82 Background of Work and Study in Public Health 



rates of cities. Primarily it was to focus on the availability of 

 adequate sewerage and pure water supply in reducing the annual 

 number of deaths from several epidemic diseases, principally 

 typhoid fever and cholera, and on the theory that diphtheria is a 

 contagious disease transmissible from person to person and from 

 place to place, like smallpox and scarlet fever, statistics were 

 gathered with regard to it and other diseases. Smith addressed a 

 letter to Dr. Max von Pettenkofer of Munich which read: 



Most esteemed Sir: — In studying the reduced death-rate from typhoid 

 fever and similar diseases, resulting from improved sanitary measures in 

 cities I have been much struck with the Munich statistics quoted from 

 you by Dr. Douglas Galton in Transactions of the Sanitary Institute of 

 Great Britain, Vol. IV., 1883. It is stated that enteric fever decreased in 

 Munich, with increase of sewerage, from a death-rate of 24.2 per 1,000,000 

 inhabitants for the quinquenium 1854 to 1859 to one of only 8.7 for the 

 quinquenium 1875 to 1880. If it is not asking too much of you, will 

 you have the kindness to inform me what has been the average enteric 

 fever mortality in Munich for the four years 1881 to 1884 — the period 

 since the Vienna Congress. 



Smith had kept watch of the international congresses. Early in 

 1884 he had offered to Sanitary News a summary of a translated 

 " interesting communication in French relative to the International 

 Sanitary Congress to be held at the Hague," the Netherlands. 



Dr. von Pettenkofer must have responded to his letter, and 

 either referred him to the source of publication or sent a reprint 

 of an article by him, which Smith translated and had published 

 in the Sanitary Neu'S of September 26, 1885, under the title, 

 "Does Hygiene Pay?" There it was argued, and with statistics 

 supporting the conclusion that " Hygiene is health-economy as 

 national economy is the science of economics applied to other 

 possessions." 



Among many other scholars, health officers, bureaus, societies, 

 and municipal, state, and national governmental agencies. Smith 

 wrote to Dr. John S. Billings of the Surgeon General's Office at 

 Washington. His requests ranged all the way from loans of 

 literature to gathered statistical information. From leading cities 

 of Germany, France, Italy, Austria, England, Russia, Mexico, and 

 the United States, information and data were obtained, and by 

 March 19-20, 1883, Smith was presenting a preliminary discussion 

 labelled, " Sewerage and Water Supply," ^"^ at a sanitary conven- 



^^^ Annual Report of the Michigan State Board of Health, suppL, 104-106, 1885. 



