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 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

===============================================================================
|Average |
|rate per|
|100,000 | Rate per 100,000
|for ten | ----------------------------------------------------------
City |years |1899 |1900 |1