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The Rural Science Series
EDITED BY L. H. BAILEY
RURAL HYGIENE
THE MACMILLAN COMPANY
NEW YORK . BOSTON . CHICAGO
ATLANTA . SAN FRANCISCO
MACMILLAN & CO., LIMITED
LONDON . BOMBAY . CALCUTTA
MELBOURNE
THE MACMILLAN CO. OF CANADA, LTD.
TORONTO
RURAL HYGIENE
BY
HENRY N. OGDEN, C.E.
PROFESSOR OF SANITARY ENGINEERING IN COLLEGE OF CIVIL ENGINEERING,
CORNELL UNIVERSITY SPECIAL ASSISTANT ENGINEER, NEW YORK STATE DEPARTMENT
OF HEALTH
New York
THE MACMILLAN COMPANY
1911
_All rights reserved_
COPYRIGHT, 1911,
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published January, 1911.
Norwood Press
J. S. Cushing Co.--Berwick & Smith Co.
Norwood, Mass., U.S.A.
PREFACE
The following pages represent an attempt to put before the rural
population a systematic treatment of those special subjects included in
what is popularly known as Hygiene as well as those broader subjects
that concern the general health of the community at large.
Usually the term "hygiene" has been limited in its application to a
study of the health of the individual, and treatises on hygiene have
concerned themselves almost entirely with discussing such topics as
food, clothing, exercise, and other questions relating to the daily life
of a person. Of late years, however, it has become more and more evident
that it is not possible for man to live to himself alone, but that his
actions must react on those living in his vicinity and that the methods
of living of his neighbors must react on his own well-being. This
interdependence of individuals being once appreciated, it follows that a
book on hygiene must deal, not only with the question of individual
living, but also with those broader questions having to do with the
cause and spread of disease, with the transmission of bacteria from one
community to another, and with those natural influences which, more or
less under the control of man, may affect a large area if their natural
destructive tendencies are allowed to develop.
Being written by an engineer, the following pages deal rather with the
structural side of public hygiene than with the medical side, and in
the chapters dealing with contagious diseases emphasis is attached to
quarantine, disinfection, and prevention, rather than to etiology and
treatment. The book is not, therefore, a medical treatise in any sense,
and is not intended to eliminate the physician or to give professional
advice, although the suggestions, if followed out, undoubtedly will have
the effect of lessening the need of a physician, since the contagious
diseases referred to may then be confined to single individuals or to
single houses.
It has not been possible, within the limits of this one book, to
describe at length the various engineering methods, and while it is
hoped that enough has been said to point the way towards a proper
selection of methods and to a right choice between processes, the
details of construction will have to be worked out in all cases, either
by the ingenuity of the householder or by the aid of some mechanic or
engineer.
Finally, it may be said that two distinct purposes have been in mind
throughout,--to promote the comfort and convenience of those living in
the rural part of the community who, unfortunately, while most happily
situated from the standpoint of health in many ways, have failed to give
themselves those comforts that might so easily be added to their life;
and in the second place, to emphasize the interdependence of the rural
community and the urban community in the matter of food products and
contagious diseases, an interdependence growing daily as interurban
communications by trolley and automobile become easy.
Cities are learning to protect themselves against the selfishness of the
individual, and city Boards of Health have large powers for the purpose
of guarding the health of the individuals within their boundaries. The
scattered populations of the open country are not yet educated to the
point at which self-protection has made such authority seem to be
necessary, and it is left largely to an exalted sense of duty towards
their fellow-men so to move members of a rural community as to order
their lives and ways to avoid sinning against public hygiene. In order
to develop such a sense of honor, it is primarily necessary that the
relation of cause and effect in matters of health shall be plainly
understood and that the dangers to others of the neglect of preventive
measures be appreciated. As a single example, the transmission of
disease at school may be cited. Measles, scarlet fever, whooping cough,
and diphtheria are all children's diseases, easily carried and
transmitted, and held in check only by preventing a sick child from
coming in contact with children not sick. No law is sufficient. The
matter must be left to the mother, who will retain children at home at
the least suspicion of sickness and keep them there until after all
traces of the disease have passed away.
The health conditions in the open country, judged by the standard of
statistics, are quite as good as those of the city. The comforts of
country life are as yet inferior, and it is hoped that this book may do
something to advance the standard of living in the families into which
it may enter.
H. N. OGDEN.
ITHACA, NEW YORK,
November 1, 1910.
CONTENTS
CHAPTER I
VITAL STATISTICS OF RURAL LIFE
PAGES
Death-rate. Ideal death-rates. Death-rates in New York State.
Accuracy of records. Effect of children. Death-rates of
children. Small cities. Tuberculosis. Diphtheria, Influenza.
Pneumonia. Old age 1-24
CHAPTER II
LOCATION OF A HOUSE--SOIL AND SURROUNDINGS
Damp soils. Location of house. Objections to trees. Space
between houses. Composition of soils. Cancer and soil
conditions. Topography. Effects of cultivation. Made
ground. Water in soil. Drainage. Ground water 25-48
CHAPTER III
CONSTRUCTION OF HOUSES AND BARNS WITH REFERENCE TO
HEALTHFULNESS
Shutting out soil air. Position of outfall for drains. Dampness
of cellar walls. Use of tar or asphalt. Dry masonry for
cellar walls. Damp courses. The cellar floor. Cellar ventilation.
The old-fashioned privy. Cow stables. Use of
concrete 49-67
CHAPTER IV
VENTILATION
Effects of bad air. Modifying circumstances. Dangers of polluted
air. Effect of changes in air. Composition of air.
Organic matter in air. Fresh-air inlet. Position of inlet.
Foul-air outlet. Size of openings. Ventilation of stables.
Cost of ventilation. Relation of heating to ventilation 68-89
CHAPTER V
QUANTITY OF WATER REQUIRED FOR DOMESTIC USE
Modern tendencies. Quantity of water needed per person.
Quantity used in stables. Maximum rate of consumption.
Variation in maximum rate. Fire stream requirements.
Rain-water supply. Computation for rain-water storage.
Computation for storage reservoir on brook. Deficiency
from well supplies 90-107
CHAPTER VI
SOURCES OF WATER-SUPPLY
Underground waters. Ordinary dug well. Construction of dug
wells. Deep wells. Springs. Extensions of springs. Supply
from brooks. Storage reservoirs. Ponds or lakes.
Pressure or head 108-130
CHAPTER VII
QUALITY OF WATER
Mineral matter. Loss of soap. Vegetable pollution. Animal
pollution. Well water. Danger of polluted water 131-152
CHAPTER VIII
WATER-WORKS CONSTRUCTION
Methods of collection. Spring reservoirs. Stream supplies.
Dams. Waste weirs. Gate house. Pipe lines. Pumping.
Windmills. Hydraulic rams. Hot-air engines. Gas
engines. Steam pumps. Air lifts. Tanks. Pressure
tanks 153-188
CHAPTER IX
PLUMBING
Installation. Supply tank. Main supply pipe. Hot-water circulation.
Kitchen sinks. Laundry tubs. Hot-water boiler.
Water-back, wash-basin, bath-tub. Cost of plumbing installation.
House drainage. Trap-vents. Water-closets 189-207
CHAPTER X
SEWAGE DISPOSAL
Definition of sewage. Stream pollution. Treatment of sewage
on land. Surface application. Artificial sewage beds. Subsurface
tile disposal. Automatic syphon. Sedimentation.
Underdrains 208-232
CHAPTER XI
PREPARATION AND CARE OF MILK AND MEAT
Bacteria in milk. Effects of bacteria. Diseases caused by milk.
Methods of obtaining clean milk. City milk. Dangers of
diseased meat. The slaughter-house 233-256
CHAPTER XII
FOODS AND BEVERAGES
The human mechanism. Digestive processes. Teachings of the
digestive operations. Balanced rations. Human appetite.
Effect of individual habits. Cooking. Muscular and psychic
reactions. Consumption of water. Condiments and drinks.
Tobacco. The drug habit 257-277
CHAPTER XIII
PERSONAL HYGIENE
Exercise. Clothing. Bathing. Mouth breathing. Eyes.
Teeth. Sleep 278-294
CHAPTER XIV
THEORIES OF DISEASE
Effects of dirt. Blood resistance. Cell disintegration. Heredity.
Age and sex. Occupation. Direct cause of disease. Parasites.
Bacterial agencies. Antitoxins. Natural immunity.
Chemical poisons. External causes 295-313
CHAPTER XV
DISINFECTION
Disinfecting agents. Antiseptics. Deodorizers. Patented disinfectants.
Disinfecting gases. Sulfur. Formaldehyde.
Liquid disinfectants. Carbolic acid. Coal-tar products.
Mercury. Lime. Soap. Heat. Dry heat. Boiling water.
Steam. Drying, light, and soil 314-331
CHAPTER XVI
TUBERCULOSIS AND PNEUMONIA
Tuberculosis. Individual resistance. Precautions by the consumptive.
Cure of consumption. Pneumonia--the germ.
Weather not the cause of pneumonia. Preventives in pneumonia.
Infection of pneumonia 332-348
CHAPTER XVII
TYPHOID FEVER
Cause of the disease. The bacillus. Methods of transmission
of typhoid. Construction of wells in reference to typhoid.
Milk infection by typhoid. Infection by flies. Other sources
of typhoid fever. Treatment of typhoid fever 349-363
CHAPTER XVIII
CHILDREN'S DISEASES
After effects. Preliminary symptoms. Contagiousness. Quarantine
for scarlet fever. Measles. Characteristic eruption
of measles. Whooping cough. Precautions against spread
of whooping cough. Chicken pox 364-376
CHAPTER XIX
PARASITICAL DISEASES
Malaria. Mosquitoes and malaria. Elimination of mosquitoes.
Limitation of mosquito infection. Yellow fever. Characteristics
of the disease. Hookworm disease. Pellagra. Bubonic
plague 377-395
CHAPTER XX
DISEASES CONTROLLED BY ANTITOXINS
Smallpox. Value of vaccination. Characteristics of smallpox.
Treatment of smallpox. Diphtheria. Cause of the disease.
Production of diphtheria antitoxin. Symptoms of diphtheria.
Rabies. Tetanus 396-409
CHAPTER XXI
HYGIENE AND LAW
Principle of laws of hygiene. Self-interest, the real basis of law.
Quality of water. Regulations governing foods. Basis of
pure food laws. Protection of milk. Laws governing quarantine 410-425
LIST OF FIGURES
FIG. PAGE
1. Map of New York State 5
2. Bad conditions about a dwelling 28
3. Grading that turns water away from the house 42
4. Modes of laying out drains 46
5. Exterior wall-drains 50
6. Interior cellar-drains 51
7. Wall modes of making air-space 53
8. Water-tight wall 54
9. Rough-backed wall 56
10. Even-backed wall 56
11. Modes of making water-proof cellar walls 57
12. Water-proofing of cellar walls 58
13. Cellar-wall forms 65
14. Letting in fresh air 78
15. Ventilating device 79
16. Ventilating device 80
17. Ventilation by means of coal stove 82
18. Coal-stove ventilation 83
19. Coal-stove ventilation 84
20. Outlets into walls 86
21. Cow-barn ventilation 88
22. How a pump works 105
23. Air-lift pump 106
24. Diagram of a spring 109
25. Water finding its way from a hillside 110
26. The sinking of wells 110
27. Mode of sinking a well 114
28. A well that will catch surface water 115
29. A well properly protected 116
30. A properly protected well 117
31. Well-drilling apparatus 118
32. Sinking a well by means of a water-jet 120
33. An enclosed spring 122
34. A spring extension 123
35. A reservoir for home use 126
36. Stream draining a privy 129
37. Contamination of a creamery from the water supply 148
38. A protected spring-chamber 157
39. Concrete core in a dam 159
40. Section of a flood dam 161
41. Section of a flood dam 162
42. A joint in tile pipe 167
43. Windmill and water tank 170
44. Installation of a ram 172
45. Means of securing fall for hydraulic ram 174
46. A hot-air engine 176
47. A gas engine 179
48. Pump operated by belt 180
49. Duplex pump operated directly by steam 180
50. Raising water by means of compressed air 182
51. Wooden tank 183
52. Iron tank 185
53. Hand pump applied to air-tank 186
54. Engine applied to air-tank 187
55. Windmill connection with tank 188
56. Construction of a wooden tank 193
57. Hot-water attachment to the kitchen stove 195
58. Enameled iron sink 197
59. Enameled iron laundry tubs 198
60. Leveling the drain 200
61. Water-supply installation 202
62. A trap 204
63. Washout water-closet 205
64. Washdown water-closet 205
65. Syphonic closet 205
66. Syphon-jet closet 206
67. Sewage beds 217
68. Plan of sewage beds 220
69. Plan of subsurface irrigation field 224
70. Section of "Miller" syphon 226
71. Plan and section of a septic tank 227
72. Section of a septic tank with syphon chamber 229
73. Plan of sewage disposal for a single house 231
74. School girl with adenoids 289
75. Outdoor sleeping porch for tuberculous patients 343
76. Mortality from pulmonary tuberculosis 344
77. Spring infected by polluted ditch 356
RURAL HYGIENE
CHAPTER I
_VITAL STATISTICS OF RURAL LIFE_
It is commonly supposed that good health is the invariable accompaniment
of country life; that children who are brought up in the country are
always rosy-cheeked, chubby, and, except for occasional colds, free from
disease; that adults, both men and women, are strong to labor, like the
oxen of the Psalmist, and that grandfathers and grandmothers are so
common and so able-bodied that in practically every farmhouse the daily
chores are assigned to these aged exponents of strong constitutions and
healthy lives. If, however, we are honest in our observations, or have
lived on a farm in our younger days, or have kept our eyes open when
visiting in the country, we will remember, one by one, certain facts
which will persistently suggest that, after all, life on the farm may
not be such a spring of health as we have been led to believe. We will
remember the frequency of funerals, especially in the winter, and the
few families in which all the children have reached maturity. We will
remember the worn-out bodies of men and women, bent and aged while yet
in middle life.
It is worth while, then, at the beginning, to find out, if we can, just
what are the conditions of health in rural communities, in order to
justify any book dealing with rural hygiene; for it is plain that if
health conditions are already perfect, or nearly so, no book dealing
with improved methods of living is needed, and the wisdom of the
grandparents may be depended on to continue such methods into the next
generation.
_Death-rate._
The usual method of measuring the health conditions of any community,
such as a city, town, county, state, or country, is to compute the
general death-rate, as it is called; that is, the number of deaths
occurring per 1000 population. For example, in 1908, with its estimated
population of 8,546,356, there occurred in New York State 138,441
deaths, or 16.2 deaths for every 1000 population. Sixteen and two-tenths
is, then, the general death-rate for the state for that year. This
method of determining the health of a community is crude and should not
be too strictly relied upon for proving the healthfulness implied. The
rate is at best only an average, and takes no account of anything but
death, one death being a greater calamity, apparently, than a dozen
persons incapacitated from disease. Then, too, this death-rate is
greatly affected by peculiarities of the community in age, sex,
nationality, and occupation, and by local conditions of climate,
altitude, and soil. The effect of these local conditions can best be
explained after a consideration of the general death-rate and its
definite values in different places.
In the United States, as a whole, or, more exactly, in that part of the
United States which keeps such records of deaths as to be reliable
(about one half), the annual average death-rate for the five-year period
1901-1905 was 16.3, and this may be compared with the death-rate in
other countries shown in the following table for the same period:--
TABLE I. DEATH-RATES IN VARIOUS COUNTRIES
Australia 11.7
Austria 24.2
Belgium 17.0
Denmark 14.8
England 16.0
France 19.6
Germany 19.9
Italy 21.9
Japan 20.9
Netherlands 16.0
New York State 17.1
Norway 14.5
Spain 26.1
Sweden 15.5
United States 16.3
_Ideal death-rates._
There are special reasons why the Australian death-rate should be low,
but, neglecting this one country entirely, it will be seen that Norway,
Denmark, and Sweden have rates of 14.5, 14.8, and 15.5, respectively;
rates which may be considered as good as any country can attain at the
present time. But the United States, as a whole, has about one more
death per 1000 than these countries, and New York State two more per
1000 population. This means that in New York State there are 16,000 more
deaths each year than if the population were living in Sweden under
Swedish conditions and laws. Or, expressed in another way, it means that
in Sweden one out of every sixty-five persons dies each year, and in New
York one out of every fifty-eight persons.
The rate in New York State is high because the state contains a large
number of cities, and concentration of population generally implies all
kinds of bad and unsanitary conditions. As a rule, a higher death-rate
may be expected in a densely populated community than in a sparsely
settled one, and we should therefore expect a rural community to show a
lower death-rate than a city or urban community. It is not a fair
estimate of the health of any rural locality, such as a county where no
large cities exist, to compare its death-rate with the average of the
state, or with the average rate of some other county which contains a
large city. This fact is plainly brought out by the statistics in Table
II, from the several sanitary districts into which the state of New York
is divided, as shown on the map, Fig. 1:--
TABLE II. SHOWING VARYING DEATH-RATES IN DIFFERENT PARTS OF NEW YORK
STATE
======================================================
| DEATH RATE IN
SANITARY DISTRICTS ---------------------------
| 1901-5 | 1906 | 1907
------------------------------------------------------
New York State | 17.1 | 17.1 | 17.5
Maritime | 19.0 | 18.2 | 18.4
Hudson Valley | 17.2 | 17.0 | 18.2
Mohawk Valley | 15.5 | 16.3 | 16.6
West Central | 15.0 | 15.6 | 16.6
Lake Ontario and Western | 14.9 | 15.5 | 15.9
East Central | 14.9 | 15.4 | 15.9
Southern Tier | 14.4 | 14.7 | 15.6
Adirondack and Northern | 13.9 | 15.1 | 15.3
======================================================
_Death-rates in New York State._
[Illustration: FIG. 1.
MAP OF THE STATE OF NEW YORK SHOWING THE SANITARY DISTRICTS]
The Maritime District includes the four counties of New York City and
comprises about half the population of the state. Its population is
almost entirely quartered under distinctly urban conditions, in some
parts with a congestion not equaled in any other city of the country. It
would naturally, therefore, have a high death-rate, and that it is no
higher than it is makes it a matter for congratulation. And yet the rate
in New York City is higher than in the other principal large cities of
the world. For example, the rates for the five-year period 1900-1904 in
Berlin averaged 18.3, in Paris 18.2, and in London 16.9, New York being
19.4 for the corresponding period. The excess in New York is due in part
to local conditions and in part to a less active oversight in matters of
public health. Similarly, the Hudson Valley District, which embraces the
large cities along the Hudson, has a higher death-rate than the state
average, whereas the other six districts have low rates, chiefly because
of the large proportion of agricultural land and small towns. The last
district should be noted particularly, since its rate is remarkably low
and its number of cities very small, compared with the area included.
The conclusion may be properly drawn, therefore, that statistics confirm
the general impression that life in the country is healthier than life
in the city.
_Accuracy of death-rate records._
One factor must be considered, however, since it plays an important part
in drawing conclusions from these kinds of statistics, and that is, the
accuracy of the records. In a city in which every one must be buried in
a public cemetery, and when the physician, the undertaker, and the
sexton all have to keep records which must agree, it is not easy for any
burial to occur without the fact being recorded and later registered in
the Census Office at Washington. But in the country, a person may be
killed by accident, for example, and buried in a private lot without the
undertaker recording it at all. The result is that the total number of
deaths seems fewer and the death-rate seems smaller than the facts
warrant, so that a false idea of the healthfulness of the community
obtains. That errors of this sort have existed in the past can be seen
by examining the death-rates for New York City and those for regions
outside that city for the past ten years:--
TABLE III. DEATH-RATES IN NEW YORK CITY AND ELSEWHERE IN NEW YORK STATE,
1898-1908
=======================================
New York Outside Difference
---------------------------------------
1898 20.4 14.5 5.9
1899 19.6 14.9 4.7
1900 20.6 15.0 5.6
1901 19.9 15.1 4.8
1902 18.6 14.1 4.5
1903 17.9 15.2 2.7
1904 18.5 17.3 1.2
1905 18.3 15.8 2.5
1906 18.4 15.7 2.7
1907 18.5 16.4 2.1
1908 16.8 15.5 1.3
=======================================
The decrease in the city rate is to be expected, since with greater
knowledge of sanitary matters, more precautions against disease would
naturally be taken. But it is not likely that the country is becoming
more careless, although the tendency to concentrate population even in
rural hamlets may have an effect. It is rather more likely that the
reports are made more carefully and that the records are more complete
now than formerly. The apparent increase in the number of deaths in
rural communities is, therefore, due to greater attention in reporting
deaths rather than to any real increase in the number.
If the difference between the rural community death-rate and the rate in
all the cities of more than 8000 population in New York State be shown,
the difference between the city rate and the country rate is even less
than that shown in the table, being only 0.7 deaths in 1000 for 1908.
This shows that the boasted superiority of the country over cities is
not very great; that it is marked only in the case of a very large city
like New York; that, as the size of the city decreases, the difference
disappears, and that the country rate in the United States is high when
compared with the general rate of other countries like Denmark or even
England, where the general rate includes the large cities.
_Effect of children on death-rate._
An interesting sidelight on the apparent tendency of the country to have
an increasing death-rate, year by year, is shown by the meager figures
which are available on the subject of the number of small children in
the different towns. The Chief Clerk in the Census Office, Mr. William
S. Rossiter, has investigated the proportion of children in two rural
counties of New York State, Otsego and Putnam, and has discovered the
startling fact that while the population in those counties has hardly
changed since 1860, the proportion of young children has decreased
almost one third in the forty years ending with 1900, as shown by the
following table:--
TABLE IV. TABLE SHOWING PERCENTAGE OF CHILDREN IN OTSEGO AND PUTNAM
COUNTIES, 1860-1900
===========================================================================
1900 1860
------------------------------------------------------------------
Total Total
White Under 10 White Under 10
County Population Years Per Cent Population Years Per Cent
---------------------------------------------------------------------------
Otsego 48,793 7,121 14.5 49,950 10,988 22.0
Putnam 13,669 2,332 16.9 13,819 3,333 24.1
------------------------------------------------------------------
Total 62,462 9,453 15.0 63,769 14,321 22.5
===========================================================================
This shows that while in 1860, when the total population was about
64,000, the number of children was about 14,000 or 22.5 per cent, in
1900, when the total population was 62,462 or nearly the same, the
number of children was only 9453, or a reduction in numbers of nearly
5000 children. In many of the small cities of New York State, the fact
that there is a constantly decreasing number of children in the
community is well recognized, the greater proportion of the population
being past middle life. The death-rate, therefore, is lower, from this
very fact.
_Death-rates of children._
That the general death-rate is directly affected by the number of
children living in a community is shown by the following table:--
TABLE V. SHOWING DEATHS FROM ALL CAUSES IN THE UNITED STATES FOR THE
YEARS 1901-1905, AT VARIOUS AGE PERIODS
================================================
No. at Each Per Cent of Total
Age Age Population
------------------------------------------------
Aggregate 529,630 ----
Under 1 year 100,268 18.93
Under 5 years 143,684 27.13
5-9 years 13,679 2.58
10-19 years 23,234 4.38
20-29 years 46,685 8.81
30-39 years 49,501 9.34
40-49 years 48,811 9.21
50-59 years 51,787 9.77
60-69 years 59,856 11.31
70-79 years 56,544 10.68
80-89 years 29,408 5.55
90 and over 6,441 1.21
================================================
This table shows two things: first, that children have a hard time
reaching five years, as nearly one third of all the children born in any
year die under five years, and second, that from five to twenty years is
the healthiest--that is, safest--time of a person's life, since after
twenty the constitutional diseases make themselves felt so that death
becomes almost uniformly distributed from twenty to eighty. It is plain,
then, that in any community a change in the relative proportion of
children born in any year would change the death-rate, since with a
smaller number of infants there could not be so many to die.
No statistics are available to determine the number of small children in
the country as compared with that in the city, but it is probable that
they are in excess in the latter, since the highest birth-rates are
found in the congested districts of cities where foreigners congregate.
If this is so, it will account for and justify a higher rate of death in
the city because of the larger number of children, as has been explained
above, and the lower rate in the country may be due, not to better
sanitary surroundings, but solely to fewer children.
According to statistics, the death-rate of children is almost 50 per
cent higher in cities than in rural districts, and it is a general
impression that most deaths in the country are from old age. English
statistics show, however, and those of the United States would probably
show the same thing, that while a baby born in the city is more likely
to die before its first birthday than a baby born in the country, they
have equal chances to finish a month of life and that the city child has
better chances to live out the first week. The advantages of the
country, therefore, do not begin to operate until after the first month
of the baby's life, and there is a decidedly greater chance of the
child's living in the city the first week on account, probably, of
better and quicker medical attendance.
_Typhoid fever and the death-rate._
Turning now to special diseases and comparing the number of deaths
caused by special diseases in the country and in the city, it is to be
noted, first of all, that a greater difference exists in the case of
certain special diseases in the country and in the city than was found
in the general death-rate. In the case of typhoid fever, basing the
comparison on the statistics of the Census Office of the United States,
we find, first, that, at present, the difference in the death-rates from
typhoid fever in cities and in rural districts is very small. It is
also to be seen (from the following table) that in both city and in
rural districts, the rate is steadily decreasing, although in neither
has the rate yet fallen to what would, in other countries, be considered
a reasonable and proper death-rate. The first line of the table is the
actual death-rate from typhoid fever per 100,000 population, based on
the total population resident in all the United States where vital
statistics are kept; the second line gives the same data for cities not
included in registration states;[1] the third line is based on figures
for cities in registration states;[1] and the fourth line is based on
the statistics for rural districts and villages of less than 8000
population:--
TABLE VI. SHOWING DEATH-RATES PER 100,000 POPULATION FROM TYPHOID FEVER
IN PLACES INDICATED
==============================================================================
Year 1900 1901 1902 1903 1904 1905 1906 1907 1908
------------------------------------------------------------------------------
The registration
area 35.9 32.4 34.5 34.4 32.0 28.1 32.1 30.3 25.3
Registration
cities 36.5 33.9 37.5 38.2 35.2 30.1 34.2 32.9 25.8
Cities in registration
states 28.5 26.5 25.9 24.6 24.0 22.0 34.2 31.7 24.5
Rural part of
registration
states 34.6 28.8 27.0 24.7 23.8 23.0 28.6 26.0 24.3
==============================================================================
[Footnote 1: States in which full credit is given by U. S. Census Office
for Vital Statistics collected from all parts of the state.]
This table shows that, taking the United States as a whole, the
typhoid-rate in rural districts is generally less than in cities and
that in cities the rate is excessively high.
When it is remembered that by filtration of public water-supplies the
typhoid-rate may be brought down to about 15 per 100,000, and that
cities with pure water-supplies will not exceed that rate, it is plain
how serious is the danger from typhoid in such cities as Cohoes or
Oswego. The following table from statistics taken in New York State
shows the same conditions as Table VI.--
TABLE VII. SHOWING DEATH-RATES FROM TYPHOID FEVER PER 100,000 POPULATION
IN NEW YORK STATE AS INDICATED
==============================================================================
Year 1900 1901 1902 1903 1904 1905 1906 1907 1908
------------------------------------------------------------------------------
Cities average 25.4 23.9 23.4 22.6 21.6 19.1 19.0 20.7 20.1
Rural districts 32.0 27.3 23.4 22.1 21.8 21.8 20.2 19.3 20.8
Average of city
population -- 38.9 33.9 43.0 40.3 32.2 30.5 32.1 32.4
Average of rural
population -- 20.3 24.1 23.2 21.3 22.3 21.3 19.9 20.8
==============================================================================
The first line is the death-rate in cities, found by taking the ratio of
all the deaths from typhoid in cities to the population in those cities,
and the second line is a similar ratio for rural districts. If the
actual rates of the several cities be averaged, a method which has 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 |1901 |1902 |1903 |1904 |1905 |1906 |1907 |1908
-------------------------------------------------------------------------------
| _Cities using unfiltered lake water:_
Auburn | 23.0 | 23.4| 39.5| 22.9| 9.7| 25.8| 28.8| 15.9| 12.1| 6.0| 46.6
Dunkirk | 40.2 | 17.5| 51.6| 32.4| 76.5| 29.0| 41.3| 39.3| 31.4| 71.8| 11.1
Geneva | 29.3 | 49.2| --- | 46.3| 9.0| 52.1| 42.0| 32.7| 24.0| 15.4| 22.1
-------------------------------------------------------------------------------
| _Cities using unfiltered river water:_
Cohoes | 84.4 | 88.3|113.0| 58.4|133.2| 91.3|103.6| 57.9| 57.8| 78.2| 62.0
Lockport | 48.4 | 18.1| 18.0| 71.5| 35.4| 75.7| 34.6| 51.8| 67.6| 50.1| 60.7
Niagara | | | | | | | | | | |
Falls |132.9 |113.0|123.3|143.7|148.1|114.0|135.3|184.4|154.5|126.0| 87.1
North | | | | | | | | | | |
Tonawanda| 30.9 | 23.1| 11.0| 32.3| 10.5| 41.1| 30.2| 39.3| 19.3| 47.2| 54.6
Ogdensburg| 54.6 | 87.8| 39.5| 31.4| 62.3| 61.7| 68.9| 53.1| 67.3| 47.1| 26.8
Oswego | 49.4 | 22.6| 45.0| 22.4| 17.5| 53.5| 62.3| 84.1| 58.0| 66.0| 62.2
Rome | 22.7 | 26.1| 6.5| 12.2| 25.2| 18.6| 24.5| 42.3| 28.2| 17.0| 26.4
Tonawanda | 30.1 | 13.5| 13.4| 13.3| --- | 26.0| 38.4| 25.3| 50.6| 25.0| 95.6
-------------------------------------------------------------------------------
| _Cities using filtered river water:_
Albany | 28.7 | 87.0| 40.3| 21.1| 30.2| 19.7| 18.5| 19.3| 20.3| 20.0| 10.9
Binghamton| 22.2 | 25.5| 42.8| 52.4| 27.1| 9.7| 9.6| 12.0| 9.1| 18.2| 15.2
Elmira | 41.0 | 33.6| 47.6| 25.4| 39.7| 80.0| 51.6| 28.8| 44.7| 28.0| 30.7
Pough- | | | | | | | | | | |
keepsie | 46.5 | 25.1| 45.7| 41.1| 20.3| 44.2| 59.7| 43.3| 39.4|112.0| 34.5
Rensselaer| 61.9 |107.3| 93.7| 61.6| 91.2| 31.8| 89.4| 37.3| 18.6| 58.3| 30.0
Watertown | 71.9 | 85.7|101.4| 35.6| 64.7| 71.0|211.0| 23.6| 50.0| 37.1| 39.0
Watervliet| 57.5 |105.7| 77.0| 55.6| 62.3| 55.2| 61.8| 47.9| 47.7| 20.4| 41.1
-------------------------------------------------------------------------------
| _Cities using well or spring water:_
Corning | 46.4 | 27.7| 54.2| 43.2| 24.9| 48.0| 46.1| 30.0| 43.1| 69.0| 78.2
Cortland | 29.2 | 55.8| 33.2|116.2| 10.1| --- | 9.2| 26.6| 8.7| 24.6| 7.9
Fulton | 33.2 | 25.0| --| 24.0| 11.8| 93.2| 34.8| 22.6| 56.5| 22.0| 42.5
Ithaca | 51.7 | 7.8| 45.6| 44.6| 7.3|357.0| 27.9| 13.7| 6.8| -- | 6.4
Olean | 19.5 | 21.6| 10.5| 20.8| 30.7| 30.3| 20.0| --- | 20.0| 19.1| 22.1
Jamestown | 28.9 | 40.5| 39.3| 25.5| 4.1| 24.1| 62.7| 23.0| 33.8| 18.2| 17.5
Schen- | | | | | | | | | | |
ectady | 31.6 | 3.3| 44.2| 40.5| 26.0| 33.5| 22.6| 8.6| 17.8| 8.7| 10.9
--------------------------------------------------------------------------------
| _Cities using water from streams and reservoirs:_
Amsterdam | 19.4 | 19.8| 14.3| 23.2| 18.1| 44.0| 17.1| 16.7| 24.8| 15.9| ---
Glens | | | | | | | | | | |
Falls | 37.6 | 24.6| 47.6| 61.4| 14.9| 28.9| 49.2| 20.4| 46.5| 45.3| 36.9
Glovers- | | | | | | | | | | |
ville | 20.0 | 16.7| 49.0| 5.4| 43.3| 10.8| 5.4| 21.4| 5.3| 5.3| 37.3
Johnstown | 19.1 | 20.2| 69.1| -- | 20.0| 30.1| --- | 10.2| 20.4| --- | 21.1
Newburgh | 39.6 | 48.4| 44.1| 23.7| 47.0| 34.7| 42.0| 37.1| 41.3| 41.0| 36.4
New | | | | | | | | | | |
Rochelle | 21.1 | 7.1| 6.8| 38.0| 29.3| 22.0| 15.5| 19.5| 23.2| 22.0| 28.0
Plattsburg| 21.0 | 24.1| 23.7| 34.1| 11.0| 21.1| --- | 39.2| 28.7| 27.6| ---
Troy | 49.2 | 65.1|101.2| 55.7| 48.8| 32.8| 44.4| 46.8| 36.2| 25.8| 34.9
Utica | 17.3 | 16.3| 14.1| 15.6| 20.3| 16.6| 17.8| 9.5| 27.6| 15.2| 20.1
Port | | | | | | | | | | |
Jervis | 42.7 | 10.6| 31.9| 31.8| 52.5| 73.1| 72.6| 72.2| 31.0| 51.0| ---
Little | | | | | | | | | | |
Falls | 36.4 | 29.3|125.2| 28.5| 37.5| 27.7| 36.4| --- | 44.7| 8.8| 25.9
Oneida | 17.2 | 26.5| 13.3| 25.9| 38.0| --- | 36.3| --- | 11.8| --- | 19.8
-------------------------------------------------------------------------------
| _Cities using filtered surface water:_
Hornell | 28.8 | 76.1| 25.1| 32.8| 32.1| 55.0| 7.7| 30.2| 7.5| 7.5| 14.1
Hudson | 59.2 | 62.8| 94.4| 41.3| 81.3| 30.0|167.7| 48.5| 38.0| 9.4| 18.1
Kingston | 19.4 | 28.9| 8.1| 12.1| 16.0| 19.9| 11.8| 31.3| 15.6| 27.0| 22.9
Middleton | 24.5 | 21.0| 13.7| 13.8| 55.1| 13.8| 6.9| 41.3| 18.8| 18.8| 42.1
Mount | | | | | | | | | | |
Vernon | 14.6 | 5.0| 4.9| 13.6| 8.8| 8.5| 20.6| 20.0| 19.4| 37.7| 7.1
Oneonta | 37.9 | 28.7| 27.9| 13.6| 66.5| 26.0| 50.8| 24.8| 48.6| 23.8| 68.2
Yonkers | 9.9 | 10.8| 4.1| 15.9| 9.3| 14.2| 15.2| 1.6| 6.2| 11.9| 9.6
===============================================================================
Another reason for the prevalence of this disease in small cities is
that the organization of their health boards is much less effective than
that of larger cities. Individuals have not yet learned to sacrifice
their own wishes for the sake of the community, and the local health
officer, however much he may desire to do his duty, is not upheld by
public opinion, and is therefore powerless.
In order to show the condition existing in the small cities of the state
of New York, the preceding table has been prepared, showing the average
death-rate for the cities of the state for the past ten years,
excluding, however, the cities of New York, Buffalo, Rochester, and
Syracuse, all of which have well-organized health boards, and where no
epidemic of typhoid fever may be expected. Remembering that a rate of 15
per 100,000 is a normal rate, it will be easily seen how excessive is
the amount of typhoid fever in most of the cities of New York State.
TABLE IX. SHOWING DEATHS FROM TUBERCULOSIS PER 100,000 POPULATION IN THE
UNITED STATES
===============================================================================
| 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908
-------------------------------------------------------------------------------
The registration| | | | | | | | |
area | 180.5| 175.1| 163.6| 165.7| 177.3| 168.2| 159.4| 158.9| 149.6
Registration | | | | | | | | |
cities | 198.8| 192.1| 180.7| 183.6| 195.5| 184.4| 181.5| 179.4| 170.1
Cities in | | | | | | | | |
Registration | | | | | | | | |
states | 204.1| 194.9| 177.7| 179.7| 189.4| 178.5| 184.0| 181.5| 169.1
Rural part of | | | | | | | | |
Registration | | | | | | | | |
states | 138.0| 133.8| 121.1| 120.7| 131.4| 126.2| 121.9| 123.8| 117.3
===============================================================================
_Tuberculosis death-rate._
Turning now to tuberculosis, the death-rate in cities is very markedly
higher than in rural districts, and the superiority of the country as a
place to live is hereby plainly demonstrated. The preceding table shows
the death rate from tuberculosis in cities for the years 1903-1907, the
data being taken from the United States Census Reports.
The death-rate in the cities is evidently about 60 per 100,000 greater
than in the rural districts, due, of course, to the crowding in city
tenements. This is true for nearly all cities, although the difference
is more marked in some parts of the country than in others. In
Massachusetts, for example, the death-rate in rural districts is
slightly higher than the death-rate in cities, but tuberculosis is much
more prevalent in that state than in any other part of the country. In
New York State the rate in cities is about 70 per 100,000 greater than
in rural districts, due, presumably, to the larger number of
manufacturing centers in this state. In New York City the rate is
constantly more than 200, and in 1908 in the borough of the Bronx it was
nearly 500.
_Diphtheria as affecting the rate._
Diphtheria is another disease that exacts heavier toll from the cities
than from the country, about three times as many deaths occurring in the
former as in the latter.
_Influenza, and its effect on death-rate._
Influenza is, on the other hand, markedly severe on people in rural
districts, the death-rate there being more than twice as high as in the
cities. It is easy to see why this is. Lack of sidewalks, lack of
protection, lack of uniform temperature in the houses, and the lack of
care in the first stages of illness, all tend to increase the death-rate
from this disease.
_Pneumonia._
The death-rate from pneumonia, on the other hand, is higher in the city,
the vitality and power of resistance of victims probably being reduced
under average city conditions.
_Other diseases._
Diseases that are induced by water, all referred to under typhoid fever,
but extending into such complaints as diarrhoea and enteritis, are
much more severe in cities than in the country. Such an excess of
general intestinal diseases shows again that a polluted water-supply is
not peculiar to the country, but is responsible for an excessive
death-rate in the city. Most of the constitutional diseases also have
higher death-rates in the city than in the country. Bright's disease,
for example, for the five years 1903-1907, had an average rate in cities
of 107.3 per 100,000, while for the same five years in the rural
districts the rate was only 68.6.
_Old age and the death-rate._
Further showing the advantage of country life, it is to be noted that
the number of deaths from old age in rural districts is nearly double
that in cities. For example, in the same period already referred to the
death-rate in cities of persons over sixty was 27.6, while in the rural
districts, for the same period, it was 49.3,--nearly double.
_The need for attention to rural hygiene._
One must conclude, therefore, that the chances of living are increased
through residence in the country or in rural districts, and one is
therefore led to ask why, if conditions there are superior to those in
the city, is it necessary to deal with the question of rural hygiene,
and why attempt to improve conditions which are already evidently
superior to those in cities. The answer to this must lie in the
statement that the death-rate does not tell the whole story of public
health. So far as the real welfare of a community is concerned, the
standard should be that of the efficiency of the lives in the different
age periods rather than the length of those periods. By efficiency in
such a connection is meant not merely a life that is free enough from
disease to permit the full number of working days in the year, and the
full number of years in the man's life usually devoted to toil, or all
together a life that contributes something of value to the world,
whether produce from the farm or books evolved from the brain; but
efficiency here means that composite development of the whole man--body,
mind, and spirit--which we believe must have been intended when man was
created with this threefold nature. It is in this composite development
that those living in the country are sadly lacking in efficiency.
Not to the same extent as twenty-five years ago, but still too often is
the farmer so exhausted by bodily toil that he has left no strength for
the cultivation of either mind or spirit. For the brief period of spring
and summer, the good farmer in the Eastern States works himself harder
than any slave of old. Up with the sun, or earlier, he follows through
the long day the hardest kind of manual labor. When the end of the day
comes, after fifteen hours' physical strain, his weary body demands
sleep, and no vitality is left for mental improvement. In the winter,
on the other hand, a lack of exercise is enforced, and the resulting
interference with normal functions is so great that he lives the winter
through in a sort of hibernation. He is nearly poisoned by lack of
ventilation in the small living room, where the one stove makes living
possible; he gets fat and indolent, and then with relaxed muscles
plunges into furious labor again when spring comes round.
"No wonder," says Woods Hutchinson, "that by forty-five he has had a
sunstroke and 'can't stand the heat' or has a 'weak back' or his 'heart
gives out' or a chill 'makes him rheumatic.'" Such a life is not
efficient any more than a steam engine is efficient when half the time
it is run at such high speed that it tends to shake itself to pieces and
the other half of the time it stands idle. Nor are the conditions under
which farmers' wives live any better. Statistics show that the highest
percentage of insanity in any class of persons in the United States (due
chiefly to overwork, overworry, and lack of proper amusements and
recreation) is to be found among farmers' wives.
An ideal life is not one which merely rounds out the allotted span, but
one which, during that span, is measurably free from ailments and
disabilities and in a condition to claim a share in the joy of living
which belongs to every human being by reason of his existence. Such
lives, to be sure, are seldom found, and no system of statistics yet
devised has been able to take account of those ailments. Insurance
companies, which make good losses for inability to work and which return
the cost of medicines and doctors' bills, give the only information on
the subject. From these, it has been shown that for each death in a
community there are a little more than two years of illness. Or,
expressed differently, for every death occurring in a village, there are
two persons constantly ill during the year. Or, still differently, there
are, on the average, thirteen days' sickness per year for every person
in a community.
It is the aim of all hygienic efforts to prevent not merely premature
death, but also the inefficiency of unhealthy living, and it is the
latter condition rather than the former which generally prevails in
rural communities. As we have seen, the death-rates in the country,
except for pneumonia, are not noticeably higher than in the city. But by
minor ailments, with the resulting loss of daily efficiency, the rural
communities are sadly overburdened. As Irving Fisher says in his Report
on National Vitality:--
"But prevention is merely the first step in increasing the breadth of
life. Life is to be broadened not only negatively by diminishing those
disabilities which narrow it, but also positively by increasing the
cultivation of vitality. Here we leave the realm of medicine and enter
the realm of physical training.... Beyond athletic sports in turn comes
mental, moral, and spiritual culture, the highest product of health
cultivation. It is an encouraging sign of the times that the
ecclesiastical view of the Middle Ages, which associated saintliness
with sickness, has given way to modern 'muscular Christianity.'... This
is but one evidence of the tendency toward the 'religion of
healthymindedness' described by Professor James. Epictetus taught that
no one could be the highest type of philosopher unless in exuberant
health. Expressions of Emerson's and Walt Whitman's show how much their
spiritual exaltation was bound up with health ideals. 'Give me health
and a day,' said Emerson, 'and I will make the pomp of emperors
ridiculous.' It is only when these health ideals take a deep hold that a
nation can achieve its highest development. Any country which adopts
such ideals as an integral part of its practical life philosophy may be
expected to reach or even excel the development of the health-loving
Greeks."