Geographic Variations in Typhoid, Etc. 55 



GEOGRAPHIC VARIATIONS IN INDIANA IN TYPHOID, 

 TUBERCULOSIS, CANCER AND IN TOTAL DEATHS. 



Stephen Sargent Visher, Indiana University. 



For some time the writer has been interested in the geography of 

 Indiana, and in the contrasts among the diflferent parts of the state. 

 In the Proceedings for 1922, may be found a paper dealing with some 

 contrasts, and in a book recently published, more than a hundred maps 

 are given showing the contrasts in the production of crops, in the 

 climate, mineral resources, etc. 



The contrasts among the counties in the death rates given by the 

 State Board of Health each year in the Yearbook of Indiana afford 

 additional illustrations that there is considerable diversity in even so 

 small and homogeneous a state as Indiana. 



As the rates are small in pi'oportion to the population, and as 

 epidemics and differences in the weather cause irregularities from year 

 to year, the following maps are based on the average death rates for 

 four or five years. 



The four special maps, figures 1, 5, 9 and 11, reveal conspicuous 

 contrasts among Indiana counties in death rates from typhoid, tuber- 

 culosis, cancer and from all causes. These contrasts may be explained 

 in part by diff"erences in geographic environment. Conditions that appear 

 to help explain the diff^erences in death rates are shown in the other 

 maps of this paper. Figures 3 and 6 (as well as 1, 5, 9 and 11) have 

 not been published before. The other five maps are from The Economic 

 Geography of Indiana, Appletons, New York, 192.3. 



Typhoid Fever, — Indiana has a rather bad record for typhoid, having 

 an average mortality of 12.8, which is 25 per cent higher than the 

 average for the registration area of the United States. Furthermore 

 the rate has fallen less in Indiana in recent years than it has in the 

 nation as a whole. Figure 1 shows that several counties, those in black, 

 have on the average, five times the death rate as do other counties, 

 those in white. In the crossed counties, there is three times the typhoid 

 risk present in the white counties. 



According to these data. Lake County with its extensive marshy 

 tracts and largely emigrant population, has the greatest average mortal- 

 ity from typhoid, an average of 35 deaths per year per 100,000 popula- 

 tion. Four counties in the limestone area, shown in figure 2, have rates 

 between 25 and 27.5. The other counties in this limestone region also 

 suff"er heavily, the disease apparently being comparatively easily spread 

 through the agency of the poorly filtered ground water. It will be 

 recalled that in limestone regions, water commonly enters the ground 

 through sink holes and moves quickly along crevices, emerging perhaps 

 miles distant, but not purified by filtration nor by spending a long period 

 beneath the ground. 



Other counties having a high death rate from typhoid are those 

 in the coal mining region (figure 3) where many miners live without 

 proper sanitary arrangements and without safe water supplies. 



"Proc. Ind. Acad. Sci., vol. 33, 1923 (1924)." 



