Rural Hygiene Part 1

Rural Hygiene.

by Henry N. Ogden.

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 pa.s.sed 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.

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 ch.o.r.es are a.s.signed to these aged exponents of strong const.i.tutions 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, s.e.x, nationality, and occupation, and by local conditions of climate, alt.i.tude, 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 j.a.pan 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 spa.r.s.ely 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._

[Ill.u.s.tration: 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 princ.i.p.al 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 s.e.xton 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 ================================================