The Rural Science Series
EDITED BY L. H. BAILEY
THE MACMILLAN COMPANY NEW YORK . BOSTON . CHICAGO ATLANTA . SAN FRANCISCO
MACMILLAN & CO., LIMITED LONDON . BOMBAY . CALCUTTA MELBOURNE
THE MACMILLAN CO. OF CANADA, LTD. TORONTO
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.
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.
VITAL STATISTICS OF RURAL LIFE
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
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
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
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
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
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
QUALITY OF WATER
Mineral matter. Loss of soap. Vegetable pollution. Animal pollution. Well water. Danger of polluted water 131-152
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
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
Definition of sewage. Stream pollution. Treatment of sewage on land. Surface application. Artificial sewage beds. Subsurface tile disposal. Automatic syphon. Sedimentation. Underdrains 208-232
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
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
Exercise. Clothing. Bathing. Mouth breathing. Eyes. Teeth. Sleep 278-294
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
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
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
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
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
Malaria. Mosquitoes and malaria. Elimination of mosquitoes. Limitation of mosquito infection. Yellow fever. Characteristics of the disease. Hookworm disease. Pellagra. Bubonic plague 377-395
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
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
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.
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
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.
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; the third line is based on figures for cities in registration states; 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 ===============================================================================
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.
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.
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."
LOCATION OF A HOUSE—SOIL AND SURROUNDINGS
In attempting to develop a system of rural hygiene, by means of which the full value of the advantages of pure air and sunlight, of healthful exercise and sound sleep, may be realized, the first step should be a proper location of the house. For, while it is possible to have good health in houses not advantageously located, and while the influence of unsanitary surroundings is not as great as was formerly supposed, yet there can be no question but that some influences, whether they be great or small, must result directly from the situation of a dwelling. For example, it has been noticed that a house whose cellar was damp was an unhealthy house to live in, and early text-books on hygiene quote statistics at length to prove this fact.
The early theories connecting ill-health with conditions in and around the house have been handed down, and to-day some are accepted as true, although by the modern science of bacteriology most of the early notions have been upset. For example, it was considered dangerous to breathe night air in the vicinity of swamps, and in one of the Rollo Books, so much read by the children of the last generation, Uncle George requires Rollo, on a night journey through the Italian marshes, to stay inside the coach with the windows closed in order not to breathe the night air and so contract malarial fever. We know to-day that malarial fever comes only from mosquitoes, that night air has nothing to do with disease, and we hear the general advice of doctors that, except where it means the admission of mosquitoes, we should always sleep with our windows open in order to breathe as much night air as possible, because the night air is purer than any other air. These early traditions have not only concerned themselves with damp cellars and night air, but they have insisted that even the vicinity of a swamp or pond might lead to disease, and the State Department of Health of New York is in constant receipt of complaints because of alleged danger to health on account of some pond or swamp in the vicinity of houses.
Again, one tradition says that a house should not be located in the midst of a dense growth of trees, because the shade of the trees, however welcome in summer, will generate and maintain a condition of dampness in the house and, therefore, be injurious to the health of the inmates.
Another tradition is that a house ought not to be located in a valley, but that a hilltop, or at least a sidehill elevation, is preferable, the possible dampness of the valley being alleged again as the reason.
To-day, so far as is known, there is no direct evidence of dampness being primarily responsible for any disease, although, heretofore, such diseases as typhoid fever, yellow fever, bilious fever, malarial fever, cholera, and dysentery have all been attributed to miasms springing from damp soil. To-day we are assured by experts that none of these diseases are induced by dampness alone. One could spend his days immersed in water up to his chin and never contract any sickness of the types mentioned merely through that act. Later on, we shall show how the presence of swamps in the vicinity of a house is objectionable because of their providing breeding places for insects, but the dampness itself never has and never will cause disease. As a concrete example, it may be noted that the country of Holland, in large part lying below the level of the sea, with drainage canals and ditches everywhere in evidence, is, in spite of such manifest possibilities of dampness, one of the most healthy countries in the world, as already pointed out in Chapter I. This fact not only emphasizes the small effect of surface waters and damp soils in promoting disease, but also magnifies the value of cleanliness for which the Dutch people are so famous.
Why is it, then, that damp soils and damp cellars are objected to? Chiefly, because of the inconvenience and discomfort they occasion. A damp cellar means conditions favorable to the development of mildew and rot; prevents vegetables from keeping a normal length of time; accounts for moldy, decaying odors throughout the house, and is generally disagreeable. One is tempted to say that such a condition is also unhealthy, and it is quite possible that a person living over a damp cellar which contains accumulations of decaying vegetables, and breathing air loaded with organic compounds, may gradually lose his normal vitality, and become thereby more readily susceptible to specific diseases, but the diseases themselves will not come from the dampness alone.
The discomfort and inconvenience, however, are quite sufficient reasons to make it eminently desirable to have the house and the cellar dry. With this in mind, the selection of the house site should be carefully made. Instinctively, and with reason, the immediate neighborhood of low, swampy, marshy ground, of stagnant ponds, or of sluggish streams should be avoided. It should not be necessary to warn prospective builders that low land, subject to inundation, even though this may happen only occasionally, is not a wise choice of a building site. Figure 2 shows an inundation in a small village of New York State in 1889. Floods are expected each spring and counted on as a part of the year's experience. The resulting exposure and the inevitable effluvia following the receding waters are both objectionable factors in hygienic living. Similarly, the vicinity of a stream carrying organic matter, such as sewage from a town above, should undoubtedly be avoided on account of possible odors in summer. Not long ago, the writer was told by the owner of a productive farm, situated below a small city in New York State, that in the summer time the windows of his house had all to be kept tightly shut at night, because of the effluvia from a stream a thousand feet distant, which carried the sewage from the city above.
Location of house.
A deep and narrow valley should be avoided, not so much because of the possible dampness in the valley, but because of the noticeably lessened amount of sunlight which such a location involves. For such a house, the morning sun comes up much later, and the afternoon sun disappears much earlier, and, since sunlight is the best foe to disease, the more sunlight enters a house, the healthier are those who live in it. On the other hand, the top of a hill exposes a house to strong and cold winds, not desirable on any account, and involving a large expense for heating in winter. Sloping ground, therefore, facing the south if possible, or better, some knoll which rises above the general surface of a southern slope, affords an ideal location. If the slope is toward the south, north winds are kept off, and every ray of the life-giving winter's sun is captured. If the house itself faces due south, the windows on the north have no sunlight. If, on the other hand, the house faces southeast or southwest, then all sides of the house will receive direct sunlight at some time of the day.
Objections to trees.
The vicinity of trees is not to be regarded as altogether evil, since they provide both shade in summer and a screen against winds in the winter. No disease comes from dampness because of their presence, and the worst thing which may be charged against a thick growth is that it keeps out the sun. Practically two points may, however, be urged against trees growing too close to a house. If near enough for leaves to drop on the roof, rain troughs and leaders become stopped up and cause trouble. A thick growth directly over a shingle roof allows organic matter to accumulate on the shingles, so that vegetation develops and the roof decays more rapidly than if exposed to sun and wind. Again, and it is no trivial matter, a house whose roof is easily accessible from trees is apt to become infested with squirrels, who get into the attic, run through the walls, and become a great nuisance. For these reasons, then, trees should be far enough away from the house to allow the sun to enter the windows freely and to keep away from the roof objectionable animals, large and small.
Space between houses.
It is a law or custom as ancient as the Romans that requires a proprietor to build his house so that the eaves should not overhang on the land of his neighbor. Our grandfathers, with the same idea, used to say that a man should be able to drive his team around his house on his own land. In our day it is highly desirable that a house should be built so as to leave as much land under control between the buildings and the lot line as possible. This, of course, does not apply to houses built on a farm of a hundred acres or more, but rather to the house in a small village where a few hundred people live closely together, under rural conditions. In such a village the water-supply usually comes from wells, and the wastes of the household are discharged into privies and cesspools. There is no law, unfortunately, which restricts the location of either of these two essential structures, and it is quite possible for a well, built within a few feet of a property line, to be ruined in quality by a cesspool, built later, on the other side of the line. It seems very unjust that, after the trouble and expense of building a well, a neighbor may render it worthless by the location of his cesspool, and yet, unless one can prove a direct underground connection between well and cesspool, no law is applicable to prevent the construction of the latter.
Besides such a menace to health, there are other objections to the immediate vicinity of neighbors which can be avoided by a judicious interposition of space. For example, the writer listened through a long evening, recently, to a hearing before a City Commissioner of Health, where one householder and a crowd of witnesses complained of the noise made by a kicking horse in an adjacent stable. The one witness who was not disturbed by the noise, and who lived in the vicinity, was unexpectedly found to be deaf.
It is wisdom also to have a reasonable space between a house and the highway, chiefly because the dust of the road is thereby kept from the house. There are people who find much enjoyment in watching passers-by on the road, and with them front windows would be as close to the road as possible, but it is wiser to have a front yard of at least fifty feet depth when possible.
Finally, the location on a sidehill, even when otherwise advantageous, is to be regarded with suspicion if the subsoil strata are horizontal and neighbors up the slope have cesspools in use. The writer knows of several cesspools, built in rock, which, so far as their owners were concerned, have worked successfully for many years, but the water leeching away through the rock was finally discovered to be the cause of continual dampness in neighboring cellars, on lower ground, to the manifest discomfort of those occupying the houses.
Composition of soils.
Having thus discussed the location of the house with reference to its surroundings, let us now more carefully examine the character of the soil or earth foundation on which the house shall be built. All soil is made up of varying proportions of mineral and vegetable matter in the interstices of which there are usually to be found more or less air, water, and watery vapor. The mineral substances of soil include almost all of the known minerals, although many of them are found in exceedingly small quantities. The most common and the most important mineral elements of the soil of New York State are carbon, silicon, aluminum, and calcium, which combine in various ways to make either sand, sandstone, clay, shale, limestone, or other rock. The particular form which these mineral elements assume is of interest in choosing a location for a house, for two reasons:—
In the first place, it has been asserted that the mineral constituents of a soil directly affect the health of persons living on that material. For instance, the earlier writers on hygiene gravely pointed out that very hard granite rocks, when weathered and disintegrated, became permeated by a fungus and caused malaria. We are, however, now so sure of the cause of malaria that we only laugh at a theory upheld by scientists of only twenty years ago.
Some constitutional diseases, including goiter and cancer, have been supposed to flourish in localities where an excess of calcium exists in the soil, and it is true that these diseases do have an unusual prevalence in certain limited districts; but no modern scientist ventures to say whether the boundaries of those districts are determined by the character of the soil constituents or by some other predisposing factor. The truth is that, in matters not absolutely determined by science, many theories usually have to be evolved and proved worthless before the real cause is found.
In the matter of appendicitis, for instance, it was formerly asserted that the seed of grapes was responsible for the local inflammation, and that one could never have appendicitis if such seeds were not swallowed. This theory is to-day almost forgotten, and one eminent surgeon has asserted that the prevalence of this disease in a district depends on the calcium in the soil, since it is to that mineral that hard water is due, although this has not been substantiated. No information is to-day available by which the fitness of a soil for securing sanitary conditions of building can be determined.
Cancer and soil conditions.
In the case of cancer, however, while no final conclusions can be drawn, there is some definite indication that the soil conditions have connection with the occurrence and continued appearance of cancer. It is known that this dread disease is abnormally prevalent in certain districts of the world where topography and climate are fairly alike. For example, the entire region between the Danube and the Alps from Vienna westward and between the Jura and Alps to Geneva furnishes the highest mortality from cancer in all Europe. The subsoil is clay with a thin covering of surface soil, the hillsides draining on to level valleys with meandering watercourses that frequently inundate and supersaturate the already moist soil.
This condition seems to prevail wherever cancer is abnormally prevalent. In England, in northwestern France, and in Spain the topography described in every case accompanies a high death-rate from cancer. It is of great interest to find that in New York State the two districts that are conspicuously affected by this disease have the same topography. The Unadilla Valley and some parts of the Allegheny Valley are noted for their cancer houses, and in both localities we find the same kinds of hillsides and water-soaked valleys as in Germany and France. It has also been noted that the older geological formations are free from the disease and that an occasional inundation does not seem to be a factor. Altogether there seems to be some ground for assuming a connection between cancer and soil conditions, at any rate until scientists have determined the real cause of the disease in those localities where it is now so markedly prevalent.
The soil, however, with its mineral characteristics, does indirectly affect the health of the householder because different kinds of rock form themselves naturally into different surface formations, some healthy and some unhealthy. For example, localities where granite rock abounds and comes near the surface are usually healthy because the surface slope is great enough to carry off all drainage water rapidly. The air therefore is dry and not influenced by the immediate vicinity of swamps. The drinking water is soft, and malarial breeding places are usually absent.
Limestone rock, on the other hand, is commonly laid down in horizontal strata, and while a succession of strata may frequently give rapid slopes, marshes are very common, existing even on the tops of the hills. The drinking water is always to be suspected as to quality because, in the first place, it is hard from absorption of lime, and in the next place, cavities and seams in the rock allow polluting material to travel for long distances.
Sandstone, being porous, may be considered a healthy foundation, and sands and gravels of all sorts are usually free from marshy land.
Gravel has always been assumed to be the healthiest soil on which a house could be built, provided the ground water reaches its highest stage three or four feet below the cellar bottom.
Sand is equally desirable except in the cases where vegetable matter has been mixed with the sand, rendering decay imminent. Water drawn from such sands in the form of springs will contain large quantities of nitrates which may lead to excessive development of vegetable life and may have on the human system the same laxative effect as comes from drinking swamp water.
Clays and heavy alluvial soils are not usually considered desirable soils on which to build. Water does not run from such soils; they hold moisture, and hence are always damp, and marshes are very apt to exist in the vicinity.
Effects of cultivation.
It was formerly thought that extensive cultivation was objectionable from the standpoint of health, that manured fields in the vicinity of a house were undesirable, and that the turning up of a well-manured field with a plow in the spring was a very likely source of fever. It is a very common belief to-day that when water pipes are to be laid in city streets, thereby disturbing the soil and bringing fresh earth to the surface, typhoid or other fevers may be expected. There is, however, no ground for this belief, and the fact that laborers and their families live healthily in the midst of the thousands of acres of sewage-irrigated fields near Berlin, where the heavily manured fields are constantly being plowed, is a sure proof of this. The earlier text-books on hygiene all assert, however, the contrary; Parkes, for instance, says that irrigated lands, especially rice fields, which give a great surface for evaporation and also exhale organic matter into the air, are hurtful, and in northern Italy the rice grounds are required to be three quarters of a mile from the small towns to protect the village inhabitants against fevers. There is no ground, however, for such a requirement.
No evidence can be found that men who work in sewers and who breathe sewer air all the time are especially unhealthy. Statistics show that the laborers on the sewage fields of Paris and Berlin are actually healthier than the average person living within those cities.
No reason can be assigned, based on our present knowledge of bacteriology, why upturned earth or manured fields should be unhealthy except as the breeding of insects may be encouraged thereby. The two essentials, however, which should be considered are: first, the topography or the formation of the soil in order that the surface water may run off freely, and second, the character of the soil so that ground water may not remain too near the surface. Whether the soil is rock or gravel makes very little difference.
One kind of soil, however, is distinctly objectionable, although, fortunately, in the country such a soil is unusual: That is, a soil made up of refuse, whether it be garbage, street sweepings from a near-by city, or factory refuse.
The writer has in mind one enterprising landowner and farmer who offered a near-by city the free privilege of dumping the city garbage on his land. This was done for several years, and the low-lying districts of his farm were all filled to a more advantageous level. This garbage was then covered with about a foot of dirt and the land sold in building lots to enterprising laborers determined to own their own homes. According to the old theories of hygiene, the occupants of such houses should have died like rats, but no particular excess of sickness in the one hundred houses so located could be observed. One must, however, believe, as we shall see later, that the repeated breathing of air drawn from such polluted soil must be unhealthy, even though the mortality records fail to show it.
It is interesting in this connection to note that the organic matter in soil gradually disappears, just as a body buried in a grave will finally decompose. Experiments show that such organic matter as wheat straw or cloth in small pieces rots and decays in about three years. But this depends very largely on an excess of air. If the soil is open and the organic matter loose, oxidation takes place rapidly; but if a large pile of organic matter is buried in clay soil, it will take decades for it to disappear. The vegetable matter in soil is usually produced by the decay of plants which have either grown on the soil or have been washed down into its voids. A great deal was formerly written on the relation between this organic matter and the prevalence of malaria, and some earlier writers believed that the amount of malaria in a district was dependent upon the amount of vegetable debris in the soil. Since we have learned that malaria is carried by mosquitoes, we are less interested in the amount of organic matter in the soil. Its mere presence is not likely to be injurious.
Water in the soil.
Only the hardest rocks are entirely solid, the others containing a certain percentage of voids or interstices. These voids are filled with air or water, as the case may be, and we may stop for a moment to inquire the effect of the presence of this air and water. In loose sands the amount of voids is 40 to 50 per cent of the total volume, in sandstone about 20 per cent, and in other rock reduced amounts. The volume of air, therefore, in the soil under a cellar to a depth of four or five feet, amounts to a good many cubic feet and would not be worth inquiring into except for the fact that it is continually in a state of motion. When the ground water, perhaps normally five feet below the cellar bottom, rises in the spring, this ground air is forced out, and in a cellar without a concrete foundation it rises into the cellar and penetrates into the house.
A house artificially warmed by stoves is continually discharging heated air from the tops of the rooms and colder air is being brought in from below to take its place. This air comes from the ground below, and in open soil may come from a great depth. A case has been noted where gas escaping from a main in a city street twenty feet from a cellar wall was, by the suction due to heat, drawn into the cellar and thence into the rooms of the house. It is possible that air from cesspools and broken drains in the vicinity of a house may, in this same way, contribute to the atmosphere breathed within the walls of the house. Gravelly and sandy soils, therefore, in order to maintain the superiority which they furnish for building construction, should not be polluted, since any pollution in the vicinity influences the quality of air which may get into the house. The method of preventing such ingress is plainly to water-proof the outside walls of the cellar and provide an air-tight floor over the cellar bottom. Methods of doing this will be discussed in the next chapter.
Moisture in soils.
The presence of water in the soil has usually been considered to be unhealthy because of the impression that it led to certain fevers. The writer has heard, for instance, of an attack of malaria being caused by a short visit to a damp vegetable cellar; and it is one of the triumphs of the century that the malarial parasite has been discovered, and the old theory of the dangers of moisture been done away with. A damp cellar has always been considered to be undesirable, but just why nobody knows. A damp cellar causes molds to form rapidly, thus destroying vegetables and other material which might naturally be stored there, but that the presence of moisture in a cellar in itself produces any organic emanation leading to disease is not true, although dampness is essential to the growth of certain organisms.
In the latter part of the nineteenth century, Dr. Bowditch, of Boston, showed that consumption developed most where the surrounding soil was moist, and generally it is the impression that dry air is the only proper air for a consumptive person to breathe. This theory, however, is being rapidly exploded, and patients now remain outdoors in any weather, and no kind of air is objected to by physicians, provided it is outdoor air. Some little time ago the writer was called by a Board of Health to investigate a certain swamp which had some odor, was considered a blot on the landscape in an unusually picturesque village, and was said to be responsible for a long list of contagious diseases. A house-to-house inquiry in the vicinity showed that among some dozen families, only one illness in the last few years could be remembered, and that was an old lady who had been on the verge of the grave for forty years.
It is curious to note the many examples which are cited by the earlier sanitarians to prove the dangerous effect of damp soil. For example, Pettenkofer, a very prominent German hygienist, says that in two royal stables near Munich, with the same arrangements as to stalls, feed, and attendance, and the same class of horses, fever affected the horses very unequally. In one stable, fever was continually prevalent; in the other, no fever was found. Horses sent from the unhealthful to the healthful stables did not communicate the disease. The difference between the two places, says Pettenkofer, was that in the healthful stables the ground water was five to six feet below the surface, while in the unhealthful ones it was only two and a half feet from the surface. A system of drainage by which the ground water was brought to the same level under both stables made them equally healthful. The writer cannot help but feel that some other factor was involved, and while he has no doubt that excessive dampness in stables or cellars is undesirable, he does not believe that such dampness can be directly the cause of fevers of any sort.
It is not desirable, however, to live over a wet cellar nor to maintain a house in a constant condition of dampness, partly on account of its bad effect on the house and partly because such dampness may, by reducing the vitality of the household, become a predisposing factor in disease.
From whatever source dampness may come, it can be guarded against by giving to the surface of the ground in the vicinity of the house, on all sides, sufficient slope away from the walls so that there will be no tendency for water to accumulate against the cellar walls. On the top of a hill this is very easy to do, and the natural surface grade takes care of the surface water without difficulty. On a sidehill or in a valley artificial grading has to be resorted to, except on one side.
Too much emphasis cannot be laid on the necessity for grading the ground surface away from the house. In some cases it may be sufficient to dig a broad shallow trench protected from wash by sods (Fig. 3). In other cases it may be desirable to pave the ditch with cobble stones or to build a cement gutter. In constructing such a surface drain, proper allowance must be made for the accumulation of snow and the resulting amount of water in the spring, so that the distance in which the ground slopes away from the house ought to be, if possible, at least ten feet, so that there can be no standing water to penetrate the house walls. The slope necessary to carry surface water away need not be great. A fall of one foot in one hundred will be ample, even on grassy areas, and if the surface is that of a macadam road or the gutters of a drive, this grade may be cut in two. A slope of more than one foot in one hundred is permissible up to a maximum of seven or eight feet per hundred, more than this being aesthetically objectionable and tending to make the house appear too high. Whenever gutters are built in driveways or ditches to intercept water coming down the slopes, a suitable outlet must be provided to carry the water thus collected either into underground pipes, by which the water is led to some stream or gulley, or directly into some well-marked surface depression.
The soil always contains water at a greater or less depth, and the elevation of this "ground water," as it is called, varies throughout the year partly with the rainfall and partly with the elevation of the water level in the near-by streams.
It is not at all unusual for this ground water to rise and fall six feet or more within the year, high levels coming usually in the spring and fall, and low levels in the late summer and winter. It is easily possible, then, that a house cellar may seem dry at the time of construction in summer and may develop water to a foot or more in depth after occupancy. The presence of such an amount of water in a cellar, whether injurious to health or not, is objectionable, and a subsoil trench should be provided in order to limit the height to which ground water may rise.
If a system of drainpipes is led around a house extending outward to include the surrounding yard, then the ground water will always be maintained at the level of those pipes, provided the system has a free outlet. Indeed, the question of an outlet for a drainage system is a most important factor, and no system of underdrains can be effective unless a stream or gulley or depression of some kind is available into which the drains may discharge. It is for this reason, quite as much as for any other, that the location of a house on a perfectly level bottom land is objectionable, since the ground there may be normally full of water with no existing depression into which it may be drained.
In the next chapter the proper method of laying drains close to the cellar wall, for the purpose of taking away the dampness from those walls, is described, but another system of drains is desirable, covering more area and more thoroughly drying the ground, provided the ground water needs attention at all. These drains should be laid like all agricultural drainage; and while substitution of broken stone, bundles of twigs, wooden boxes, or flat stone may be made, the only proper material to be used is burnt clay in the form of tile. These tiles are made in a variety of patterns, but the most common in use to-day is one which is octagonal outside and circular inside. They are about one foot in length and may be had from two to six inches inside diameter. The ordinary size for laterals is four-inch diameter, while the mains into which these laterals discharge are generally of six-inch diameter. These tiles are laid in trenches about fifteen feet apart, although in porous soil, such as coarse sand or gravel, this distance may be increased to twenty feet. If the tiles are laid more than four feet below the surface, this distance may be increased, and if the tiles are five feet deep, the distance apart of the several lines may be fifty feet.
The grade of the line must be carefully taken care of, and while it is possible to lay a line of tile with a carpenter's level and a sixteen-foot straightedge, it is much safer to have an engineer's or architect's level and set grade stakes, as in regular sewer work. A fall of one fourth of an inch to the foot is a proper grade, although a greater slope is not objectionable. It is sometimes desirable in soft ground to lay down a board six inches wide in the bottom of a trench on which to rest the tile, but, unless the ground is very soft, this is not necessary. Care must be taken, however, if the board is not used, to have the bottom of the trench very carefully smoothed so that a perfectly even grade in the tile is maintained. There are three ways of laying out a line of trench as shown in the following sketches (Fig. 4). It is usually sufficient to run parallel lines of tile from fifteen to fifty feet apart over the area which it is desired to drain, and let the ends of these lines enter a cross line which shall carry off the water led into it. This cross line should be six inches in diameter as a general rule, unless there is more than a mile of small drains, in which case the size of the cross pipe ought to be increased to eight inches. This cross line then becomes the main outlet, and great care must be taken to see that it has a perfectly free delivery at all times of the year. In cities and sometimes in small villages it is possible to discharge this outlet pipe into a regular public sewer, provided the sewer is deep enough, and provided the municipal ordinances allow such a connection. Otherwise, the outfall must be carried to a natural depression.
In level ground, the problem of finding a suitable outlet is a serious one, and in many cases impossible of solution, so that the householder, being unable to find an outlet, must put up with the ground water and be as patient as possible during its prevalence. It does not do to trust one's eye to find a practicable outlet, since even a trained eye is easily deceived. An engineer with a level can tell in a few moments where a proper point of discharge may be found, and it is absurd to begrudge the small amount which it will cost, in view of the large expense involved in digging a long trench to no purpose.
Some years ago the writer was able to note the conditions in a house where the cellar excavation went three feet into limestone rock. The strata were perfectly level and the cellar floor of natural rock was apparently all that could be desired, smooth and flat, without involving any expense for concrete. One wall came where a vertical seam in the rock existed, and since this natural rock face was smooth and vertical and just where the cellar wall should go, it seemed unnecessary to dig it out and lay up masonry in its place. So it was left and the house built. When the spring rains came, however, the cellar was turned into a pond, water dripping everywhere from the vertical rock face, and coming up through the cellar bottom like springs. It cost a great deal more then to make the changes and improvements necessary in order to secure a dry cellar than it would have done at the outset. This serves as an illustration of the need of taking every precaution at the beginning to insure a dry and well-drained soil around and below the cellar walls.
CONSTRUCTION OF HOUSES AND BARNS WITH REFERENCE TO HEALTHFULNESS
Any liability to disease that may come from faulty construction of habitations is likely to spring from a polluted subsoil. Such pollution vitiates the air drawn from that soil and is a source of danger on account of the resulting impurity of the whole atmosphere within the house.
Shutting out soil air.
We have already seen (Chapter II) how it is possible for soil charged with organic matter to deliver, either through suction from a heated house or on account of a rising ground water, soil air into the cellar, and also that moist air may enter the house in the same way. In order to prevent this, it is plainly necessary to interpose some air-tight or water-tight layer between the house and the soil, and also, since perfection in this layer is impossible, to make provision for draining away any water which may accumulate against the walls. Ordinary builders do not lay much emphasis on the importance of either of these precautions, and while one may often see cellar walls roughly and carelessly coated on the outside, with tar or asphalt, a thoroughly water-tight coating is not a common practice. Similarly, while draintile are often laid around a house, they are either laid so near the surface as to be useless or else they have no porous filling.
To prevent moisture from entering the cellar, the first provision should be a tile drain (not less than four inches in diameter) laid completely around the house (see Fig. 5) on a grade of not less than six inches in one hundred feet. This drain at its highest point ought to be one foot below the bottom of the concrete floor of the cellar, and more than this, of course, at the lower end. This should be laid before or at the time the foundations for the house are being built, although it is possible to dig the necessary trenches and lay the tile after the house is built. If the available grade is small, this drain may be laid in two lines directly under the cellar floor as shown in Fig. 6. At the points A the bottom of the tile should be at least a foot below the dirt on which the cellar floor will be laid, and at the point B, about two feet. This drainpipe is best laid with regular sewer pipe and without cement in the joints. Then coarse gravel should be filled in around this tile so as to allow water to enter the pipe without carrying soil that later might settle in the pipe.
Position of outfall.
There is always a question of where this drain shall end and into what it shall discharge, for in some soils this drainpipe may discharge continually. To allow the drain to empty on the ground means that its outer end will be broken; that if discharge takes place just before freezing weather, the drain will fill with ice and be broken, so that some other method must be devised. If the outer end can be laid into a brook where the velocity prevents the water from freezing, or where the outer end can be kept below water, a satisfactory disposal is found. Otherwise, it is better to discharge into a small covered cesspool, provided the soil is sufficiently porous to take care of the water, and provided the level of the ground water allows the construction of such a cesspool. In any case, it should be at some distance from the house, so that if it overflows, the water will not seep back to the cellar walls. By water-proofing the main wall and then backfilling against the wall with coarse gravel or broken stone, the same results as with open areaways are obtained and at a much smaller cost.