23.0 | 33.8 | 18.2 | 17.5 |
| Schenectady | 31.6 | 3.3 | 44.2 | 40.5 | 26.0 | 33.5 | 22.6 | 8.6 | 17.8 | 8.7 | 10.9 |
| Cities using water from streams and reservoirs: | |||||||||||
| Amsterdam | 19.4 | 19.8 | 14.3 | 23.2 | 18.1 | 44.0 | 17.1 | 16.7 | 24.8 | 15.9 | —- |
| Glens Falls | 37.6 | 24.6 | 47.6 | 61.4 | 14.9 | 28.9 | 49.2 | 20.4 | 46.5 | 45.3 | 36.9 |
| Gloversville | 20.0 | 16.7 | 49.0 | 5.4 | 43.3 | 10.8 | 5.4 | 21.4 | 5.3 | 5.3 | 37.3 |
| Johnstown | 19.1 | 20.2 | 69.1 | — | 20.0 | 30.1 | —- | 10.2 | 20.4 | —- | 21.1 |
| Newburgh | 39.6 | 48.4 | 44.1 | 23.7 | 47.0 | 34.7 | 42.0 | 37.1 | 41.3 | 41.0 | 36.4 |
| New Rochelle | 21.1 | 7.1 | 6.8 | 38.0 | 29.3 | 22.0 | 15.5 | 19.5 | 23.2 | 22.0 | 28.0 |
| Plattsburg | 21.0 | 24.1 | 23.7 | 34.1 | 11.0 | 21.1 | —- | 39.2 | 28.7 | 27.6 | —- |
| Troy | 49.2 | 65.1 | 101.2 | 55.7 | 48.8 | 32.8 | 44.4 | 46.8 | 36.2 | 25.8 | 34.9 |
| Utica | 17.3 | 16.3 | 14.1 | 15.6 | 20.3 | 16.6 | 17.8 | 9.5 | 27.6 | 15.2 | 20.1 |
| Port Jervis | 42.7 | 10.6 | 31.9 | 31.8 | 52.5 | 73.1 | 72.6 | 72.2 | 31.0 | 51.0 | —- |
| Little Falls | 36.4 | 29.3 | 125.2 | 28.5 | 37.5 | 27.7 | 36.4 | —- | 44.7 | 8.8 | 25.9 |
| Oneida | 17.2 | 26.5 | 13.3 | 25.9 | 38.0 | —- | 36.3 | —- | 11.8 | —- | 19.8 |
| Cities using filtered surface water: | |||||||||||
| Hornell | 28.8 | 76.1 | 25.1 | 32.8 | 32.1 | 55.0 | 7.7 | 30.2 | 7.5 | 7.5 | 14.1 |
| Hudson | 59.2 | 62.8 | 94.4 | 41.3 | 81.3 | 30.0 | 167.7 | 48.5 | 38.0 | 9.4 | 18.1 |
| Kingston | 19.4 | 28.9 | 8.1 | 12.1 | 16.0 | 19.9 | 11.8 | 31.3 | 15.6 | 27.0 | 22.9 |
| Middleton | 24.5 | 21.0 | 13.7 | 13.8 | 55.1 | 13.8 | 6.9 | 41.3 | 18.8 | 18.8 | 42.1 |
| Mount Vernon | 14.6 | 5.0 | 4.9 | 13.6 | 8.8 | 8.5 | 20.6 | 20.0 | 19.4 | 37.7 | 7.1 |
| Oneonta | 37.9 | 28.7 | 27.9 | 13.6 | 66.5 | 26.0 | 50.8 | 24.8 | 48.6 | 23.8 | 68.2 |
| Yonkers | 9.9 | 10.8 | 4.1 | 15.9 | 9.3 | 14.2 | 15.2 | 1.6 | 6.2 | 11.9 | 9.6 |
Another reason for the prevalence of this disease in small cities is that the organization of their health boards is much less effective than that of larger cities. Individuals have not yet learned to sacrifice their own wishes for the sake of the community, and the local health officer, however much he may desire to do his duty, is not upheld by public opinion, and is therefore powerless.
In order to show the condition existing in the small cities of the state of New York, the preceding table has been prepared, showing the average death-rate for the cities of the state for the past ten years, excluding, however, the cities of New York, Buffalo, Rochester, and Syracuse, all of which have well-organized health boards, and where no epidemic of typhoid fever may be expected. Remembering that a rate of 15 per 100,000 is a normal rate, it will be easily seen how excessive is the amount of typhoid fever in most of the cities of New York State.
Table IX. Showing Deaths from Tuberculosis per 100,000 Population in the United States
| 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908 | |
| The registration area | 180.5 | 175.1 | 163.6 | 165.7 | 177.3 | 168.2 | 159.4 | 158.9 | 149.6 |
| Registration cities | 198.8 | 192.1 | 180.7 | 183.6 | 195.5 | 184.4 | 181.5 | 179.4 | 170.1 |
| Cities in Registration states | 204.1 | 194.9 | 177.7 | 179.7 | 189.4 | 178.5 | 184.0 | 181.5 | 169.1 |
| Rural part of Registration states | 138.0 | 133.8 | 121.1 | 120.7 | 131.4 | 126.2 | 121.9 | 123.8 | 117.3 |