¹ Meeker, Edward, “The Social Rate of Return on Investment in Public Health, 1880–1910”, this Journal, 34 (06 1974), p.417.Google ScholarPubMed

² Whipple, George, Typhoid Fever: Its Causation, Transmission, and Prevention (New York, 1908).Google Scholar

³ London began filtering its water in 1852, following a major cholera epidemic. Poughkeepsie, N. Y., was the first American city to build a filtration plant in 1875. Johnson, George, “Present Day Water Filtration Practices”, Journal of the American Waterworks Association, 1 (1914), p. 31;Google ScholarEllms, Joseph, Water Purification (New York, 1917), p. 46.Google Scholar

⁴ Thomas, Lewis, “Scientific Frontiers and National Frontiers: A Look Ahead,” Foreign Affairs, 62 (Spring 1984), p. 980.CrossRefGoogle Scholar

⁵ Shryock, Richard, Medicine in America (Baltimore, 1966).Google Scholar

⁶ Fuchs, Victor, Who Shall Live? (New York, 1974)Google Scholar, and Kitagawa, Evelyn and Hauser, Philip, Differential Mortality in the United States (Cambridge, Mass., 1973) are good examples of the inverse relationship.CrossRefGoogle ScholarAuster, Richard, Levenson, Irving, and Sarachek, Deborah, “The Production of Health”, Journal of Human Resources, 4 (Fall 1969), pp. 411–36CrossRefGoogle Scholar and Grossman, Michael, The Demand for Health (New York, 1972) examine the positive relationship which arises from an individual's ability to purchase a faster-paced, unhealthy lifestyle.Google Scholar Historical studies supporting the inverse relationship are found in Dublin, Louis, Health and Wealth (New York, 1928), p. 187Google Scholar and Sydenstricker, Edgar, Health and Environment (New York, 1933), pp. 84–104.Google Scholar

⁷ Kitagawa and Hauser, Differential Mortality, p. 17; Fuchs, Who Shall Live?, pp. 30–55; Auster, Levenson, and Sarachek, “Production of Health”, p. 152.Google Scholar

⁸ Higgs, Robert and Booth, David, “Mortality Differentials Within Large American Cities”, Journal of Human Ecology, 7 (12. 1979), pp. 353–70.CrossRefGoogle ScholarPubMed

⁹ U.S. Department of Commerce, Bureau of the Census, Historical Statistics of the United States (Washington, D.C., 1975), pp. 105–6.Google Scholar

¹⁰ Mortality rates in these countries were as high as twice that in the United States. Rates per 1000 were 29.8 in Russia, 22.2 in Austria, 21.1 in Italy, 14.9 in England, and 14.7 in the United States.Google Scholar

¹¹ Kitagawa and Hauser, Differential Mortality, pp. 93–98.Google Scholar

¹² U. S. Department of Commerce, Bureau of the Census, Mortality Statistics of the United States 1910 (Washington, D.C., 1913), p. 16.Google Scholar

¹³ Formal models of mortality and fertility are presented in Schultz, T. Paul, Economics of Population (Reading, Mass., 1981).Google Scholar

¹⁴ For similar findings see Aldrich, Mark, “Determinants of Mortality Among New England Cotton Mill Workers During the Progressive Era”, this JOURNAL, 42 (12. 1982), pp.847–64.Google ScholarPubMed

¹⁵ Dublin, Health and Wealth; Sydenstricker, Health and Environment.Google Scholar

¹⁶ See Whipple, Typhoid Fever.Google Scholar

¹⁷ Hering, Rudolph, “Sewage and Solid Refuse Removal” in Ravenal, Mazyck, ed., A Half Century of Public Health (New York, 1970), pp. 181–96.Google Scholar

¹⁸ Hazen, Allen, Clean Water and How to Get It (New York, 1909).Google Scholar

¹⁹ Typhoid cases actually increased in Washington, D.C. and Youngstown, Ohio, after filtration systems were installed. This was attributed to other sources of the disease, such as polluted wells and contaminated milk. See Whipple, Typhoid Fever, pp. 248–56.Google Scholar

²⁰ Sedgewick, W. T. and MacNutt, J. S., “On the Mills-Reinicke Phenomenon,” Journal of Infectious Diseases, 7 (08. 1910), pp. 489–564.Google Scholar

²¹ A time-series analysis of Chicago showed a steady decrease in typhoid fever deaths, but no major decline occurred after the introduction of a filtered water supply. The major factors held to be responsible for the decline were Chicago's sewage canal, the widespread pasteurization of milk from 1908 to 1916, and the introduction of chlorinated water in the late 1910s. See Dublin, Louis, Lotka, Alfred, and Spiegelman, Mortimer, Length of Life (New York, 1935), p. 158.Google Scholar

²² Jordan, Edwin, “Profitable and Fruitless Lines of Endeavor in Public Health Work”, in Congress of Technology, Technology and Industrial Efficiency (Boston, 1911).Google Scholar

²³ In 1910 the typhoid death rate was 22.5 per 100,000. The total crude death rate in the United States was 1720 per 100,000. This point was stressed in a discussion of the relative merits of filtration by an engineer from Rhode Island. See Journal of the American Waterworks Association, 11 (1914), p. 502.Google Scholar

²⁴ Shryock, Medicine in America, p. 152.Google Scholar

²⁵ Meeker, “Social Rate of Return,” includes as benefits from public health expenditures declines in morbidity and decreases in work time due to illness; we do not consider any factors other than mortality.Google Scholar