REVIEW OF PUBLIC HEALTH WORK IN INDIANA. 231 



Rate Per Ten Thousand Deaths. 



Mass. Ohio. 



Typhoid Fever 3.1 5.5 



Consumption 21.2 20.4 



Diphtheria 7.8 7.2 



Scarlet P ever 2.1 1.2 



"All but Indiana," said the report have put forth extra efforts to prevent 

 typhoid fever and diptheria, and not until very lately have unusual exertions 

 been made in any of the States to control and suppress consumption. The 

 efforts made in all the States named, to suppress and control diphtheria and 

 scarlet fever, are of the same character, viz., quarantine and its attendant 

 precautions. The introduction of diphtheria anti-toxin has certainly lessened 

 the mortality from diphtheria, and it is probably that to this agent we must 

 look for still further improvement. From the table it will be observed that 

 Massachusetts, Ohio and Michigan have worked hard, with a good measure 

 of success, to suppress typhoid fever. The rate per ten thousand deaths, 

 from typhoid in Massachusetts, is 3.1; in Ohio, 5.5; in Michigan, 4.1; while in 

 Indiana it is 13.4. What a serious comment this is upon our State. Why 

 should Indiana permit ten people to die, where Massachusetts saves them, 

 disease and death are not a source of wealth and power and we can ill afford 

 to permit this fearful destruction to continue. It is a reflection, too, upon 

 the morals of the State, for typhoid fever, like sin, is a reproach to any com- 

 munity. One thousand, four hundred and eighteen deaths were reported 

 from this disease in 1897, and as shown above, this can not be more than 

 one-third of the real number. We must, therefore, estimate the deaths 

 from this preventable disease to have been in the neighborhood of four thou- 

 sand. This means at the very least twenty to twenty-flve thousand cases. 

 What a fearful waste of life and what an awful subordination of liberty and 

 loss of happiness. Prodigious indeed is the responsibility of the medical 

 profession in this matter. 



The cure of the trouble lies first, in disposing of the wastes of life by 

 proper sanitary methods, and second, in securing to every home, pure 

 drinking water. In Indiana, as in other States, typhoid seems to be a rural 

 disease. That is, if we count with what is truly rural our small towns and 

 hamlets. Well drained cities, possessing good water supplies, always have 

 low typhoid rates." 



It seems fair to account in the following way for the prevalence of typhoid 

 and bowel disorders on the farm : A man buj^s a farm. A site for his house 

 is selected almost entirely from the standpoint of convenience, health not 

 materially entering into the calculation. Water is supplied by digging a hole 

 into the ground or driving down an iron pipe. The position of the well is in 

 the rear of the house and if the surface contour permits, is frequently placed 

 below the level of the house in order to save digging or driving so deep as 



