Rural Hygiene. Henry N. Ogden
rel="nofollow" href="#ue89101a1-da2c-4e77-a35b-07775197796c">[1] the third line is based on figures for cities in registration states;[**] and the fourth line is based on the statistics for rural districts and villages of less than 8000 population:—
Table VI. Showing Death-rates per 100,000 Population from Typhoid Fever in Places Indicated
| Year | 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908 |
| The registration area | 35.9 | 32.4 | 34.5 | 34.4 | 32.0 | 28.1 | 32.1 | 30.3 | 25.3 |
| Registration cities | 36.5 | 33.9 | 37.5 | 38.2 | 35.2 | 30.1 | 34.2 | 32.9 | 25.8 |
| Cities in registration states | 28.5 | 26.5 | 25.9 | 24.6 | 24.0 | 22.0 | 34.2 | 31.7 | 24.5 |
| Rural part of registration states | 34.6 | 28.8 | 27.0 | 24.7 | 23.8 | 23.0 | 28.6 | 26.0 | 24.3 |
This table shows that, taking the United States as a whole, the typhoid-rate in rural districts is generally less than in cities and that in cities the rate is excessively high.
When it is remembered that by filtration of public water-supplies the typhoid-rate may be brought down to about 15 per 100,000, and that cities with pure water-supplies will not exceed that rate, it is plain how serious is the danger from typhoid in such cities as Cohoes or Oswego. The following table from statistics taken in New York State shows the same conditions as Table VI.—
Table VII. Showing Death-rates from Typhoid Fever per 100,000 Population in New York State as Indicated
| Year | 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908 |
| Cities average | 25.4 | 23.9 | 23.4 | 22.6 | 21.6 | 19.1 | 19.0 | 20.7 | 20.1 |
| Rural districts | 32.0 | 27.3 | 23.4 | 22.1 | 21.8 | 21.8 | 20.2 | 19.3 | 20.8 |
| Average of city population | — | 38.9 | 33.9 | 43.0 | 40.3 | 32.2 | 30.5 | 32.1 | 32.4 |
| Average of rural population | — | 20.3 | 24.1 | 23.2 | 21.3 | 22.3 | 21.3 | 19.9 | 20.8 |
The first line is the death-rate in cities, found by taking the ratio of all the deaths from typhoid in cities to the population in those cities, and the second line is a similar ratio for rural districts. If the actual rates of the several cities be averaged, a method which has the effect of giving the rate found for a city of 10,000 equal value in the average with one of 1,000,000, the third line of the table is obtained; and in the same way, by averaging the death-rates of the counties of the state, excluding cities, the fourth line is obtained. These last two lines show that the average of the city rates is noticeably higher than the average of the rural rates, and that, while since 1900 the average of the rural districts has remained uniform, the death-rate in cities has been continually decreasing.
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