Part 1 (1/2)
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
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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