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The Rural Science Series

EDITED BY L. H. BAILEY




RURAL HYGIENE

THE MACMILLAN COMPANY
NEW YORK · BOSTON · CHICAGO
ATLANTA · SAN FRANCISCO

MACMILLAN & CO., LIMITED
LONDON · BOMBAY · CALCUTTA
MELBOURNE

THE MACMILLAN CO. OF CANADA, LTD.
TORONTO




RURAL HYGIENE

BY

HENRY N. OGDEN, C.E.

PROFESSOR OF SANITARY ENGINEERING IN COLLEGE OF CIVIL ENGINEERING,
CORNELL UNIVERSITY SPECIAL ASSISTANT ENGINEER, NEW YORK STATE DEPARTMENT
OF HEALTH

New York
THE MACMILLAN COMPANY
1911

_All rights reserved_

COPYRIGHT, 1911,
BY THE MACMILLAN COMPANY.

Set up and electrotyped. Published January, 1911.


Norwood Press
J. S. Cushing Co.--Berwick & Smith Co.
Norwood, Mass., U.S.A.




PREFACE


The following pages represent an attempt to put before the rural
population a systematic treatment of those special subjects included in
what is popularly known as Hygiene as well as those broader subjects
that concern the general health of the community at large.

Usually the term "hygiene" has been limited in its application to a
study of the health of the individual, and treatises on hygiene have
concerned themselves almost entirely with discussing such topics as
food, clothing, exercise, and other questions relating to the daily life
of a person. Of late years, however, it has become more and more evident
that it is not possible for man to live to himself alone, but that his
actions must react on those living in his vicinity and that the methods
of living of his neighbors must react on his own well-being. This
interdependence of individuals being once appreciated, it follows that a
book on hygiene must deal, not only with the question of individual
living, but also with those broader questions having to do with the
cause and spread of disease, with the transmission of bacteria from one
community to another, and with those natural influences which, more or
less under the control of man, may affect a large area if their natural
destructive tendencies are allowed to develop.

Being written by an engineer, the following pages deal rather with the
structural side of public hygiene than with the medical side, and in
the chapters dealing with contagious diseases emphasis is attached to
quarantine, disinfection, and prevention, rather than to etiology and
treatment. The book is not, therefore, a medical treatise in any sense,
and is not intended to eliminate the physician or to give professional
advice, although the suggestions, if followed out, undoubtedly will have
the effect of lessening the need of a physician, since the contagious
diseases referred to may then be confined to single individuals or to
single houses.

It has not been possible, within the limits of this one book, to
describe at length the various engineering methods, and while it is
hoped that enough has been said to point the way towards a proper
selection of methods and to a right choice between processes, the
details of construction will have to be worked out in all cases, either
by the ingenuity of the householder or by the aid of some mechanic or
engineer.

Finally, it may be said that two distinct purposes have been in mind
throughout,--to promote the comfort and convenience of those living in
the rural part of the community who, unfortunately, while most happily
situated from the standpoint of health in many ways, have failed to give
themselves those comforts that might so easily be added to their life;
and in the second place, to emphasize the interdependence of the rural
community and the urban community in the matter of food products and
contagious diseases, an interdependence growing daily as interurban
communications by trolley and automobile become easy.

Cities are learning to protect themselves against the selfishness of the
individual, and city Boards of Health have large powers for the purpose
of guarding the health of the individuals within their boundaries. The
scattered populations of the open country are not yet educated to the
point at which self-protection has made such authority seem to be
necessary, and it is left largely to an exalted sense of duty towards
their fellow-men so to move members of a rural community as to order
their lives and ways to avoid sinning against public hygiene. In order
to develop such a sense of honor, it is primarily necessary that the
relation of cause and effect in matters of health shall be plainly
understood and that the dangers to others of the neglect of preventive
measures be appreciated. As a single example, the transmission of
disease at school may be cited. Measles, scarlet fever, whooping cough,
and diphtheria are all children's diseases, easily carried and
transmitted, and held in check only by preventing a sick child from
coming in contact with children not sick. No law is sufficient. The
matter must be left to the mother, who will retain children at home at
the least suspicion of sickness and keep them there until after all
traces of the disease have passed away.

The health conditions in the open country, judged by the standard of
statistics, are quite as good as those of the city. The comforts of
country life are as yet inferior, and it is hoped that this book may do
something to advance the standard of living in the families into which
it may enter.

H. N. OGDEN.

ITHACA, NEW YORK,
November 1, 1910.




CONTENTS


CHAPTER I

VITAL STATISTICS OF RURAL LIFE

                                                                 PAGES

Death-rate. Ideal death-rates. Death-rates in New York State.
Accuracy of records. Effect of children. Death-rates of
children. Small cities. Tuberculosis. Diphtheria, Influenza.
Pneumonia. Old age                                                1-24


CHAPTER II

LOCATION OF A HOUSE--SOIL AND SURROUNDINGS

Damp soils. Location of house. Objections to trees. Space
between houses. Composition of soils. Cancer and soil
conditions. Topography. Effects of cultivation. Made
ground. Water in soil. Drainage. Ground water                    25-48


CHAPTER III

CONSTRUCTION OF HOUSES AND BARNS WITH REFERENCE TO
HEALTHFULNESS

Shutting out soil air. Position of outfall for drains. Dampness
of cellar walls. Use of tar or asphalt. Dry masonry for
cellar walls. Damp courses. The cellar floor. Cellar ventilation.
The old-fashioned privy. Cow stables. Use of
concrete                                                         49-67


CHAPTER IV

VENTILATION

Effects of bad air. Modifying circumstances. Dangers of polluted
air. Effect of changes in air. Composition of air.
Organic matter in air. Fresh-air inlet. Position of inlet.
Foul-air outlet. Size of openings. Ventilation of stables.
Cost of ventilation. Relation of heating to ventilation          68-89


CHAPTER V

QUANTITY OF WATER REQUIRED FOR DOMESTIC USE

Modern tendencies. Quantity of water needed per person.
Quantity used in stables. Maximum rate of consumption.
Variation in maximum rate. Fire stream requirements.
Rain-water supply. Computation for rain-water storage.
Computation for storage reservoir on brook. Deficiency
from well supplies                                              90-107


CHAPTER VI

SOURCES OF WATER-SUPPLY

Underground waters. Ordinary dug well. Construction of dug
wells. Deep wells. Springs. Extensions of springs. Supply
from brooks. Storage reservoirs. Ponds or lakes.
Pressure or head                                               108-130


CHAPTER VII

QUALITY OF WATER

Mineral matter. Loss of soap. Vegetable pollution. Animal
pollution. Well water. Danger of polluted water                131-152


CHAPTER VIII

WATER-WORKS CONSTRUCTION

Methods of collection. Spring reservoirs. Stream supplies.
Dams. Waste weirs. Gate house. Pipe lines. Pumping.
Windmills. Hydraulic rams. Hot-air engines. Gas
engines. Steam pumps. Air lifts. Tanks. Pressure
tanks                                                          153-188


CHAPTER IX

PLUMBING

Installation. Supply tank. Main supply pipe. Hot-water circulation.
Kitchen sinks. Laundry tubs. Hot-water boiler.
Water-back, wash-basin, bath-tub. Cost of plumbing installation.
House drainage. Trap-vents. Water-closets                      189-207


CHAPTER X

SEWAGE DISPOSAL

Definition of sewage. Stream pollution. Treatment of sewage
on land. Surface application. Artificial sewage beds. Subsurface
tile disposal. Automatic syphon. Sedimentation.
Underdrains                                                    208-232


CHAPTER XI

PREPARATION AND CARE OF MILK AND MEAT

Bacteria in milk. Effects of bacteria. Diseases caused by milk.
Methods of obtaining clean milk. City milk. Dangers of
diseased meat. The slaughter-house                             233-256


CHAPTER XII

FOODS AND BEVERAGES

The human mechanism. Digestive processes. Teachings of the
digestive operations. Balanced rations. Human appetite.
Effect of individual habits. Cooking. Muscular and psychic
reactions. Consumption of water. Condiments and drinks.
Tobacco. The drug habit                                        257-277


CHAPTER XIII

PERSONAL HYGIENE

Exercise. Clothing. Bathing. Mouth breathing. Eyes.
Teeth. Sleep                                                   278-294


CHAPTER XIV

THEORIES OF DISEASE

Effects of dirt. Blood resistance. Cell disintegration. Heredity.
Age and sex. Occupation. Direct cause of disease. Parasites.
Bacterial agencies. Antitoxins. Natural immunity.
Chemical poisons. External causes                              295-313


CHAPTER XV

DISINFECTION

Disinfecting agents. Antiseptics. Deodorizers. Patented disinfectants.
Disinfecting gases. Sulfur. Formaldehyde.
Liquid disinfectants. Carbolic acid. Coal-tar products.
Mercury. Lime. Soap. Heat. Dry heat. Boiling water.
Steam. Drying, light, and soil                                 314-331


CHAPTER XVI

TUBERCULOSIS AND PNEUMONIA

Tuberculosis. Individual resistance. Precautions by the consumptive.
Cure of consumption. Pneumonia--the germ.
Weather not the cause of pneumonia. Preventives in pneumonia.
Infection of pneumonia                                         332-348


CHAPTER XVII

TYPHOID FEVER

Cause of the disease. The bacillus. Methods of transmission
of typhoid. Construction of wells in reference to typhoid.
Milk infection by typhoid. Infection by flies. Other sources
of typhoid fever. Treatment of typhoid fever                   349-363


CHAPTER XVIII

CHILDREN'S DISEASES

After effects. Preliminary symptoms. Contagiousness. Quarantine
for scarlet fever. Measles. Characteristic eruption
of measles. Whooping cough. Precautions against spread
of whooping cough. Chicken pox                                 364-376


CHAPTER XIX

PARASITICAL DISEASES

Malaria. Mosquitoes and malaria. Elimination of mosquitoes.
Limitation of mosquito infection. Yellow fever. Characteristics
of the disease. Hookworm disease. Pellagra. Bubonic
plague                                                         377-395


CHAPTER XX

DISEASES CONTROLLED BY ANTITOXINS

Smallpox. Value of vaccination. Characteristics of smallpox.
Treatment of smallpox. Diphtheria. Cause of the disease.
Production of diphtheria antitoxin. Symptoms of diphtheria.
Rabies. Tetanus                                                396-409


CHAPTER XXI

HYGIENE AND LAW

Principle of laws of hygiene. Self-interest, the real basis of law.
Quality of water. Regulations governing foods. Basis of
pure food laws. Protection of milk. Laws governing quarantine  410-425




LIST OF FIGURES


FIG.                                                      PAGE
 1. Map of New York State                                    5
 2. Bad conditions about a dwelling                         28
 3. Grading that turns water away from the house            42
 4. Modes of laying out drains                              46
 5. Exterior wall-drains                                    50
 6. Interior cellar-drains                                  51
 7. Wall modes of making air-space                          53
 8. Water-tight wall                                        54
 9. Rough-backed wall                                       56
10. Even-backed wall                                        56
11. Modes of making water-proof cellar walls                57
12. Water-proofing of cellar walls                          58
13. Cellar-wall forms                                       65
14. Letting in fresh air                                    78
15. Ventilating device                                      79
16. Ventilating device                                      80
17. Ventilation by means of coal stove                      82
18. Coal-stove ventilation                                  83
19. Coal-stove ventilation                                  84
20. Outlets into walls                                      86
21. Cow-barn ventilation                                    88
22. How a pump works                                       105
23. Air-lift pump                                          106
24. Diagram of a spring                                    109
25. Water finding its way from a hillside                  110
26. The sinking of wells                                   110
27. Mode of sinking a well                                 114
28. A well that will catch surface water                   115
29. A well properly protected                              116
30. A properly protected well                              117
31. Well-drilling apparatus                                118
32. Sinking a well by means of a water-jet                 120
33. An enclosed spring                                     122
34. A spring extension                                     123
35. A reservoir for home use                               126
36. Stream draining a privy                                129
37. Contamination of a creamery from the water supply      148
38. A protected spring-chamber                             157
39. Concrete core in a dam                                 159
40. Section of a flood dam                                 161
41. Section of a flood dam                                 162
42. A joint in tile pipe                                   167
43. Windmill and water tank                                170
44. Installation of a ram                                  172
45. Means of securing fall for hydraulic ram               174
46. A hot-air engine                                       176
47. A gas engine                                           179
48. Pump operated by belt                                  180
49. Duplex pump operated directly by steam                 180
50. Raising water by means of compressed air               182
51. Wooden tank                                            183
52. Iron tank                                              185
53. Hand pump applied to air-tank                          186
54. Engine applied to air-tank                             187
55. Windmill connection with tank                          188
56. Construction of a wooden tank                          193
57. Hot-water attachment to the kitchen stove              195
58. Enameled iron sink                                     197
59. Enameled iron laundry tubs                             198
60. Leveling the drain                                     200
61. Water-supply installation                              202
62. A trap                                                 204
63. Washout water-closet                                   205
64. Washdown water-closet                                  205
65. Syphonic closet                                        205
66. Syphon-jet closet                                      206
67. Sewage beds                                            217
68. Plan of sewage beds                                    220
69. Plan of subsurface irrigation field                    224
70. Section of "Miller" syphon                             226
71. Plan and section of a septic tank                      227
72. Section of a septic tank with syphon chamber           229
73. Plan of sewage disposal for a single house             231
74. School girl with adenoids                              289
75. Outdoor sleeping porch for tuberculous patients        343
76. Mortality from pulmonary tuberculosis                  344
77. Spring infected by polluted ditch                      356




RURAL HYGIENE




CHAPTER I

_VITAL STATISTICS OF RURAL LIFE_


It is commonly supposed that good health is the invariable accompaniment
of country life; that children who are brought up in the country are
always rosy-cheeked, chubby, and, except for occasional colds, free from
disease; that adults, both men and women, are strong to labor, like the
oxen of the Psalmist, and that grandfathers and grandmothers are so
common and so able-bodied that in practically every farmhouse the daily
chores are assigned to these aged exponents of strong constitutions and
healthy lives. If, however, we are honest in our observations, or have
lived on a farm in our younger days, or have kept our eyes open when
visiting in the country, we will remember, one by one, certain facts
which will persistently suggest that, after all, life on the farm may
not be such a spring of health as we have been led to believe. We will
remember the frequency of funerals, especially in the winter, and the
few families in which all the children have reached maturity. We will
remember the worn-out bodies of men and women, bent and aged while yet
in middle life.

It is worth while, then, at the beginning, to find out, if we can, just
what are the conditions of health in rural communities, in order to
justify any book dealing with rural hygiene; for it is plain that if
health conditions are already perfect, or nearly so, no book dealing
with improved methods of living is needed, and the wisdom of the
grandparents may be depended on to continue such methods into the next
generation.

_Death-rate._

The usual method of measuring the health conditions of any community,
such as a city, town, county, state, or country, is to compute the
general death-rate, as it is called; that is, the number of deaths
occurring per 1000 population. For example, in 1908, with its estimated
population of 8,546,356, there occurred in New York State 138,441
deaths, or 16.2 deaths for every 1000 population. Sixteen and two-tenths
is, then, the general death-rate for the state for that year. This
method of determining the health of a community is crude and should not
be too strictly relied upon for proving the healthfulness implied. The
rate is at best only an average, and takes no account of anything but
death, one death being a greater calamity, apparently, than a dozen
persons incapacitated from disease. Then, too, this death-rate is
greatly affected by peculiarities of the community in age, sex,
nationality, and occupation, and by local conditions of climate,
altitude, and soil. The effect of these local conditions can best be
explained after a consideration of the general death-rate and its
definite values in different places.

In the United States, as a whole, or, more exactly, in that part of the
United States which keeps such records of deaths as to be reliable
(about one half), the annual average death-rate for the five-year period
1901-1905 was 16.3, and this may be compared with the death-rate in
other countries shown in the following table for the same period:--

TABLE I. DEATH-RATES IN VARIOUS COUNTRIES

Australia               11.7
Austria                 24.2
Belgium                 17.0
Denmark                 14.8
England                 16.0
France                  19.6
Germany                 19.9
Italy                   21.9
Japan                   20.9
Netherlands             16.0
New York State          17.1
Norway                  14.5
Spain                   26.1
Sweden                  15.5
United States           16.3

_Ideal death-rates._

There are special reasons why the Australian death-rate should be low,
but, neglecting this one country entirely, it will be seen that Norway,
Denmark, and Sweden have rates of 14.5, 14.8, and 15.5, respectively;
rates which may be considered as good as any country can attain at the
present time. But the United States, as a whole, has about one more
death per 1000 than these countries, and New York State two more per
1000 population. This means that in New York State there are 16,000 more
deaths each year than if the population were living in Sweden under
Swedish conditions and laws. Or, expressed in another way, it means that
in Sweden one out of every sixty-five persons dies each year, and in New
York one out of every fifty-eight persons.

The rate in New York State is high because the state contains a large
number of cities, and concentration of population generally implies all
kinds of bad and unsanitary conditions. As a rule, a higher death-rate
may be expected in a densely populated community than in a sparsely
settled one, and we should therefore expect a rural community to show a
lower death-rate than a city or urban community. It is not a fair
estimate of the health of any rural locality, such as a county where no
large cities exist, to compare its death-rate with the average of the
state, or with the average rate of some other county which contains a
large city. This fact is plainly brought out by the statistics in Table
II, from the several sanitary districts into which the state of New York
is divided, as shown on the map, Fig. 1:--

TABLE II. SHOWING VARYING DEATH-RATES IN DIFFERENT PARTS OF NEW YORK
STATE

======================================================
                           |    DEATH RATE IN
    SANITARY DISTRICTS     ---------------------------
                           | 1901-5 |  1906  |  1907
------------------------------------------------------
New York State             |  17.1  |  17.1  |  17.5
  Maritime                 |  19.0  |  18.2  |  18.4
  Hudson Valley            |  17.2  |  17.0  |  18.2
  Mohawk Valley            |  15.5  |  16.3  |  16.6
  West Central             |  15.0  |  15.6  |  16.6
  Lake Ontario and Western |  14.9  |  15.5  |  15.9
  East Central             |  14.9  |  15.4  |  15.9
  Southern Tier            |  14.4  |  14.7  |  15.6
  Adirondack and Northern  |  13.9  |  15.1  |  15.3
======================================================

_Death-rates in New York State._

[Illustration: FIG. 1.

MAP OF THE STATE OF NEW YORK SHOWING THE SANITARY DISTRICTS]

The Maritime District includes the four counties of New York City and
comprises about half the population of the state. Its population is
almost entirely quartered under distinctly urban conditions, in some
parts with a congestion not equaled in any other city of the country. It
would naturally, therefore, have a high death-rate, and that it is no
higher than it is makes it a matter for congratulation. And yet the rate
in New York City is higher than in the other principal large cities of
the world. For example, the rates for the five-year period 1900-1904 in
Berlin averaged 18.3, in Paris 18.2, and in London 16.9, New York being
19.4 for the corresponding period. The excess in New York is due in part
to local conditions and in part to a less active oversight in matters of
public health. Similarly, the Hudson Valley District, which embraces the
large cities along the Hudson, has a higher death-rate than the state
average, whereas the other six districts have low rates, chiefly because
of the large proportion of agricultural land and small towns. The last
district should be noted particularly, since its rate is remarkably low
and its number of cities very small, compared with the area included.
The conclusion may be properly drawn, therefore, that statistics confirm
the general impression that life in the country is healthier than life
in the city.

_Accuracy of death-rate records._

One factor must be considered, however, since it plays an important part
in drawing conclusions from these kinds of statistics, and that is, the
accuracy of the records. In a city in which every one must be buried in
a public cemetery, and when the physician, the undertaker, and the
sexton all have to keep records which must agree, it is not easy for any
burial to occur without the fact being recorded and later registered in
the Census Office at Washington. But in the country, a person may be
killed by accident, for example, and buried in a private lot without the
undertaker recording it at all. The result is that the total number of
deaths seems fewer and the death-rate seems smaller than the facts
warrant, so that a false idea of the healthfulness of the community
obtains. That errors of this sort have existed in the past can be seen
by examining the death-rates for New York City and those for regions
outside that city for the past ten years:--

TABLE III. DEATH-RATES IN NEW YORK CITY AND ELSEWHERE IN NEW YORK STATE,
1898-1908

=======================================
       New York   Outside   Difference
---------------------------------------
1898    20.4       14.5        5.9
1899    19.6       14.9        4.7
1900    20.6       15.0        5.6
1901    19.9       15.1        4.8
1902    18.6       14.1        4.5
1903    17.9       15.2        2.7
1904    18.5       17.3        1.2
1905    18.3       15.8        2.5
1906    18.4       15.7        2.7
1907    18.5       16.4        2.1
1908    16.8       15.5        1.3
=======================================

The decrease in the city rate is to be expected, since with greater
knowledge of sanitary matters, more precautions against disease would
naturally be taken. But it is not likely that the country is becoming
more careless, although the tendency to concentrate population even in
rural hamlets may have an effect. It is rather more likely that the
reports are made more carefully and that the records are more complete
now than formerly. The apparent increase in the number of deaths in
rural communities is, therefore, due to greater attention in reporting
deaths rather than to any real increase in the number.

If the difference between the rural community death-rate and the rate in
all the cities of more than 8000 population in New York State be shown,
the difference between the city rate and the country rate is even less
than that shown in the table, being only 0.7 deaths in 1000 for 1908.
This shows that the boasted superiority of the country over cities is
not very great; that it is marked only in the case of a very large city
like New York; that, as the size of the city decreases, the difference
disappears, and that the country rate in the United States is high when
compared with the general rate of other countries like Denmark or even
England, where the general rate includes the large cities.

_Effect of children on death-rate._

An interesting sidelight on the apparent tendency of the country to have
an increasing death-rate, year by year, is shown by the meager figures
which are available on the subject of the number of small children in
the different towns. The Chief Clerk in the Census Office, Mr. William
S. Rossiter, has investigated the proportion of children in two rural
counties of New York State, Otsego and Putnam, and has discovered the
startling fact that while the population in those counties has hardly
changed since 1860, the proportion of young children has decreased
almost one third in the forty years ending with 1900, as shown by the
following table:--

TABLE IV. TABLE SHOWING PERCENTAGE OF CHILDREN IN OTSEGO AND PUTNAM
COUNTIES, 1860-1900

===========================================================================
                      1900                               1860
         ------------------------------------------------------------------
           Total                            Total
           White    Under 10                White      Under 10
County   Population   Years    Per Cent   Population     Years    Per Cent
---------------------------------------------------------------------------
Otsego     48,793     7,121      14.5       49,950       10,988     22.0
Putnam     13,669     2,332      16.9       13,819        3,333     24.1
         ------------------------------------------------------------------
Total      62,462     9,453      15.0       63,769       14,321     22.5
===========================================================================

This shows that while in 1860, when the total population was about
64,000, the number of children was about 14,000 or 22.5 per cent, in
1900, when the total population was 62,462 or nearly the same, the
number of children was only 9453, or a reduction in numbers of nearly
5000 children. In many of the small cities of New York State, the fact
that there is a constantly decreasing number of children in the
community is well recognized, the greater proportion of the population
being past middle life. The death-rate, therefore, is lower, from this
very fact.

_Death-rates of children._

That the general death-rate is directly affected by the number of
children living in a community is shown by the following table:--

TABLE V. SHOWING DEATHS FROM ALL CAUSES IN THE UNITED STATES FOR THE
YEARS 1901-1905, AT VARIOUS AGE PERIODS

================================================
               No. at Each    Per Cent of Total
Age                Age            Population
------------------------------------------------
Aggregate        529,630             ----
Under 1 year     100,268             18.93
Under 5 years    143,684             27.13
5-9 years         13,679              2.58
10-19 years       23,234              4.38
20-29 years       46,685              8.81
30-39 years       49,501              9.34
40-49 years       48,811              9.21
50-59 years       51,787              9.77
60-69 years       59,856             11.31
70-79 years       56,544             10.68
80-89 years       29,408              5.55
90 and over        6,441              1.21
================================================

This table shows two things: first, that children have a hard time
reaching five years, as nearly one third of all the children born in any
year die under five years, and second, that from five to twenty years is
the healthiest--that is, safest--time of a person's life, since after
twenty the constitutional diseases make themselves felt so that death
becomes almost uniformly distributed from twenty to eighty. It is plain,
then, that in any community a change in the relative proportion of
children born in any year would change the death-rate, since with a
smaller number of infants there could not be so many to die.

No statistics are available to determine the number of small children in
the country as compared with that in the city, but it is probable that
they are in excess in the latter, since the highest birth-rates are
found in the congested districts of cities where foreigners congregate.
If this is so, it will account for and justify a higher rate of death in
the city because of the larger number of children, as has been explained
above, and the lower rate in the country may be due, not to better
sanitary surroundings, but solely to fewer children.

According to statistics, the death-rate of children is almost 50 per
cent higher in cities than in rural districts, and it is a general
impression that most deaths in the country are from old age. English
statistics show, however, and those of the United States would probably
show the same thing, that while a baby born in the city is more likely
to die before its first birthday than a baby born in the country, they
have equal chances to finish a month of life and that the city child has
better chances to live out the first week. The advantages of the
country, therefore, do not begin to operate until after the first month
of the baby's life, and there is a decidedly greater chance of the
child's living in the city the first week on account, probably, of
better and quicker medical attendance.

_Typhoid fever and the death-rate._

Turning now to special diseases and comparing the number of deaths
caused by special diseases in the country and in the city, it is to be
noted, first of all, that a greater difference exists in the case of
certain special diseases in the country and in the city than was found
in the general death-rate. In the case of typhoid fever, basing the
comparison on the statistics of the Census Office of the United States,
we find, first, that, at present, the difference in the death-rates from
typhoid fever in cities and in rural districts is very small. It is
also to be seen (from the following table) that in both city and in
rural districts, the rate is steadily decreasing, although in neither
has the rate yet fallen to what would, in other countries, be considered
a reasonable and proper death-rate. The first line of the table is the
actual death-rate from typhoid fever per 100,000 population, based on
the total population resident in all the United States where vital
statistics are kept; the second line gives the same data for cities not
included in registration states;[1] the third line is based on figures
for cities in registration states;[1] and the fourth line is based on
the statistics for rural districts and villages of less than 8000
population:--

TABLE VI. SHOWING DEATH-RATES PER 100,000 POPULATION FROM TYPHOID FEVER
IN PLACES INDICATED

==============================================================================
Year              1900   1901   1902   1903   1904   1905   1906   1907   1908
------------------------------------------------------------------------------
The registration
  area            35.9   32.4   34.5   34.4   32.0   28.1   32.1   30.3   25.3
Registration
  cities          36.5   33.9   37.5   38.2   35.2   30.1   34.2   32.9   25.8
Cities in registration
  states          28.5   26.5   25.9   24.6   24.0   22.0   34.2   31.7   24.5
Rural part of
  registration
  states          34.6   28.8   27.0   24.7   23.8   23.0   28.6   26.0   24.3
==============================================================================

[Footnote 1: States in which full credit is given by U. S. Census Office
for Vital Statistics collected from all parts of the state.]

This table shows that, taking the United States as a whole, the
typhoid-rate in rural districts is generally less than in cities and
that in cities the rate is excessively high.

When it is remembered that by filtration of public water-supplies the
typhoid-rate may be brought down to about 15 per 100,000, and that
cities with pure water-supplies will not exceed that rate, it is plain
how serious is the danger from typhoid in such cities as Cohoes or
Oswego. The following table from statistics taken in New York State
shows the same conditions as Table VI.--

TABLE VII. SHOWING DEATH-RATES FROM TYPHOID FEVER PER 100,000 POPULATION
IN NEW YORK STATE AS INDICATED

==============================================================================
Year             1900   1901   1902   1903   1904   1905   1906   1907   1908
------------------------------------------------------------------------------
Cities average    25.4   23.9   23.4   22.6   21.6   19.1   19.0   20.7   20.1
Rural districts   32.0   27.3   23.4   22.1   21.8   21.8   20.2   19.3   20.8
Average of city
  population        --   38.9   33.9   43.0   40.3   32.2   30.5   32.1   32.4
Average of rural
  population        --   20.3   24.1   23.2   21.3   22.3   21.3   19.9   20.8
==============================================================================

The first line is the death-rate in cities, found by taking the ratio of
all the deaths from typhoid in cities to the population in those cities,
and the second line is a similar ratio for rural districts. If the
actual rates of the several cities be averaged, a method which has the
effect of giving the rate found for a city of 10,000 equal value in the
average with one of 1,000,000, the third line of the table is obtained;
and in the same way, by averaging the death-rates of the counties of the
state, excluding cities, the fourth line is obtained. These last two
lines show that the average of the city rates is noticeably higher than
the average of the rural rates, and that, while since 1900 the average
of the rural districts has remained uniform, the death-rate in cities
has been continually decreasing.

It is, then, not fair to say, despite frequent but careless statements
by writers on typhoid fever, that this disease is a country disease, and
that it is transmitted to the city by the vacationist who finds the
disease lurking in the waters of the farm well. Some years ago it was
pointed out that the period of maximum development of typhoid fever is
in the fall, and the conclusion was drawn that the disease was
particularly prevalent then because that season is the end of the
vacation period. That this is not true, or at any rate not entirely
true, may be seen from the consideration of two facts, viz. first, that
the death-rate in the country districts is low compared with the rates
in cities, and second, that those stricken with the disease on their
return to the city are quite as apt to have traveled through other
cities and to have taken water from other places than farm wells.

_Typhoid in small cities._

As a matter of fact, the greatest danger from typhoid fever is neither
in the country nor the large city, but in the village or small city.
Here the growth and congestion of population has made necessary the
introduction of a water-supply, and in many cases this has not been
supplemented by the construction of a sewerage system. The ground
becomes saturated with filth, percolating, in many cases, into wells not
yet abandoned, and the introduction of the typhoid germ brought in from
outside is all that is needed to start a widespread epidemic.

TABLE VIII. MORTALITY FROM TYPHOID FEVER IN THE CITIES OF NEW YORK
STATE, SHOWING TOTAL DEATHS FROM TYPHOID FEVER AND DEATHS PER 100,000
POPULATION

===============================================================================
          |Average |
          |rate per|
          |100,000 |                       Rate per 100,000
          |for ten | ----------------------------------------------------------
City      |years   |1899 |1900 |1901 |1902 |1903 |1904 |1905 |1906 |1907 |1908
-------------------------------------------------------------------------------
          |    _Cities using unfiltered lake water:_
Auburn    | 23.0   | 23.4| 39.5| 22.9|  9.7| 25.8| 28.8| 15.9| 12.1|  6.0| 46.6
Dunkirk   | 40.2   | 17.5| 51.6| 32.4| 76.5| 29.0| 41.3| 39.3| 31.4| 71.8| 11.1
Geneva    | 29.3   | 49.2| --- | 46.3|  9.0| 52.1| 42.0| 32.7| 24.0| 15.4| 22.1
-------------------------------------------------------------------------------
          |      _Cities using unfiltered river water:_
Cohoes    | 84.4   | 88.3|113.0| 58.4|133.2| 91.3|103.6| 57.9| 57.8| 78.2| 62.0
Lockport  | 48.4   | 18.1| 18.0| 71.5| 35.4| 75.7| 34.6| 51.8| 67.6| 50.1| 60.7
Niagara   |        |     |     |     |     |     |     |     |     |     |
 Falls    |132.9   |113.0|123.3|143.7|148.1|114.0|135.3|184.4|154.5|126.0| 87.1
North     |        |     |     |     |     |     |     |     |     |     |
 Tonawanda| 30.9   | 23.1| 11.0| 32.3| 10.5| 41.1| 30.2| 39.3| 19.3| 47.2| 54.6
Ogdensburg| 54.6   | 87.8| 39.5| 31.4| 62.3| 61.7| 68.9| 53.1| 67.3| 47.1| 26.8
Oswego    | 49.4   | 22.6| 45.0| 22.4| 17.5| 53.5| 62.3| 84.1| 58.0| 66.0| 62.2
Rome      | 22.7   | 26.1|  6.5| 12.2| 25.2| 18.6| 24.5| 42.3| 28.2| 17.0| 26.4
Tonawanda | 30.1   | 13.5| 13.4| 13.3| --- | 26.0| 38.4| 25.3| 50.6| 25.0| 95.6
-------------------------------------------------------------------------------
          |      _Cities using filtered river water:_
Albany    | 28.7   | 87.0| 40.3| 21.1| 30.2| 19.7| 18.5| 19.3| 20.3| 20.0| 10.9
Binghamton| 22.2   | 25.5| 42.8| 52.4| 27.1|  9.7|  9.6| 12.0|  9.1| 18.2| 15.2
Elmira    | 41.0   | 33.6| 47.6| 25.4| 39.7| 80.0| 51.6| 28.8| 44.7| 28.0| 30.7
Pough-    |        |     |     |     |     |     |     |     |     |     |
 keepsie  | 46.5   | 25.1| 45.7| 41.1| 20.3| 44.2| 59.7| 43.3| 39.4|112.0| 34.5
Rensselaer| 61.9   |107.3| 93.7| 61.6| 91.2| 31.8| 89.4| 37.3| 18.6| 58.3| 30.0
Watertown | 71.9   | 85.7|101.4| 35.6| 64.7| 71.0|211.0| 23.6| 50.0| 37.1| 39.0
Watervliet| 57.5   |105.7| 77.0| 55.6| 62.3| 55.2| 61.8| 47.9| 47.7| 20.4| 41.1
-------------------------------------------------------------------------------
          |      _Cities using well or spring water:_
Corning   | 46.4   | 27.7| 54.2| 43.2| 24.9| 48.0| 46.1| 30.0| 43.1| 69.0| 78.2
Cortland  | 29.2   | 55.8| 33.2|116.2| 10.1| --- |  9.2| 26.6|  8.7| 24.6|  7.9
Fulton    | 33.2   | 25.0|   --| 24.0| 11.8| 93.2| 34.8| 22.6| 56.5| 22.0| 42.5
Ithaca    | 51.7   |  7.8| 45.6| 44.6|  7.3|357.0| 27.9| 13.7|  6.8|  -- |  6.4
Olean     | 19.5   | 21.6| 10.5| 20.8| 30.7| 30.3| 20.0| --- | 20.0| 19.1| 22.1
Jamestown | 28.9   | 40.5| 39.3| 25.5|  4.1| 24.1| 62.7| 23.0| 33.8| 18.2| 17.5
Schen-    |        |     |     |     |     |     |     |     |     |     |
 ectady   | 31.6   |  3.3| 44.2| 40.5| 26.0| 33.5| 22.6|  8.6| 17.8|  8.7| 10.9
--------------------------------------------------------------------------------
          |      _Cities using water from streams and reservoirs:_
Amsterdam | 19.4   | 19.8| 14.3| 23.2| 18.1| 44.0| 17.1| 16.7| 24.8| 15.9| ---
Glens     |        |     |     |     |     |     |     |     |     |     |
 Falls    | 37.6   | 24.6| 47.6| 61.4| 14.9| 28.9| 49.2| 20.4| 46.5| 45.3| 36.9
Glovers-  |        |     |     |     |     |     |     |     |     |     |
 ville    | 20.0   | 16.7| 49.0|  5.4| 43.3| 10.8|  5.4| 21.4|  5.3|  5.3| 37.3
Johnstown | 19.1   | 20.2| 69.1|  -- | 20.0| 30.1| --- | 10.2| 20.4| --- | 21.1
Newburgh  | 39.6   | 48.4| 44.1| 23.7| 47.0| 34.7| 42.0| 37.1| 41.3| 41.0| 36.4
New       |        |     |     |     |     |     |     |     |     |     |
 Rochelle | 21.1   |  7.1|  6.8| 38.0| 29.3| 22.0| 15.5| 19.5| 23.2| 22.0| 28.0
Plattsburg| 21.0   | 24.1| 23.7| 34.1| 11.0| 21.1| --- | 39.2| 28.7| 27.6| ---
Troy      | 49.2   | 65.1|101.2| 55.7| 48.8| 32.8| 44.4| 46.8| 36.2| 25.8| 34.9
Utica     | 17.3   | 16.3| 14.1| 15.6| 20.3| 16.6| 17.8|  9.5| 27.6| 15.2| 20.1
Port      |        |     |     |     |     |     |     |     |     |     |
 Jervis   | 42.7   | 10.6| 31.9| 31.8| 52.5| 73.1| 72.6| 72.2| 31.0| 51.0| ---
Little    |        |     |     |     |     |     |     |     |     |     |
 Falls    | 36.4   | 29.3|125.2| 28.5| 37.5| 27.7| 36.4| --- | 44.7|  8.8| 25.9
Oneida    | 17.2   | 26.5| 13.3| 25.9| 38.0| --- | 36.3| --- | 11.8| --- | 19.8
-------------------------------------------------------------------------------
          |      _Cities using filtered surface water:_
Hornell   | 28.8   | 76.1| 25.1| 32.8| 32.1| 55.0|  7.7| 30.2|  7.5|  7.5| 14.1
Hudson    | 59.2   | 62.8| 94.4| 41.3| 81.3| 30.0|167.7| 48.5| 38.0|  9.4| 18.1
Kingston  | 19.4   | 28.9|  8.1| 12.1| 16.0| 19.9| 11.8| 31.3| 15.6| 27.0| 22.9
Middleton | 24.5   | 21.0| 13.7| 13.8| 55.1| 13.8|  6.9| 41.3| 18.8| 18.8| 42.1
Mount     |        |     |     |     |     |     |     |     |     |     |
 Vernon   | 14.6   |  5.0|  4.9| 13.6|  8.8|  8.5| 20.6| 20.0| 19.4| 37.7|  7.1
Oneonta   | 37.9   | 28.7| 27.9| 13.6| 66.5| 26.0| 50.8| 24.8| 48.6| 23.8| 68.2
Yonkers   |  9.9   | 10.8|  4.1| 15.9|  9.3| 14.2| 15.2|  1.6|  6.2| 11.9|  9.6
===============================================================================

Another reason for the prevalence of this disease in small cities is
that the organization of their health boards is much less effective than
that of larger cities. Individuals have not yet learned to sacrifice
their own wishes for the sake of the community, and the local health
officer, however much he may desire to do his duty, is not upheld by
public opinion, and is therefore powerless.

In order to show the condition existing in the small cities of the state
of New York, the preceding table has been prepared, showing the average
death-rate for the cities of the state for the past ten years,
excluding, however, the cities of New York, Buffalo, Rochester, and
Syracuse, all of which have well-organized health boards, and where no
epidemic of typhoid fever may be expected. Remembering that a rate of 15
per 100,000 is a normal rate, it will be easily seen how excessive is
the amount of typhoid fever in most of the cities of New York State.

TABLE IX. SHOWING DEATHS FROM TUBERCULOSIS PER 100,000 POPULATION IN THE
UNITED STATES

===============================================================================
                | 1900 | 1901 | 1902 | 1903 | 1904 | 1905 | 1906 | 1907 | 1908
-------------------------------------------------------------------------------
The registration|      |      |      |      |      |      |      |      |
  area          | 180.5| 175.1| 163.6| 165.7| 177.3| 168.2| 159.4| 158.9| 149.6
Registration    |      |      |      |      |      |      |      |      |
  cities        | 198.8| 192.1| 180.7| 183.6| 195.5| 184.4| 181.5| 179.4| 170.1
Cities in       |      |      |      |      |      |      |      |      |
  Registration  |      |      |      |      |      |      |      |      |
  states        | 204.1| 194.9| 177.7| 179.7| 189.4| 178.5| 184.0| 181.5| 169.1
Rural part of   |      |      |      |      |      |      |      |      |
  Registration  |      |      |      |      |      |      |      |      |
  states        | 138.0| 133.8| 121.1| 120.7| 131.4| 126.2| 121.9| 123.8| 117.3
===============================================================================

_Tuberculosis death-rate._

Turning now to tuberculosis, the death-rate in cities is very markedly
higher than in rural districts, and the superiority of the country as a
place to live is hereby plainly demonstrated. The preceding table shows
the death rate from tuberculosis in cities for the years 1903-1907, the
data being taken from the United States Census Reports.

The death-rate in the cities is evidently about 60 per 100,000 greater
than in the rural districts, due, of course, to the crowding in city
tenements. This is true for nearly all cities, although the difference
is more marked in some parts of the country than in others. In
Massachusetts, for example, the death-rate in rural districts is
slightly higher than the death-rate in cities, but tuberculosis is much
more prevalent in that state than in any other part of the country. In
New York State the rate in cities is about 70 per 100,000 greater than
in rural districts, due, presumably, to the larger number of
manufacturing centers in this state. In New York City the rate is
constantly more than 200, and in 1908 in the borough of the Bronx it was
nearly 500.

_Diphtheria as affecting the rate._

Diphtheria is another disease that exacts heavier toll from the cities
than from the country, about three times as many deaths occurring in the
former as in the latter.

_Influenza, and its effect on death-rate._

Influenza is, on the other hand, markedly severe on people in rural
districts, the death-rate there being more than twice as high as in the
cities. It is easy to see why this is. Lack of sidewalks, lack of
protection, lack of uniform temperature in the houses, and the lack of
care in the first stages of illness, all tend to increase the death-rate
from this disease.

_Pneumonia._

The death-rate from pneumonia, on the other hand, is higher in the city,
the vitality and power of resistance of victims probably being reduced
under average city conditions.

_Other diseases._

Diseases that are induced by water, all referred to under typhoid fever,
but extending into such complaints as diarrhoea and enteritis, are
much more severe in cities than in the country. Such an excess of
general intestinal diseases shows again that a polluted water-supply is
not peculiar to the country, but is responsible for an excessive
death-rate in the city. Most of the constitutional diseases also have
higher death-rates in the city than in the country. Bright's disease,
for example, for the five years 1903-1907, had an average rate in cities
of 107.3 per 100,000, while for the same five years in the rural
districts the rate was only 68.6.

_Old age and the death-rate._

Further showing the advantage of country life, it is to be noted that
the number of deaths from old age in rural districts is nearly double
that in cities. For example, in the same period already referred to the
death-rate in cities of persons over sixty was 27.6, while in the rural
districts, for the same period, it was 49.3,--nearly double.

_The need for attention to rural hygiene._

One must conclude, therefore, that the chances of living are increased
through residence in the country or in rural districts, and one is
therefore led to ask why, if conditions there are superior to those in
the city, is it necessary to deal with the question of rural hygiene,
and why attempt to improve conditions which are already evidently
superior to those in cities. The answer to this must lie in the
statement that the death-rate does not tell the whole story of public
health. So far as the real welfare of a community is concerned, the
standard should be that of the efficiency of the lives in the different
age periods rather than the length of those periods. By efficiency in
such a connection is meant not merely a life that is free enough from
disease to permit the full number of working days in the year, and the
full number of years in the man's life usually devoted to toil, or all
together a life that contributes something of value to the world,
whether produce from the farm or books evolved from the brain; but
efficiency here means that composite development of the whole man--body,
mind, and spirit--which we believe must have been intended when man was
created with this threefold nature. It is in this composite development
that those living in the country are sadly lacking in efficiency.

Not to the same extent as twenty-five years ago, but still too often is
the farmer so exhausted by bodily toil that he has left no strength for
the cultivation of either mind or spirit. For the brief period of spring
and summer, the good farmer in the Eastern States works himself harder
than any slave of old. Up with the sun, or earlier, he follows through
the long day the hardest kind of manual labor. When the end of the day
comes, after fifteen hours' physical strain, his weary body demands
sleep, and no vitality is left for mental improvement. In the winter,
on the other hand, a lack of exercise is enforced, and the resulting
interference with normal functions is so great that he lives the winter
through in a sort of hibernation. He is nearly poisoned by lack of
ventilation in the small living room, where the one stove makes living
possible; he gets fat and indolent, and then with relaxed muscles
plunges into furious labor again when spring comes round.

"No wonder," says Woods Hutchinson, "that by forty-five he has had a
sunstroke and 'can't stand the heat' or has a 'weak back' or his 'heart
gives out' or a chill 'makes him rheumatic.'" Such a life is not
efficient any more than a steam engine is efficient when half the time
it is run at such high speed that it tends to shake itself to pieces and
the other half of the time it stands idle. Nor are the conditions under
which farmers' wives live any better. Statistics show that the highest
percentage of insanity in any class of persons in the United States (due
chiefly to overwork, overworry, and lack of proper amusements and
recreation) is to be found among farmers' wives.

An ideal life is not one which merely rounds out the allotted span, but
one which, during that span, is measurably free from ailments and
disabilities and in a condition to claim a share in the joy of living
which belongs to every human being by reason of his existence. Such
lives, to be sure, are seldom found, and no system of statistics yet
devised has been able to take account of those ailments. Insurance
companies, which make good losses for inability to work and which return
the cost of medicines and doctors' bills, give the only information on
the subject. From these, it has been shown that for each death in a
community there are a little more than two years of illness. Or,
expressed differently, for every death occurring in a village, there are
two persons constantly ill during the year. Or, still differently, there
are, on the average, thirteen days' sickness per year for every person
in a community.

It is the aim of all hygienic efforts to prevent not merely premature
death, but also the inefficiency of unhealthy living, and it is the
latter condition rather than the former which generally prevails in
rural communities. As we have seen, the death-rates in the country,
except for pneumonia, are not noticeably higher than in the city. But by
minor ailments, with the resulting loss of daily efficiency, the rural
communities are sadly overburdened. As Irving Fisher says in his Report
on National Vitality:--

"But prevention is merely the first step in increasing the breadth of
life. Life is to be broadened not only negatively by diminishing those
disabilities which narrow it, but also positively by increasing the
cultivation of vitality. Here we leave the realm of medicine and enter
the realm of physical training.... Beyond athletic sports in turn comes
mental, moral, and spiritual culture, the highest product of health
cultivation. It is an encouraging sign of the times that the
ecclesiastical view of the Middle Ages, which associated saintliness
with sickness, has given way to modern 'muscular Christianity.'... This
is but one evidence of the tendency toward the 'religion of
healthymindedness' described by Professor James. Epictetus taught that
no one could be the highest type of philosopher unless in exuberant
health. Expressions of Emerson's and Walt Whitman's show how much their
spiritual exaltation was bound up with health ideals. 'Give me health
and a day,' said Emerson, 'and I will make the pomp of emperors
ridiculous.' It is only when these health ideals take a deep hold that a
nation can achieve its highest development. Any country which adopts
such ideals as an integral part of its practical life philosophy may be
expected to reach or even excel the development of the health-loving
Greeks."




CHAPTER II

_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.

_Damp soils._

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.

[Illustration: FIG. 2--Bad conditions about a dwelling.]

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.

_Topography._

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.

_Made ground._

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 débris 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.

_Drainage._

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.

[Illustration: FIG. 3.--A grading that turns water away from the house.]

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 æsthetically 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.

_Ground water._

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.

[Illustration: FIG. 4.--Modes of laying out drains.]

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.




CHAPTER III

_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.

[Illustration: FIG. 5.--Exterior wall-drains.]

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.

[Illustration: FIG. 6.--Interior cellar-drains.]

_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.

_Dampness of masonry walls._

One fact peculiar to all kinds of masonry and known to all careful
observers is that stone work, brick work, and concrete will allow
dampness to permeate, whether it comes from water-bearing soil or a
driving rain. One objection to concrete-block houses has been that a
hard rain would cause moisture to form on the inside. Brick buildings
have the same defect when the walls are built solid.

An air-space in the cellar walls is the only way of insuring a dry
cellar, if the bottom of the cellar is below the level of the ground
water. A four-inch course of hollow brick may be used on the inside, or
the wall may be actually divided into two walls with a space between.

[Illustration: FIG. 7.--Wall modes of making air-space.]

Figure 7 (after Warth) shows three different ways by which an air-space
is secured and the two component parts of the wall held together. In the
top view, the two walls, one eight-inch and one four-inch, are held
together by wire ties, leaving an air-space of about four inches. In the
middle drawing the walls are tied together by making the air-space three
inches wide and then lapping the brick laid as headers over both walls.
In the bottom view special terra-cotta blocks are used which pass
through both walls. There can be no question of the value of such
construction in eliminating dampness from the inside wall, but, it must
be admitted, the cost of the walls is increased somewhat.

_Use of tar or asphalt on the wall._

Instead of an open space, nowadays, it is more customary to thoroughly
plaster the outside of the cellar wall, and then paint it with a tar
paint put on hot, which will adhere fairly well to the cement or
masonry. Asphalt cannot be very readily used for this purpose unless it
is an asphalt oil with but little bitumen paste. A paving asphalt, for
example, even applied hot, does not adhere to the masonry, but slides
down the walls as fast as it is applied. A successful method, however,
of using such asphalt is to build the cellar wall in two parts,
separated about half an inch, and filling in the intervening space with
liquid asphalt. In this way, the asphalt is held in position, and is an
absolute prevention of dampness.

Another method used successfully in the construction of one of the large
railroad stations in Boston consists in painting the outside of the wall
with tar and then pressing into the hot tar several layers of tar paper,
the separate sheets overlapping in a special coating of tar. These
sheets are thus made continuous around the building and under the
basement so that no water can enter the building.

[Illustration: FIG. 8.--Water-tight wall.]

A cross-section of one of the depressed tracks entering the Boston
Station is shown in Fig. 8. The heavy black line represents ten
thicknesses of tar paper, each one thoroughly painted with a thick paint
of hot tar. It should be noticed that this water-tight coating is
inclosed between masonry walls, so that the coating cannot be injured.

It is possible theoretically by these methods to build an underground
cellar so truly water-tight that it could be set down in a lake, where
it might float like a boat and not leak a drop, and there may be some
locations that require such construction, such as a low river valley or
an old salt marsh or a city flat, where no adequate drainage is
provided. But practically such construction will always be found
expensive, and is, in most cases, unnecessary and ineffective, as
already indicated, and where the percolating water cannot be tolerated,
involves the installation of some kind of pump to throw out the water
that will inevitably, in larger or small quantities, pass through the
best water-proofing. It is, therefore, the part of wisdom to place
reliance on draining the water away from the house rather than on
water-proofing the cellar wall.

_Dry masonry for cellar walls._

It may not be out of place to add a word of caution against the practice
of building cellar walls of loose stone, without mortar. They make no
pretense of being water-tight, they offer no resistance to the entrance
of rats, and they soon yield to the pressure of the earth and present
that wobbly, uncertain appearance of cellar walls seen in rural
districts. Nor should the idea that the interior is to be visible and
the exterior invisible blind the builder to the fact that it is far more
important to have the outside smooth. If smooth, there are no projecting
surfaces for water to collect in, no edges for the frozen earth to cling
to and by expansion tear off from the wall. If smooth, the joints in the
masonry can be pointed or filled with mortar, and thus a suitable
surface for the tar or asphalt is provided.

[Illustration: FIG. 9.--Rough-backed wall.]

In Fig. 9 (after Brown) is shown a cellar wall with rough, irregular
back, and it is easy to see how water would readily find its way down to
one of the projecting stones and then along such a stone, through the
wall into the cellar. With such a wall the action of the frost is more
severe than with a wall with a smooth back, so that the wall in Fig. 9
is gradually pulled apart by alternate freezings and thawings. Figure 10
(after Brown), on the other hand, shows the cellar wall as it should be
with smooth, even exterior, along which the water passes easily, with
gravel backing, through which the water escapes to the drainpipe.

[Illustration: FIG. 10.--Even-backed wall.]

_Damp courses in walls._

[Illustration: FIG. 11.--Four modes of making water-proof cellar walls.]

Another important means of keeping moisture from the cellar walls is to
provide what is called a damp course at about a level with the top of
the cellar floor. Where the soil is naturally damp, and where the cellar
wells are not adequately water-proof, a second damp course should be
provided at the level of the ground so that moisture from the damp
cellar walls may not pass up into the above ground portion, which is
naturally dry. These damp courses, in their simplest form, consist in
bringing the masonry level around the building, and painting the top
surface with liquid coal tar.

[Illustration: FIG. 12.--Waterproofing of cellar walls.]

Another method is to paint the masonry with liquid asphalt, and then
imbed in this paint a thickness of asphalt-covered building paper which
is again painted with asphalt. This may be done in the horizontal layer
where it could not conveniently be done vertically.

Four different ways used in France for securing dry cellar walls are
shown in Fig. 11. The heavy black line represents the damp course,
which, when added to the effect of the interwall space, which is shown
in all the drawings but the first, and there replaced by a deep drain,
insures absolute freedom from all moisture within the cellar. Figure 12
shows sections recommended by Dr. George M. Price, and indicates clearly
the location of the damp course.

_The cellar floor._

The floor of the cellar, in the same way, must be kept from dampness,
and this is best done by covering the cellar floor with a layer of
concrete, one part cement, three parts sand, and six parts broken stone;
or, one part cement and eight parts gravel may be used. Care should be
taken, however, that the gravel does not contain an excess of sand, and
it is always well in using gravel for concrete to check the proportion
of these two materials. This may be done as follows: Sift the gravel
through an ash sieve so that it is free from sand; fill a ten-quart pail
even full with the gravel and then pour in water to the top of the pail,
keeping account of the amount of water poured in. This volume of water
gives the proper amount of sand to use with the gravel for concrete, and
if more sand than this was present in the original gravel, it should be
sifted out until the proper proportion is reached.

Concrete is not water-tight, and the concrete floor of the cellar must
be treated in some way to prevent water or moisture rising through this
floor. One method is to cover the concrete thus laid with a denser
mixture of cement and sand, put on three fourths of an inch thick, and
made by mixing equal parts of sand and cement; or the asphalt layer
already referred to in the cellar walls may be carried across the
cellar, putting, as before, a paint layer on the concrete, then paper,
then another paint layer, making it continuous and without a break from
outside to outside. On top of this, to prevent wear and tear, a floor of
brick, laid flat, or a two-inch layer of concrete may be laid.

_Cellar ventilation._

The great importance of the cellar as that part of the house where, if
anywhere, unhealthy conditions exist, justifies this prolonged
discussion, and before leaving the subject, ventilation in the cellar
should receive a word of encouragement. Too many cellars are damper than
need be, are musty and close, full of odors of decaying vegetables and
rotting wood, entirely from lack of ventilation. The cellar windows are
small and always, closed. The cellar door is seldom opened, and never
with the idea of admitting air. The impression on entering such a cellar
is of a tomb.

The cellar, even in that part devoted to storing vegetables, needs
ventilation as much as the house does, for the cellar air finds its way
up into the house, and an unventilated cellar means a house with air
deficient in oxygen and overloaded with carbonic acid, a condition which
causes pale faces and anæmic bodies. Far better and healthier is it to
open all the cellar windows, covering them with coarse netting to keep
out animals and with fine netting to keep out insects, and let the
disease-killing oxygen and sunlight in. Malaria comes from the cellar,
whenever the malarial mosquito can find there a breeding place. The
writer has seen many cellars in which mosquitoes were living the year
through in entire comfort, utilizing the moisture and warmth of the
cellar to enjoy the winter months and up and ready for their mission at
the first sign of spring. A cistern in the cellar is objectionable on
this account, and if one exists, it should be covered with mosquito
netting.

_The old-fashioned privy._

Another source of ill-health as well as of temporary discomfort is the
typical construction and continued use of an outside closet or privy.
The physical shrinking from the use of the ordinary building is most
reasonable. As generally constructed, great draughts of air (presumably
for ventilation) are continually passing through the small building, and
when the temperature of the outside air is at zero, or thereabouts, only
the strongest physique can withstand the exposure involved without
serious danger of consumption, influenza, and pneumonia, or at least
inviting those diseases by reducing the vitality of the body. Two
improvements suggest themselves and should be put into effect wherever
this primitive construction must continue to be used.

In the first place, the building itself should not be fifty or a hundred
feet away from the house, so that every one is exposed to rain, snow,
slush, and ice in making the journey thither. But some corner of the
woodshed or barn should be utilized or the small building should be
moved up by the back door and connected therewith by a roofed passage.
The barn location is objectionable if it involves outdoor exposure in
going from the house to the barn. A liberal use of earth in the privy
vault will eliminate odors, and a water-tight box or bucket makes a
frequent removal of the night soil practicable.

In the second place, a small stove ought to be provided to warm the
closet in the coldest weather. Then the dislike to suffer from the cold,
which leads so many to postpone nature's call, will be avoided, and the
consequent digestive disorders which come from constipation and
intestinal fermentations prevented.

_Cow stables._

In matters of health, aside from ventilation, which is discussed in the
next chapter, there is little to be said concerning the other buildings
on the farm. Barns for hay are not involved. A few words may profitably
be devoted to barns for stock, involving, as they do, by their
construction, the health of the stock. One enthusiastic farmer writes
that it is possible for farmers to keep their stock at all times under
conditions which are an improvement upon the month of June. He believes
that the cow stable should be as comfortable for the cows as the house
is for the owner, subject to no fluctuations of temperature, and that,
in this way, the health as well as the comfort and milk production of
the cows would be maintained.

Light should be listed as the first essential of healthy stables, light
to kill disease-producing bacteria, to make dirty corners and holes
impossible, and to react on the vitality of the animals. Compare this
with some stables where fifteen, twenty, or thirty head are stabled in
an underground dugout with two or three small windows not giving more
than four square feet in all. Stable windows should be set, like house
windows, in two sashes and capable of being raised or lowered at will.
In winter a large sash may be screwed over the regular window to keep
out frost and moisture, provided there is some independent method of
ventilation.

For good healthy conditions, a cow needs about 500 cubic feet of space,
with active ventilation. In old stables, with poor construction, as
little as 200 cubic feet per cow was allowed, and when stables were made
tight with matched boards and building paper, 200 cubic feet was found
to be too small, and it was recommended that one cubic foot be allowed
for each pound of cow. But when tried by wealthy amateurs, it was found
that this was too large; the stables were damp and cold in winter and
became a predisposing factor in the development of tuberculosis. Between
the two extremes, 200 and 1000, is the practical average named above,
namely, 500 cubic feet of air space for each cow.

For the health of the cow as well as for the good quality of the milk
the stable should be built with special reference to being kept clean.
The ceiling should be dust-tight, so that if hay is stored above, it
will not sift through. The part of the barn where the cows are kept
should be separated from the rest of the barn by tight partitions and a
door into the cow stable. Nothing dusty or dirty should accumulate. The
floor of all stables for cows, horses, hens, and pigs should be of
concrete to insure the most sanitary construction. Planks absorb
liquids and wear out rapidly under the feet of the stock. Concrete can
be kept clean, is nonabsorptive, and if covered with some non-conducting
material, like sawdust, shavings, or straw, is a perfectly comfortable
floor for the animals.

_Use of concrete._

No development of recent times has tended more toward the improvement
and greater comfort of house building than the use of concrete. In the
earlier houses, the cellar walls were so badly built and the connection
between the top of the cellar wall and the timber sill of the house was
so poor that the winter's wind blew through above to the manifest
discomfort of those in the house. The writer remembers sitting in the
best room of a well-to-do farmer, and watching, with great interest, the
carpet rise and fall with the gusts of wind outside. To avoid such
unhappy consequences, farmers have been accustomed to bank up the house
outdoors in the fall with dry leaves, spruce-boughs, or manure, usually
to a point on the woodwork. This, of course, closes the cellar windows
for the winter for the sake of keeping out the wind. A concrete wall, at
the present price of cement, using gravel for the mixture instead of
stone, need cost but little more than the price of the cement and the
labor involved, and a tight cellar wall may thereby be obtained.

If the soil in which the cellar is dug is firm enough, the outside of
the excavation can be made so that no form on that side will be
required, but it is always better to make the excavation about two feet
more than necessary, to put forms inside and outside, and, after their
removal, plaster or wash the wall with a thick cream of cement and
water. In carrying the wall above the ground, forms must be used with
great care to secure a smooth surface, and Fig. 13 shows two methods
suggested by the Atlas Cement Company.

[Illustration: Fig. 13.--Cellar-wall forms.]

There are so many forms of construction where concrete is not merely a
convenience but a great advantage in the matter of health around the
house, and particularly a house in the country, that there would be no
end if one once began enumerating and describing the various methods and
processes involved. Besides the cellar walls and cellar floor, there are
outside the house, silos, manure bins, walks, curbing, steps,
horse-blocks, hitching and other posts, watering troughs, and drainpipe,
all successfully made of this useful material. In the barn, the barn
floor, the gutters, the manger and watering troughs, cooling tanks, and
sinks are also made of cement. While it is possible to differentiate
between the methods and the mixtures for these various purposes, it will
not be greatly in error if the construction always follows the following
principle.

Use enough cement to fill the voids in the gravel or in the sand and
stone mixture employed, and have enough sand in the gravel or with the
stone to fill the voids in the stone. This is readily determined, as
already suggested, by the use of water. The water, which will occupy the
voids in the stone, represents the necessary sand. When this amount of
sand and stone is well mixed, the water then permeating the interstices
represents the necessary cement, though it is a good plan to add about
10 per cent extra to allow for imperfect mixtures.

The mixing should always be done so thoroughly that when put together
dry, no variation can be seen in the color of the mixture. It is
surprising to see how readily a streak of unmixed dirt or of unmixed
cement can be detected in a pile by the difference in the color which it
presents. Such mixtures should always be made dry first and then the
water added and again mixed until the result is of a perfectly firm
consistency. Such a mixture can be applied to any of the purposes
mentioned, and, in general, it is better to have too much water than not
enough. The only difficulty with a very wet mixture is that the forms
require to be made nearly water-tight, whereas with dry mixtures the
same attention to the forms is not necessary.

If the concrete is to be used in thin layers, as in pipe or watering
trough, where a smooth surface is wanted, better results are usually
obtained by using a dry mixture and fine gravel and tamping the mixture
with unusual thoroughness. It is always unsafe to smooth up or
re-surface a piece of concrete. The difference in texture of the surface
coat causes it to expand and contract differently from the mass of
concrete underneath, and inevitably a separation occurs. If it is
desired to put on a sidewalk, for instance, a smooth top coat, the
consistency of the two kinds of concrete should be alike, and the top
coat should be applied almost immediately after the bottom layer is put
in place. Where concrete is used to hold water, a coat of neat cement
should always be put on with a broom or a whitewash brush, mixing the
neat cement with water in a pail, and it does no harm to go over the
surface three or four times, the object being to thoroughly close the
pores in the concrete.

For floors of cellars or barns, the dirt should be evened off and tamped
and then the cement concrete should be spread evenly over it, and tamped
just enough to bring the water to the surface. When partially dry, a
better finish is obtained by lightly troweling the concrete. In a cellar
or barn, it is not necessary to divide up the area into squares or
blocks as is done with sidewalk work, but the entire area may be laid in
one piece. In order to keep the surface level, however, it may be found
convenient to lay down pieces of 2" x 4" scantling, the tops of which
shall be on the desired level of the finished floor. By filling in
behind these scantlings, which can be moved ahead as the filling
progresses, the exact level desired can be obtained. Usually four inches
thick will be a proper depth of concrete for this purpose.




CHAPTER IV

_VENTILATION_


The average individual breathes in and out about eighteen times a
minute, taking into his lungs the air surrounding him at the time and
expelling air so modified as to contain large amounts of carbonic acid,
organic vapor, and other waste products of the lungs. The volume of air
taken in is about the same quantity as that expelled and amounts to
eighteen cubic feet per hour. Fortunately, the air expired at a breath
is at once rapidly diffused throughout the surrounding atmosphere, so
that, even if no fresh air were introduced, the second breath inhaled
would not be very different from the first. But after a certain length
of time the air becomes so saturated with the waste products of the
lungs that it is no longer fit to breathe, and it is evident that in
order to keep the air in a room so that it can be taken into the lungs
with any reasonable degree of comfort, there must be a continual supply
of fresh air admitted with a proper provision for discharging polluted
air. If this is not done, there is, so far as the lungs are concerned, a
process established similar to that which is occasionally found when a
village takes its water-supply from a pond and discharges its sewage
into the same pond.

Not long ago, the writer found in the Adirondacks a hotel built on the
side of a small lake which pumped its water-supply from the lake, and
discharged its sewage into the same lake only a few feet away from the
water intake. That the hotel had a reputation of being unhealthy, and
that it had difficulty in filling its guest rooms, is not to be wondered
at, and yet individuals will treat their lungs exactly as the hotel
treated its patrons.

_Effects of bad air._

In order to establish a proper relation between the amount of impurities
diffused through the air and the physiological effect on individuals
breathing that air, certain observations have been noted and certain
experiments have been made which prove without question the injurious
effect of vitiated air.

Professor Jacob, late Professor of Pathology, Yorkshire College, Leeds,
gives the following example on a large scale, to show the results of
insufficient ventilation: "A great politician was expected to make an
important speech. As there was no room of sufficient dimensions
available in the town, a large courtyard, surrounded with buildings, was
temporarily roofed over, some space being left under the eaves for
ventilation. Long before the appointed time several thousand people
assembled, and in due course the meeting began; but before the speaker
got well into his subject, there arose from the vast multitude a cry for
air, numbers of people were fainting, and every one felt oppressed and
well-nigh stifled. It was only after some active persons had climbed on
the roof and forcibly torn off the boards for a space about twenty feet
square that the business of the meeting could be resumed."

Remembering that the process of breathing is for the purpose of
supplying oxygen to the blood and that the absorption of oxygen in the
lungs is the same process which goes on when a candle burns, the
following experiments were made by Professor King of the University of
Wisconsin, to show the effect of expired air on a candle flame. He took
a two-quart mason jar and lowered a lighted candle to the bottom, noting
that the candle burned with scarcely diminished intensity. Through a
rubber tube, he breathed gently into the bottom of the jar, with the
result that the candle gradually had a reduced flame and was finally
extinguished. He observed also that if the candle were raised as the
flame showed signs of going out, the brilliancy of the flame was
restored, while lowering the candle tended to extinguish the flame. Even
when the candle was raised to the top of the jar, the flame was
extinguished after sufficient air had been breathed into the jar.
Clearly, then, he argued, air once breathed is not suitable for
respiration, unless much diluted with pure air. He argued from this that
if a candle using oxygen for combustion could not burn in expired air,
therefore an individual using oxygen for the renewal of the blood could
not be properly supplied in a room partially saturated with the expired
products of the lungs.

Professor King also experimented with a candle burning in a jar on which
the cover had been placed, and found that the candle was extinguished in
thirty seconds, and he argued that if a candle was thus extinguished on
account of the carbonic acid given off, so a person shut up in an
air-tight chamber would similarly be extinguished in the course of
time.

To prove that expired air is poisonous to animal life, Professor King
experimented on a hen, placing the same in a cylindrical metal air-tight
chamber eighteen inches in diameter and twenty inches deep. The hen
became severely distressed for want of ventilation and died at the end
of four hours and seventeen minutes.

In the Wisconsin Agricultural Experimental Station, an experiment was
conducted for fourteen days on the effect of ample and deficient
ventilation on a herd of cows. The stable was chiefly underground and
had two large ventilators which could be opened or closed at will. The
food eaten, the water drunk, the milk produced, and weight of the cows
were recorded each day. For a part of the time the cows were kept
continuously in the stable with all openings closed, and then the
ventilators were opened, the alternate conditions being repeated at
intervals of four days. The amount of food consumed was practically the
same under both conditions. The quantity of milk given was greater with
good ventilation. The chief difference was in the amount of water
consumed, since with the insufficient ventilation the cows drank on the
average 11.4 pounds more water each, daily, and yet lost in weight 10.7
pounds at the end of each two-day period. Examination of the animals
themselves also showed that a rash had developed on their bodies which
could be felt by the hand and which was apparently very irritating,
since it was so rubbed by the animals as to cause the surface to bleed.
The evident teaching of the experiment is that under conditions of poor
ventilation, it was impossible for the lungs to remove waste products to
as great an extent as usual, and, therefore, the demand for additional
water was felt in order to stimulate greater action on the part of the
kidneys to care for these waste products. That this was not a successful
substitute was shown by the loss of weight in the animals, and by the
irritation of the skin which evidently was trying to eliminate some of
the remaining impurities through its surface.

_Modifying circumstances._

Fortunately for mankind, it has not been customary, nor even possible,
to build dwellings or stables approaching the air-tightness of a fruit
jar. Air has great power of penetration, particularly when in motion,
and a wind will blow air through wooden walls, and even through brick
walls, in considerable quantity. It is practically impossible to build
window casings and door frames so that cracks do not exist, through
which air may find its way. When, however, in the wintertime, storm
windows have been put on, or when, as occasionally happens, to keep out
drafts, strips of paper are pasted carefully around all window casings,
or when rubber weather strips are nailed tight against the windows and
doors, conditions are obtained which resemble the mason fruit jar, and
under those conditions, a person living continuously in such a room is
experimenting on himself as Professor King did with the candle.

Another reason why it is difficult to make a room an air-tight chamber
is that if a stove or fire-place be in the room, a strong suction is
produced through the flame, and such suction requires the entrance of
outside air. It is a common experience that a fire-place in a room
otherwise tight will refuse to draw and will smoke persistently until a
door or window is opened, when, a supply of air being provided, the fire
is made bright and active.

Fortunately, the vitiation of the air in a room is never so severe as
that in an experimental chamber, and there are few examples which can be
cited of men or women dying from lack of ventilation in an ordinary
room. But the serious aspect of inadequate ventilation is not that it
actually induces death, but that it decreases the powers and activities
of the various organs of the body; that it interferes with their normal
processes, that it loads up in the body an accumulation of organic
matter which is normally oxidized by fresh air and which, if not
oxidized, obstructs the activities of other organs of the body.

_Danger of polluted air._

Unfortunately, it is not possible to detect by the physical senses that
point at which the human organism suffers from insufficient ventilation.
Some years ago, Dr. Angus Smith built an air-tight chamber or box in
which he allowed himself to be shut up for various lengths of time in
order to analyze his own sensations on breathing vitiated air. He found
that, far from being disagreeable, the sensation was pleasurable, and he
says, "There was unusual delight in the mere act of breathing," although
he had remained in the chamber nearly two hours. On another occasion he
stayed in more than two hours without apparent discomfort, although
after opening the door, persons entering from the outside found the
atmosphere intolerable. He placed candles in the box, which were
extinguished in a hundred and fifty minutes, and a young lady, who was
interested in the experiment, going into the box as the candles went
out, breathed it for five minutes easily; she then became white, and
could not come out without help.

Nor is it possible to conclude from the experiments and observations
cited that the body remains indifferent to polluted air until the latter
has reached a certain definite saturated condition. There can be little
doubt but that a degree of pollution far short of that necessary to
produce death has a weakening effect on the human organism, and that by
means of the increased functional activity of other organs doing work
intended for the lungs the resistance to disease is much impaired. Life
is a continual struggle of the bodily tissues against the attacks of the
micro-organisms and their tendencies to destroy life; hence inadequate
ventilation or any other condition which interferes with the normal
action of the organs of the body causes weakness and affords opportunity
for the attack of some disease-producing germ. It stands to reason that
an individual whose lung tissues have become soft and incapacitated must
be more liable to succumb to disease than another whose lung capacity is
large and whose blood has been continually and sufficiently oxygenated.

Perhaps no more impressive proof of this is seen than in the ravages of
consumption, which is so prone to attack those whose vitality is
diminished by living in unhealthy and unventilated cellars or in crowded
tenements. Statistics are very definite on the subject of tuberculosis
among Indians, who rarely suffer from the disease when living in tents
or on the open prairie, but when they become semi-civilized and crowd
together in houses heated through the winter months by stoves, the germs
of tuberculosis take firm hold, and the deaths from this disease are
greater in proportion to population among this race than anywhere else.

_Effect of change in air._

This discussion illustrates another law of disease which makes the
necessity for ventilation particularly great among rural communities
where for nine months in the year outdoor life is freely enjoyed,
namely, that when either an individual or people are brought under
changed conditions, perhaps not unwholesome to those accustomed to them,
those unaccustomed will suffer severely. So a lack of ventilation during
the winter months in a farmhouse is very serious in its consequences to
those who have had the full enjoyment of fresh air through the rest of
the year.

Reference has already been made (in Chapter 1) to the prevalence of
influenza in rural communities, and it is quite probable that this would
be largely eliminated if the lungs were not deprived of their oxygen as
they are in most houses on the farm.

_Composition of air._

Ordinary air contains about 0.04 per cent of carbon dioxid; that is,
four parts in ten thousand parts of air, the other nine thousand nine
hundred ninety-six being made up of oxygen and nitrogen. Of course, it
is not possible to express any definite value for the amount of carbon
dioxid which is objectionable in air, because, in the first place, it is
not certain that the carbon dioxid in itself is the cause of diminished
vitality due to insufficient ventilation, and, in the next place,
insufficient ventilation affects different people in different ways. But
it is known that in the lungs the life-giving oxygen is changed to
carbon dioxid, and that just as carbon dioxid gas will prevent the
combustion of a candle flame, so carbon dioxid gas will destroy the life
of man.

When a deep well is to be cleaned out, the decomposition of organic
matter in the bottom of the well will have, in all probability, caused
the formation of this same carbon dioxid gas, and it is not uncommon for
a man descending into such a well to be overcome by the gas, which, in
some cases, even causes death. For this reason, it is common to lower
into a well, before it is entered by a man, a candle or lantern, on the
probability that if the lantern can stand it, certainly the man can,
while if the lantern goes out, it is wise to avoid the risk of having a
man's life put out in the same way.

_Organic matter in air._

The stuffy and close feeling perceived in an ill-ventilated room is,
however, due to the organic matter from the lungs, which is expired
along with the carbon dioxid, and some chemists have argued that this
amount of organic vapor ought to be measured instead of the carbon
dioxid.

At the present time there is no simple and direct method of measuring
organic vapor, and because this vapor increases in the atmosphere
proportionately to the carbon dioxid gas, it is much simpler to measure
the latter. Then it is impossible to fix a standard of carbon dioxid
because a person whose lungs are well developed and whose blood is well
oxygenated, or, as we say, one who has good red blood can stand, even if
uncomfortable, a few hours of a bad atmosphere without suffering serious
discomfort, while an anæmic or poor-blooded person would be affected to
a greater degree. It is for this reason that in any house no living
room, especially one heated by a coal stove, should be shut up tight
against fresh air. This is the reason why the women of the family, who
have to breathe the same air over and over all day, are pale and weak
and easily susceptible to disease, while the men, who are out of doors
most of the time, and when indoors are made restless by the bad air,
suffer much less from the ill effects.

Experiments seem to show that when the amount of carbon dioxid in the
air has doubled, that is, when the expired air mixed with the air in the
room has increased the proportion of carbon acid from four parts in ten
thousand to eight parts in ten thousand, that the air is seriously
affected, and that such ventilation ought to be provided that no greater
amount than this could occur. This is such a condition that the room
smells "close" or stuffy to a person coming in from outdoors, indicating
organic emanations as well as an excess of carbonic acid gas. The
question then is: how may this condition be avoided in an ordinary
house, or in an ordinary stable, because the health of the cattle on a
farm, judging at least by the character of the buildings provided, is
quite as important as the health of the farmer's family.

We must take it for granted that no such elaborate schemes are possible
as in public buildings or schools, where fans are provided, either to
force air into the several rooms or else to suck it out. The ventilation
of the house must be more simple and easily adjusted and must depend on
the principle of physics that warm air rises and that if the warm air of
a room is to be removed, air must in some way be supplied to take its
place. The two essentials for ventilation are opportunity for the
ingress and the egress of air--ingress for fresh air and egress for
polluted air.

_Fresh-air inlet._

In the construction, of a dwelling house, special and adequate
preparation for the admission of fresh air is seldom provided, so that
the existing openings must be used for the purpose. This means that in
the summertime an open window will furnish all the fresh air which a
room receives and, when the temperature of the outside air is
approximately that of the living room, such provision is ample and
satisfactory. But in the wintertime, when the outside air is cold, the
average person will prefer to suffer from the bad effects of impure air
rather than admit cold air which may cause an unpleasant draft.

[Illustration: FIG. 14.--Letting in fresh air.]

One of the simplest and best methods of providing an inlet for fresh
air, without at the same time allowing blasts of wind to enter the room,
is to fasten in front of the lower part of the window a board which
shall just fill the window opening; then, raising the lower sash a few
inches will allow fresh air to enter both at the bottom, where the board
is placed, and at the middle of the window between the sashes (see Fig.
14). Persons sitting close by a window thus arranged may feel a draft
even under these conditions, since the cold air thus admitted will sink
at once to the floor and then gradually rise through the room to the
ceiling, but unless one sits too near the window, this is an admirable
method of admitting fresh air.

Another method, where steam or hot-water radiators are placed in the
room, is to connect the outer air, either through the lower part of the
window or through the wall of the room just below the window opening,
with a space back of the radiator, so that the cold air entering will
pass around and through the radiator and so be warmed as it enters.

[Illustration: FIG. 15.--Ventilating device.]

The picture (Fig. 15, after Jacobs) shows the arrangement of the
radiators in one of the buildings of the University of Pennsylvania. A
is the opening in the wall below the window; _D_ is a valve which
regulates the amount of air entering through the opening; _R_ is the
radiator; _B_ is a tin-lined box which surrounds the radiator; _T_ is a
door in front of the box, which when raised allows the air of the room
to be heated and to circulate through the radiator. By adjusting the two
valves _D_ and _T_, air of any desired temperature can usually be
obtained. Figure 16 (after Billings) shows an English device intended
for the same purpose. The valve _D_ in this case operates to admit air,
either through the radiator or to the space between the radiator and the
wall, in order to vary the temperature of the entering air. The valve
_T_ may be open or closed, and its position, together with that of the
valve _F_, determines the proportion of the room air which is reheated.

[Illustration: FIG. 16.--Ventilating device.]

The writer remembers one schoolhouse where these methods were used
successfully, the radiators being placed directly in front of the window
and inclosed at the back, sides, and top, except for an opening to the
outer air through the wall, properly controlled by a damper. In the
writer's own office the radiators are by the side of the window and are
boxed in, the connection being made with the outside air through a
wooden box entering under the radiator. This is an admirable method,
provided the radiator has sufficient surface to warm the fresh air
admitted.

Another excellent arrangement is to provide a narrow screen similar to
that used for protection against flies, but with the screening material
of muslin cloth instead of wire cloth. This muslin will break up the
current of air so completely that no draft is felt by persons sitting
even close to the open window.

_Position of inlet._

The inlet for fresh air, if connecting directly with the outside air,
should not be at the top of the room, since then the inlet would not
serve to admit air, but rather to allow the warm air of the room to
escape, and a burning match would inevitably show a draft outward
instead of inward.

Neither is it desirable to have the fresh-air inlet near the floor of
the room unless the entering air is warm, because cold air admitted will
flow across the floor and remain there, not disturbing the warm upper
layers. The effect then is not to improve the ventilation, but only to
chill the feet of persons sitting in the room. The position of the
window lends itself, therefore, to admission of fresh air, since it is
neither at the top nor at the bottom of the room, but at the level most
suitable for such admission.

_Foul-air outlet._

Very few houses have any provision for the outlet of spent air, and if
ventilation is thought of at all, the only idea usually is to provide,
in part at least, for the admission of air and to make no adequate
arrangement for its egress. Whenever a stove or fire-place is in use,
the mere burning of fuel requires the consumption of air, and in cases
where apparently no air is admitted to the room, insensible ventilation
is at work bringing into the room, through the walls and through cracks
around the doors and windows, the necessary air for combustion.

[Illustration: FIG. 17.--Ventilation by means of coal stove.]

It may be proved by the laws of physics that a coal stove burning freely
in a room causes adequate ventilation; and that only where the dampers
of the stove are closed, so that not merely is the supply of fresh air
diminished, but also the products of combustion are thrown out into the
room, is there danger from lack of ventilation. The stovepipe in this
case furnishes the necessary outlet for the impure air, and the
following suggestion has been made in order to utilize this outlet, even
when the fire is not burning freely or when the damper in the stovepipe
is closed. If the stovepipe from a stove is carried horizontally, as it
usually is, an elbow must be provided to raise the pipe to the stove
hole in the chimney. Then providing a T connection at the point marked
_A_ in Fig. 17 (after Billings), the lower part of the _T_ may be
carried to within a foot of the floor with a damper at the points _B_
and _C_. When the fire is burning freely, the damper at _C_ is closed,
and ventilation is secured through the stove, the damper at _B_ being
open. When the damper at _B_ is closed and the fire checked, then the
damper at _C_ may be opened and the impure air drawn up the chimney from
the level of the floor. This, it is said, is an effective arrangement
for drawing off the polluted air of a room.

[Illustration: FIG. 18.--Coal-stove ventilation.]

Another method is to surround the stove with a sheet-iron casing, as
shown in Fig. 18 (after Billings), the top of the casing having a pipe
leading into the chimney independently from the stovepipe. The casing
becomes warm and heats the room by radiation, just as the stove does,
but if the damper in the flue from the casing be opened partly, a strong
draft along the floor and into this casing will be developed and the
foul air thereby discharged into the chimney. It will be easily
possible, of course, to carry away all the heat from the stove in this
method, and the damper in the flue of the casing must be carefully
regulated to carry away only the desired amount of foul air.

[Illustration: FIG. 19.--Coal-stove ventilation.]

Still another method of using the heat of a stove to secure ventilation
is shown in Fig. 19 (after Billings). Here the stove is surrounded with
a sheet-iron jacket extending from the floor to about six feet above
that level. A pipe is carried from the outside air up through the floor
directly under the stove. By regulating the damper in this pipe the
supply of fresh warmed air entering the room can be regulated. Doors in
the casing must, of course, be provided for the purpose of taking care
of the fire, and of allowing air from the room near the floor to be
heated instead of the outside air.

A most objectionable method of providing an outlet for polluted air from
a room is to have a register in the ceiling with the ostensible purpose
of warming the room above. It was the writer's misfortune once to stay a
week in the country, in a room over the kitchen where this method of
heating was employed, and the odors of cabbage, onions, and codfish
which permeated the upper room, and clung there all night, still remain
as a most unpleasant memory.

_Size of openings for fresh air._

As an indication of the size of the openings needed, it has been said
that in order to provide the necessary air movement, and yet to restrict
the velocity of the moving air so that no objectionable drafts will be
experienced, at least twenty-four square inches sectional area should be
allowed as an inlet for each person, so that one square foot is required
for six persons. This is, perhaps, a theoretical requirement. Certainly,
it is more area than is likely to be obtained in actual ventilation. The
space between two windows, for instance, is about one inch by thirty
inches,--barely enough, according to this rule, for one person, and yet
that opening is sufficient to appreciably improve the quality of the air
in a room occupied by three or four persons.

Taking into account the necessary air required by lamps or gas burners,
the inlet flue should have at least ten square inches area for each
person, so that the ordinary single register should provide the
necessary amount of air for a living room. When, as happens in houses
where a studied effort is made to preserve the health of the
inhabitants, an outlet is cut into the wall and a flue carried up
through the roof, the flue should be preferably near the floor and on
the side of the room opposite the window or inlet. With such an
arrangement (see Fig. 20) the air entering rises at first, but sinks at
once because of the temperature, so that the direction of the air
currents are diagonally across the room from the ceiling to the floor,
thus renewing and changing all the air particles except those directly
over the outlet. Where the air is introduced mechanically, that is,
forced into the room, it is better to have the inlet and outlet on the
same side, so that the entering air is shot in at the top, flowing
across the room, then sinking and coming back, just below the point
where it entered.

[Illustration: FIG. 20.--Outlets into the walls.]

_Ventilation of stables._

All that has been said on the subject of ventilation in houses applies
equally well to the ventilation of stables, and a little book by
Professor King of the University of Wisconsin, entitled "Ventilation,"
deals most thoroughly with the principles and practices of ventilation,
not merely for dwellings but also for stables. Professor King proves by
his experiments that the condition of cattle is much improved and that
the milk-giving qualities are increased by a proper supply of fresh air,
and in the book referred to, he gives a number of examples of the proper
construction to provide adequate ventilation. It is most convincing to
see how unscientific is the old-fashioned underground stable, the sole
idea of which was to conserve the animal heat by crowding together the
cows and by absolutely excluding the outside air. For further details of
his work, its principles and practices, the reader is referred to the
book, which may be obtained from the author at Madison, Wisconsin.

_Cost of ventilation._

To ventilate a house is expensive, and to ventilate a barn requires not
only a certain expenditure of money but also a considerable amount of
judgment. It is evidently cheaper to heat the same air in a room over
and over than to be continually admitting cold fresh air, which will
have to be warmed. This extra cost is, however, not excessive, when the
movement of the air currents is properly controlled. The cost of warming
the air necessary for ventilation for five persons should not be, at the
rate of 1000 cubic feet of air to each person, more than ten cents a day
in zero weather, with coal at five dollars a ton. Enough coal will have
to be burned in addition to compensate for radiation, or, in other
words, it requires a certain amount of coal to keep an empty room warm
in winter without any question of ventilation, and in some badly built
houses this amount is large.

_Relation of heating to ventilation._

It does not follow because much heat is lost in this way that the
ventilation is good, since the heated air may ascend to the ceiling and
there escape without influencing the ventilation. In fact, one of the
first principles of ventilation is that as soon as regular inlets and
outlets are provided, all other openings ought to be rigidly closed.
Then and then only can the warmed pure air be admitted as desired, at
the points intended, and the full value of the heat utilized. Especially
is this control of openings important in ventilating barns. Here each
animal is a natural heater, warming the air by direct contact and by
rapidly breathing in and out large volumes of air which are thereby
changed to a temperature of over ninety degrees Fahrenheit. The air
around their bodies being warmed rises to the ceiling and spreads out to
the two sides and is there gradually cooled and at the same time mixed
with fresh air which enters at the top, so that the cow is constantly
supplied with freshened air. A flue is needed to carry the foul air up
through the roof, and fresh-air inlets in the outer walls on both sides
are required, and with these openings carefully controlled and with no
others interfering, the stable may be well ventilated, as shown in Fig.
21 (after King).

[Illustration: FIG. 21.--Cow-barn ventilation.]

In all cases where ventilation is to be practiced, the walls and ceiling
should not merely be tight in themselves, but they should be double, and
the strictest attention paid to limiting the amount of heat lost by
radiation. All the heat used ought to be concerned in ventilation, and
in that only. To secure air-tight walls and ceiling, the studding and
joists should be boarded in, both on the inside and out, and the space
between should be filled with shavings, straw, dry moss, or any similar
fibrous substance. The outside sheathing must be well laid and must be
water-tight in order that rain shall not penetrate to the inside of the
wall, and the roof must be tight so that the ceiling filling does not
get wet and rot.

The choice, therefore, so far as ventilation of either house or barn
goes, lies between a poorly built, loose-jointed structure without
artificial ventilation and with poor economy in heat, and a well-built,
air-tight structure, with ample ventilating pipes, carefully and
intelligently planned and built. The first is healthy so far as pure air
is concerned, but drafty and uncomfortable. The second is more expensive
to build, but insures lasting health and comfort. Then the choice cannot
but fall on the building which is easy to warm, healthful to live in,
and readily ventilated.




CHAPTER V

_QUANTITY OF WATER REQUIRED FOR DOMESTIC USE_


Until the last few years it has been a sad commentary on the
intelligence of the average farmer that but few attempts have been made
to supply the farmhouse with running water, adequate to the needs of
domestic use. The men of the farm long ago realized that carrying water
for stock in pails was both laborious and time-consuming, and very few
barnyards have not had running water leading into a trough to supply the
needs of cattle. In many cases this supply has been extended into the
barn, and in some cases into individual stalls, so that the farmer has
long since eliminated the necessity of hauling water for his stock.
Perhaps, because the farmer did not himself carry the water, but rather
his wife, he has until recently not concerned himself with any extension
of the water-supply into the house, and so long as the well in the yard
did not run dry, he felt that his duty had been done. To be sure,
bringing water from the well to the house in mid-winter involves much
exposure and sometimes real suffering; occasionally the farmer has been
moved on this account to have the well located in the woodshed or on
the back stoop, avoiding the long outdoor trip, but increasing the
dangers of pollution to the water. It would be interesting to make a
census of the farm water-supplies in any county for the purpose of
estimating the intelligence of the farm-owners, since one cannot but
feel that such a primitive water-supply argues, in most cases, an
undeveloped or one-sided intelligence on the part of the property owner.

_Modern tendencies._

Happily, such primitive methods of bringing water to the house are being
superseded by satisfactory installations, and one by one, each farmhouse
is being provided with running water in the kitchen sink and with a
bath-room containing all the modern conveniences. One cannot deny that
this costs money, both because of the pipe line necessary to bring the
water to the house and because of the plumbing fixtures required in the
house. Again, a water-supply in the house involves a well-heated house,
since pipes not kept warm will, in the winter, inevitably freeze,
ruining the pipe line and perhaps the ceilings and walls of the house
itself. But if the owner of a house has any money to expend in
improvements, surely no better way of adding to the comfort and health
of his family can be found. An abundant supply of water increases the
self-respect of the whole family and has been known even to change the
temper of an entire household. For another reason, also, it is a good
investment, inasmuch as the quality of the water supplied from a spring
on a hillside is, generally speaking, better than that of a well
surrounded by barnyards and privies.

It has been said that the civilization of a community is measured by
the amount of soap that it consumes, and it is almost the same thing to
say that the refinement of a household is measured by the amount of
water it uses. The poorer a family, the greater struggle it is to keep
up the appearance of cleanliness, and no surer sign of rapid progress on
a downhill road can be found than neglect of those practices which tend
toward personal neatness. As the life of the farmer, then, becomes
easier, as his condition becomes more prosperous, and as his family make
more requirements, so, inevitably, is there in the farmhouse a greater
demand for water in the kitchen, in the laundry, and in the bath-room.

_Quantity of water needed per person._

Just how much water is needed in any house is not easy to predict,
unless, at the same time, it is known, not merely the present habits of
the family, but also their capacity to respond to the refining influence
of unlimited water.

It has been shown by measuring the amount of water used in families of
different social standing in cities of New England that the amount of
water varies directly with the habits and social usages of the family.
For example, in Newton, Massachusetts, where there are a large number of
small houses with the water-supply limited to a single faucet, it was
found that the water used amounted to seven gallons per day for each
person in the house, while in houses supplied with all modern
conveniences, the consumption of water was at the rate of twenty-seven
gallons per day for each person. In Fall River, the conditions were much
the same except that the poorer houses generally had one bath-tub and
one water-closet, the amount of water used being eight and a half
gallons per head per day, while the most expensive house in the city
used twenty-six gallons per head per day. In Boston, the poorest class
apartment houses used water at the rate of seventeen gallons per head
per day, the moderate class apartment houses at the rate of thirty-two
gallons, first-class apartment houses at the rate of forty-six gallons,
and the highest class apartment houses at the rate of fifty-nine gallons
per head per day. The difference in these rates is easily understood by
considering the habits of the individuals who make up the different
classes referred to. In the poorer class of houses, the workers of the
family are gone all day, and are too tired when home to spend much time
in bathing. The children of such households are washed only
occasionally, and the external use of water is generally regarded as an
unnecessary trouble. In those families, on the other hand, where the
necessity for daily toil is not so pressing, where bathing is more
frequent, and where ablutions during the day are more often repeated,
the amount of water used is much larger.

Another factor that affects the measured amount of water used in a
family is the number of plumbing fixtures. At first sight, it would not
seem possible that because there were two wash-basins in a house, an
individual should use more water than if there were only one basin. Nor
would it seem possible that an individual would take more baths with
three bath-rooms available than if only one existed, and yet the number
of fixtures does influence the individual who washes his hands
frequently. With a wash-basin on the same floor, for instance, he washes
often, whereas if it were always necessary to go upstairs for the
purpose, his hands would go unwashed. Also, the more fixtures there
are, the greater is the amount of leakage, since every faucet will, in
the course of time, begin to leak unless the packing is continually
replaced. The amount of leakage is, therefore, in direct proportion to
the number of fixtures.

The amount of water used then, per head per day, varies from seven to
sixty gallons, but only by an intimate knowledge of the habits of the
household can one predict the amount of water likely to be used. Perhaps
as an average in a house having a kitchen sink and a bath-room
containing a wash-basin, bath-tub, and water-closet, a fair estimate of
the water used would be twenty-five gallons per head per day. This
amount must be multiplied by a maximum number of persons to be in the
house at any time, and then this number must be increased by the amount
of water used in the barn and in the yard, if these are to be supplied
from the same source as the house.

_Quantity used in stables._

The amount of water used in the barn is even more than that used in the
house, a variant depending on the habits of the manager. The minimum
quantity needed per day is determined by the number of pailfuls of water
which each head actually drinks multiplied by the number of head. But
besides this there are many other uses to which water may reasonably be
put in connection with stock.

On a dairy farm, there is the water needed to wash cans and bottles and
in some cases to furnish a running stream of cold water for the aerator.
In some stables a large amount of water is used for washing harnesses
and carriages; in others, but a small amount goes for such purposes.
Some farmers have concrete floors in cow stables and pig pens and use a
hose frequently to wash these floors clean. Other stables never see a
stream of water and only see a shovel at infrequent intervals. The
amount of water used outside the house is too uncertain a quantity to
estimate on the average, but its influence and importance must not be
overlooked.

_Maximum rate of water-use._

It should now be noted that the quantity of water already referred to is
the average quantity used through the twenty-four hours and does not
mean the rate at which the water comes from the faucet. For example,
three persons in a house use water, according to the above statement, at
the rate of seventy-five gallons per day, but a whole day has 1440
minutes, and if seventy-five gallons be divided equally among the number
of minutes, it means one gallon in every twenty minutes, or one quart in
five minutes. It is obvious that no water-supply system for a house,
designed to supply water at the average rate for the twenty-four hours
would be satisfactory, since no person would care to wait all day for
the amount. To wait five minutes to draw a quart of water would try the
patience of any one, and while the total amount of water used in the
house will be seventy-five gallons, provision must be made by which it
can be drawn in small amounts at much higher rates. Practically all of
the amount is used in the daylight hours or in twelve hours out of the
twenty-four, so that the rate would be twice the average rate, and with
this correction, two quarts of water could be drawn in five minutes.

But even this is too slow, and if one were to take a quart cup to a
kitchen faucet and note the time necessary to fill the measure with the
water running at a satisfactory rate, he would find that unless the cup
was filled in about ten seconds it would be considered too slow a flow.
Since it is possible for more than one fixture to be in use at the same
time, the pipes ought to be able to deliver the total amount running
from different faucets open at the same time, and if it is considered
possible for three faucets to run at once, as, for instance, the kitchen
faucet, bath-room faucet, and barn faucet, then the supply pipe must be
able to deliver, under our assumption, three quarts in ten seconds, or
at the rate of about six thousand gallons a day. It is necessary,
therefore, to distinguish carefully between the total quantity of water
used per day and the rate at which such water is used.

The first of these requirements governs the size of the reservoir from
which the water comes or the yield of the well or spring, or the
capacity of a pump from a pond to a distributing tank; the other
requirement governs the size of the pipe or faucet or the capacity of a
pump which supplies direct pressure. It should be noted also that with
ordinary fixtures, the rate of delivery and the corresponding sizes of
the fixtures are not affected by the number of persons in the house,
whereas the first requirement, that is, the total quantity of water used
per day, is directly affected by the number of persons.

_Variation in maximum rates of water-use._

The quantity of water used, however, is not uniform throughout the day
or the week. It is commonly known, for instance, that on Monday, or
wash-day, when the well is the only supply, a great deal more water has
to be carried on that day than on any other day in the week, and this
same increased demand for water is made when the water comes in pipes
into the house. Probably about half as much water again is used on
Monday as on other days.

Again, in the hot weather of summer, more water is used for bathing and
laundry purposes than in cold weather. But, on the other hand, there is
a great tendency in cold weather to let the water run in a slow stream
from faucets in order to prevent freezing. This has been found to just
about double the amount of water used. It is only a reasonable
safeguard, therefore, if it has been decided that the family needs are
such as to require twenty-five gallons per head per day, to provide for
double that amount in order to meet the demands of excessive daily
consumption or of the hot and cold weather extremes.

_Fire streams._

If a water-supply is to be installed for any house, the possibility of
providing mains of sufficient size for adequate fire protection should
always be considered, although it may not be found to be a necessary
expenditure. In case of a fire a large amount of water is needed for a
few hours, entirely negligible if it is computed as an average for the
year, but a controlling factor in determining the size of mains or the
amount of storage.

A good-sized fire stream delivers about 150 gallons per minute, and for
a house in flames, four streams are none too many. The rate of delivery,
therefore, for a fire should be at least 600 gallons per minute or a
rate of nearly a million gallons per day, and if it is assumed that the
fire might burn an hour before being extinguished, 36,000 gallons of
water would be used. If a spring or tank is the source of supply, the
storage should be 36,000 gallons, and the pipe line from the tank to the
hydrants must be large enough to freely deliver water at the rate of 600
gallons per minute. If the distance is not over 500 feet, a four-inch
pipe is sufficiently large; but if the distance involved (from the
reservoir or tank to the farthest hydrant) is more than about 500 feet,
four-inch pipe is not large enough. This is because the friction in a
large line of pipe is so great that the water cannot get through in the
desired quantity. A four-inch pipe, discharging 600 gallons a minute,
would need a fall of one foot in every four feet, while a six-inch pipe
would need a fall of only one in thirty. Of course, if the reservoir
from which the water comes is at such an elevation that the greater fall
is obtainable, the smaller pipe may be used. It is more than likely,
though, that the reservoir is about 3000 feet or more away, and the
entire fall available only about thirty feet or one foot in one hundred.
Then an eight-inch pipe would have to be used.

Whether fire-protection piping, therefore, is a wise investment or not,
depends largely on the cost of installation. A four-inch cast-iron pipe
laid will cost about forty cents per running foot, while an inch pipe,
large enough for everything except fires, will cost about ten cents, so
that the excess cost per foot for the sake of fire protection is thirty
cents, for a distance up to 500 feet (when the grade is 1 to 4) or $150.
If the grade is not 1 to 4, then the pipe must be six-inch, and the
excess cost is fifty cents or the cost for 500 feet will be $250. If the
distance is greater than 500 and the fall not great, so that an
eight-inch pipe has to be used, the excess cost is sixty-five cents a
foot, or $650 for a 1000-foot line.

It is sometimes possible to economize by building a large tank
containing about 36,000 gallons and using only a small pipe to fill, but
always keeping the tank full. Such a tank would contain 4800 cubic feet
or would be twenty-two feet square and ten feet deep, or it may be
twenty-five feet in diameter and ten feet deep. This tank would have to
be erected in the air, higher up than the top of the buildings, and
would require heavy supports and a great expenditure. Unless, therefore,
a convenient knoll or sidehill is available on which to build a concrete
tank, the large pipe direct from the water-supply must be provided for
fire protection. Whether it is worth while depends on the cost of
insurance and whether it is considered cheaper to pay high rates for
insurance or to spend the large sum for protection. A third choice is
also open, namely, to carry no insurance and to install no fire hydrants
and to run the inevitable risk of losing the house by fire. Perhaps the
decision is a mark of the type of man whose property is concerned.

_Rain water-supply._

It will often happen that no pond or brook is available for a
water-supply, and if water is obtained, it must come directly from the
rain. Apparently, this is quite feasible, since an ordinary house has
about 1000 square feet area on which rain water might be caught and
carried to a tank. In the eastern part of the United States, the annual
rainfall is, on the average, 3-3/4 vertical inches per month, or the
volume of water from the roof will be 310 cubic feet. This is nearly 80
gallons a day, or enough for three or four people. The rain from the
house and barns might be combined, making perhaps 5000 square feet, and
giving an ample volume of water for the needs of a dozen people.

In discussing the size of tank necessary to hold rain water for a family
supply, it must be remembered that for many weeks at a time no rain
occurs, and that a tank must be large enough to tide over these
intervals of no rainfall. In the temperate zone there is no regularity
in the monthly rates of rainfall. In the eastern part of the United
States, the months of June and September are usually the months of least
precipitation, although the general impression, perhaps, is that July
and August have less rainfall than any other months. The truth is that,
while wells and rivers are low in July and August, the actual rainfall
for those months is not below the normal, and the low flows in the
streams are caused by excessive evaporation and by the demands of
growing crops. Although June and September have usually less rainfall
than other months, in Boston the fall has been as high as 8.01 inches in
June and 11.95 inches in September. Again, in Boston, typifying the
eastern part of the United States, and taken because of the great length
of rainfall statistics available there, the two months of highest
rainfall on the average are March and August, and yet, in each month, in
some particular year, the rainfall has been the lowest for any of the
twelve months in the year.

As shown by statistics, the average rainfall in each month, taking a
period of forty years or so, is practically constant for each month, and
it is only the deviations from the average which would make trouble in a
supply tank depending upon rainfall. Fortunately, statistics also show
that while a month whose average rate of rainfall is three inches may be
as low as three tenths of an inch, it is not often that two months of
minimum rainfall come together, and in looking over the rainfall
statistics the writer finds that for any three consecutive months,
including the minimum, the amount of rainfall is generally two thirds of
the monthly average for that year; and this is stated in this way
because it gives what seems to the writer a basis for determining a fair
and reasonable capacity of a rain-water storage tank. It depends, one
will notice, on the average annual rainfall; that is, on the depth to
which the rainfall would reach in any year if none ran off. This varies
from about ten inches in the southeastern part of the United States to
one hundred inches in the extreme northwest, the average for the eastern
part of the country being about forty-five inches, so that the monthly
average is 3.75 inches.

_Computation for rain-water storage._

With this for a basis, it may be determined how large a storage tank
ought to be, assuming a family of five persons using water at the
average rate of 25 gallons per head per day or 125 gallons each day.
Doubling this amount to take care of emergencies and of the extra water
used in hot weather, let us say that 250 gallons a day must be provided,
or 7500 gallons a month. If we could be sure of starting at the
beginning of any month with the tank full and that exactly thirty days
would be the period of no rainfall, then a tank holding 7500 gallons
would be the proper size. Unfortunately, with any month, as August, in
which the rainfall may be practically zero, the preceding month may also
have been so short of rain that the consumption was equal to or even
more than the rainfall, and the month of August would start with no rain
in the tank.

But if we take a three-month period, those inequalities will be averaged
and the supply will be, so far as one can foresee, ample in amount; that
is, we shall take the supply required in three months, namely, 22,500
gallons, and subtract from it the amount of water furnished in the three
months, which is presumably two thirds of the average rainfall on the
area contributing to the tank. The normal rainfall in three months is
three times 3-3/4 inches, or 11-1/4 vertical inches, and if this falls
on a roof area of, say, 2000 square feet, the total amount of water is
1850 cubic feet or 13,875 gallons, and two thirds of this is 9250. The
tank, then, must hold the difference between the 22,500 gallons and
9250, or 13,250 gallons, whereas a month's supply would be 7500 gallons.
The actual tank, therefore, is made to hold a little less than two
months' supply. Such a tank would be ten feet deep and fourteen feet
square, a good deal larger tank, of course, than one ordinarily finds
with a rain water-supply; but the estimate of the use of water has been
high and a long period of rainfall has been assumed, so that there is
little likelihood of a house with this provision being ever without
water.

_Computation for storage reservoir on a brook._

In determining the quantity of water that may be taken from a small
stream the area of the watershed answers the same purpose as the area of
the roof which delivers water into a tank, the only difference being
that from the roof all the water is always delivered, except a small
proportion that evaporates at the beginning of a rain in summer. From
the surface of a watershed, on the contrary, a large amount, and in
some cases all of a stream, will be absorbed by the ground and by the
vegetation and will never be delivered into the stream which drains an
area. On large streams it is fair to assume that, on the average, only
one half of the rainfall on the area will reach the stream, while with
sandy soils this may be as small as 20 per cent. From December to May
inclusive, when the ground is frozen, when there is no vegetation to
absorb the water, and when evaporation is very light, practically all of
the rainfall reaches the streams. From June to August, on the other
hand, when the soil becomes rapidly parched, when vegetation is most
active, and when evaporation is high, frequently no rainfall reaches the
streams and the ground water sinks lower and lower, so that often
streams themselves dry up. It is necessary, therefore, in providing for
a definite quantity of water to be taken from a reservoir built on a
small stream, to make the reservoir large enough to furnish water from
June to September without being supplied with rain. This does not call
for a very large dam or a very large storage, and three months' supply
will usually be ample.

We have already estimated above that the quantity of water needed for
three months will be 45,000 gallons, or about 6000 cubic feet. If the
reservoir is built in a small gulley or ravine, its width may be
twenty-five feet. If the length of the reservoir or pond formed by the
dam is 240 feet, then the reservoir will furnish 6000 cubic feet for
every foot of depth, and a reservoir of that size holding one foot of
water will tide over a dry season.

Evaporation during these same three months will use up about a foot and
a half in depth over whatever area the reservoir covers, so that two
and a half feet in depth must be provided above the lowest point to
which it is desirable to draw off the water. It would be well to allow a
depth of at least ten feet in order to avoid shallow, stagnant pools,
and if this depth is provided, even more than the two-and-a-half foot
depth mentioned might be withdrawn in extremely dry seasons, though
perhaps at some reduction in the quality of the water.

_Deficiency from well supplies._

A large number of water-supplies in the country, perhaps the largest
number, at present comes from wells, either dug or drilled. It often
happens that after plumbing fixtures have been installed with a pump to
raise the water to the necessary elevated tank, the increased
consumption causes the well to run dry for a number of weeks in the
summer. The question then arises, Shall the well supply be supplemented
or shall an entirely new supply be developed?

There are two methods of supplementing a dug well supply, and it may be
of advantage to point them out. If the sand or gravel in which the water
is carried is fine, it may be that the water will not at times of low
water enter the well as fast as the pump takes it out. Such a well
always has water in it in the morning, but a short pumping exhausts the
supply. One remedy here is to provide a more easy path for the water,
and that can be done by running out pipe drains in different directions.
If there are any evidences that the underground water flows in any
direction, then the drains should preferably run out at right angles to
this direction, to intercept as much water as possible. The drains must
be laid in trenches and be surrounded with gravel, and of course the
method is inapplicable if the well is more than about fifteen feet deep,
because of the depth of trench involved.

[Illustration: FIG. 22.--How a pump works.]

Another remedy is to sink the well deeper, hoping to find a more porous
stratum or to increase the head of water in the well. In one well, the
writer remembers seeing two lengths of twenty-four-inch sewer pipe, that
is, four feet, that had been sunk in the sandy bottom of the well by
operating a posthole digger inside and standing on the top of the pipe
to furnish the necessary weight for sinking.

Still another remedy is to drive pipe down in the bottom of the well,
hoping to find artesian water which will rise into the well from some
lower stratum. This method has been successfully employed in the village
of Homer, New York, where the public supply formerly came from a dug
well twenty feet in diameter. The supply becoming deficient, pipe wells
were driven in the bottom and an excellent supply of water found fifty
feet below the surface, the water rising up in the dug well to within
eight feet of the surface of the ground.

If the well is a driven well and the water in the casing falls so low
that the ordinary suction pump will no longer draw, two remedies may be
applied. A so-called deep-well pump may be used; that is, a pump which
fits inside the piping and can be lowered down to the water level. The
ability to bring up water then depends on the power to work the pump and
on the presence of the water. Figure 22 shows the principle on which
this pump works. At some point, it may be three or four hundred feet
below the surface of the ground, a valve _A_ opening upward is set in
the well so that it is always submerged. Just above this is a second
valve fastened to the lower end of the long pump rod which reaches up to
the engine or windmill which operates the pump. At each up stroke water
is lifted by the closed valve _B_ and sucked through the open valve _A_.
At each down stroke, the water is held by the closed valve _A_ and
forced up through the open valve _B_.

[Illustration: FIG. 23.--Pump installation.]

The other method of developing a greater quantity of water from a deep
well is to use air pressure to force the water either the entire
distance to the tank or to a point where the suction of an ordinary pump
can reach it, as indicated in Fig. 23. In this method an air blower is
needed, and since this means an engine for operation, it is not
generally feasible, but is suited to occasional needs, where an engine
is already installed for other purposes and is therefore available.

The operation is very simple. An air pipe leads from a blower and
delivers compressed air at the end of the air pipe, which must be below
the level of the water in the well. The pressure of the air then causes
the water to rise, the distance depending on the pressure at which the
air is delivered.




CHAPTER VI

_SOURCES OF WATER-SUPPLY_


Having arrived at the quantity of water necessary to supply the needs of
the average household, we must next investigate the possible sources
from which this quantity can be obtained. Before the advantages of
running water in the house are understood, a well is the normal and
usual method of securing water, although in a few cases progressive
farmers have made use of spring water from the hillsides. It is rare,
indeed, for surface water, so called, to be used for purposes of
water-supply until after modern plumbing conveniences have been
installed. Then the use of surface water becomes almost a necessity
because of the large volume of water needed. The only drawback to its
use is its questionable quality. Without modern plumbing, a well meets
the requirements of family life, but does not answer the demands of
convenience. With modern plumbing, a well is found to be pumped dry long
before the domestic demands are satisfied. The result is an attempt to
secure an unfailing supply, and for this a surface supply is sought.

Let us divide, then, the possible sources of water for domestic
consumption into two groups, those found under the surface of the soil
and those found on or above the surface. In the first group will come
wells and springs, and in the second group will come brooks, streams,
and lakes.

_Underground waters._

Springs result from a bursting out of underground waters from the
confined space in which they have been stored or through which they have
been running. Thus in Fig. 24 is seen how water falling on the pervious
area _a-b_ is received into the soil and gradually finds its way
downward between impervious strata which may be clay or dense rock. At
the point _B_, where the cover layer has, for any reason, been weakened,
the pressure of the water forces its way upward and a spring is
developed at the point _C_. Or, conditions may be as shown in Fig. 25,
where the confined water, instead of being forced upward by pressure,
flows slowly out from the side of a hill, making a spring at the point
_D_, while the water enters the pervious stratum at the point _a-b_ as
before.

[Illustration: FIG. 24.--Diagram of a spring.]

[Illustration: FIG. 25.--Water finding its way from a hillside.]

[Illustration: FIG. 26.--The sinking of wells.]

If the water is held in the ground as in the first case, it is possible
to develop the spring artificially; that is, to drill through or bore
through the overlying impervious strata so as to allow the escape of the
water. When this happens, the water bursts forth exactly as in a natural
spring except that under some conditions the pressure may be sufficient
to force the water rising in a pipe instead of through the ground to
flow above the surface of the ground as a fountain or jet, making what
is known as an "artesian well." A true well, on the other hand, may be
put down in the ground and through strata where springs could never
develop; that is, where no pressure exists in such a way as to bring the
water to the surface, as in Fig. 26. The well here is sunk until it
reaches the water, and it is safe to say that one can always reach a
layer of water in the ground by a well if the well is deep enough.

The flow of underground water is, however, always very uncertain and
confusing, and even in localities where water would naturally be
expected in quantity, as, for instance, in the bottom of a valley filled
with glacial drift, much disappointment is often experienced because the
expected water is not found. The city supply of Ithaca, New York, is a
case in point. For six miles south of the lake there is a broad, almost
level valley filled many hundred feet deep with glacial drift and
presumably filled with water flowing at some unknown depth below the
surface into the lake. When the city was recovering from the typhoid
fever epidemic which, in 1903, committed such ravages, well water seemed
to the panic-stricken citizens the only safe water. Geologists were
called in, and they gravely asserted that the valley contained glacial
drift to a great depth and that an ample supply of pure water could be
counted on. It was known that water was met all through this valley at
depths of from six to twelve feet and then that there would be found a
layer of finely powdered silt to a depth of about one hundred feet, when
another layer of water would be found, and that all the private wells
reached this layer. When tested by the city, however, it was found that
this water-bearing stratum was of too fine material to yield its water
freely, and the supply from the depth was altogether inadequate. In one
section of the town large quantities of good water were found at a depth
of about three hundred feet, and the city thought that other wells of
the same depth should add to the quantity, but experiment showed that
this three hundred-foot water was limited to one particular section, and
after a considerable expenditure of money, an underground water-supply
for the city was given up.

_Ordinary dug well._

The ordinary well at a farmhouse is what is known as a shallow well or
sometimes a "dug well," usually ten to twenty feet deep. This type does
not usually pierce any impervious layer and thus reach a water-bearing
stratum, otherwise inaccessible. The water is found almost at the
surface, and the depth of the well is only that necessary to reach the
first water layer. A very good example of this kind of well is to be
found on the south shores of Long Island Sound, where a pipe can be
driven into the sand at any point, and at a depth of a few feet an
abundant and cheap supply of water may be secured. The amount of water
that such a well can furnish depends upon the area from which the water
comes and upon the size of the particles of sand or gravel through which
the water has to percolate, it being evident that the finer the
material, the more difficult for the water to penetrate.

The writer remembers superintending the digging of trenches in the
streets of a city where the texture of the soil varied continually from
clay to sand and even to gravel, all saturated with subsoil water into
which wells could have been dug. It was very striking to see how the
coarseness of the material affected the quantity of water that had to be
pumped from the trenches,--the finest sand requiring only one hand pump
at a time, while the coarse gravel required either a dozen men or a
steam pump to keep a short trench reasonably free from water. The same
conditions exist when a well is in operation, modified by the fact that
the coarse material yielding a larger supply will be most quickly
exhausted unless the area drained is very large.

A shallow well is most uncertain as to its quantity and is likely to be
of doubtful quality. There are, however, some examples of shallow well
supplies which furnish large amounts of water; as, for instance, the one
at Waltham, Massachusetts, or at Bath, New York,--the latter, a dug well
some twenty feet in diameter and about twenty-eight feet deep,
furnishing a constant supply of good water to a village of about 4000
people.

_Construction of dug wells._

The construction of shallow wells requires little comment. Ordinarily,
they are dug down to the water, or to such a depth below the level of
the water as is convenient, by the use of an ordinary boat pump to keep
down the water, and then are stoned up with a dry wall. Such a well for
a single house requires an excavation of about eight feet diameter, with
an inside dimension of about five feet.

[Illustration: FIG. 27.--Mode of sinking a well.]

If the soil at the bottom of the well is sandy, it is possible to take a
barrel or a large sewer pipe and sink it into the bottom of the well in
the water by taking out material from the inside and loading the outside
to keep it pressed down into the sand. This same plan may be used to
sink the whole body of the well wall, first supporting the lower course
of masonry on a curb, so called (see Fig. 27). This curb is usually made
of several thicknesses of two-inch plank well nailed together, the plank
breaking joints in the three or four layers used. It is a good plan to
have this shoe or curb extend outwardly beyond the walls of the well so
that some clearance may be had, otherwise the dirt may press against the
walls so hard as to hold it up and prevent its sinking. While this
arrangement may be put down in water, it requires some sort of bucket
which will dig automatically under water and has not been therefore a
customary method except for large excavations where machinery can be
installed. There is no reason, however, why the method might not be used
for a single house.

[Illustration: FIG. 28.--A well that will catch surface waste.]

In whatever way the well is dug, one point in the construction that
needs to be emphasized is that the wall should be well cemented
together, beginning about six feet below the surface and reaching up to
a point at least one foot above the surface. This is to prevent
pollution from the surface gaining direct access to the well, and if
this cementing is well done for the distance named, it is not likely
that any surface pollution in the vicinity of the well could ever damage
the water. Figure 28 shows the section of a well where no such
precautions have been taken, and it is evident that not only surface
wash, but subsurface pollution may readily contaminate the water. Figure
29 (after Imbeaux), on the other hand, shows a shallow well properly
protected by a good wall and water-tight cover. Figure 30 shows a
photograph also of this latter type of well. Even if a cesspool or privy
is located dangerously near the well, in the second case the fact that
the contaminating influence must pass downward through at least six feet
of soil before it can enter the well is a guarantee that the danger is
reduced to the smallest possible terms.

[Illustration: FIG. 29.--A well properly protected.]

_Deep wells._

Deep wells are of the same general character as shallow wells. Usually,
the ground on which the rainfall occurs is more distant, so that the
source of the water is often unknown, and usually, also, the stratum
from which the water comes is overlaid by an impervious one.

[Illustration: FIG. 30.--A properly protected well.]

It often happens that there are several layers of water or of
water-bearing strata alternating with more or less impervious strata,
and that wells might be so dug as to take water from any one of them.
Indeed, not infrequently in driving down a pipe to reach water, a fairly
satisfactory quantity is obtained at a certain level, and then, in
order to increase the supply, the pipe is driven further, shutting off
the first supply and reaching some other, less abundant.

Deep wells are reached usually by wrought-iron pipe driven into the
ground. Sometimes this is done by taking a one-and-one-quarter inch
pipe, with its lower end closed and pointed, and driving it with wooden
mauls into the ground. When it has gone six or eight feet, it is pulled
up, cleared from the earth, and replaced, to be driven six feet again.

[Illustration: FIG. 31.--Well-drilling apparatus.]

With ordinary soil, the pipe is easily withdrawn with a chain wrench,
and two men will drive one hundred feet in a couple of days. When water
is reached, a well point is put on through which water may percolate
without carrying too much soil. This type of well is suitable for use in
soft ground or sand, up to depths of about one hundred feet, and in
places where the water is not abundant. It is most useful for testing
the ground to see where water may be found and by pumping from such a
well to see what quantity of water may be expected. This type is often
used as a shallow well, and the author has seen such wells driven only a
dozen feet. Such a well has no protection against pollution, and an
ordinary dug well is better for shallow depths. A driven well always has
a disadvantage also from the ever present danger that the iron pipe will
rust through at the top of the ground water and so admit to the well the
most polluted part of the drainage.

For larger supplies and for greater depths, a machine like a pile-driver
has to be used for forcing down the pipe. This is not usually removed,
but driven down as far as possible, and when the limit of the machine
has been reached, a smaller size is slipped down inside the driven pipe,
to be in turn driven to refusal. In rock, that is, if the well has to
penetrate a layer of rock, a drill is used that will work inside of the
pipe last driven, and by alternately lifting and dropping the drill, and
at the same time twisting it back and forth, a hole through rock may be
made many hundred feet below the surface of the ground. Figure 31 shows
a cut of a common type of well-drilling machine.

In some soils, not rock, it is necessary to keep the drill going in
order to churn up or soften the earth so that the pipe may be lowered.
The churned-up soil is removed by a sand pump, which is a hollow tube
with a flap valve at the lower end opening inwards and a hook on the
upper end. By alternately drilling, pipe-driving, and pumping the wet
material, length after length of pipe can be forced into the ground
until water of a satisfactory quantity is reached. Very often a jet of
water is used to wash out the dirt from the interior of the well instead
of a sand pump. As shown by Fig. 32 water under pressure is forced down
the small pipe _A_ which runs to the bottom of the well. The large pipe
_B_ can then, as the sand is loosened by the water, be driven down by
the one thousand-pound hammer _M_. The water and sand together flow up
in the space outside the small pipe and inside the large pipe,
overflowing through the waste pipe _W_. This type of well has been very
largely used throughout New York State; on Long Island, in connection
with the Brooklyn Water-supply; along the Erie Canal, in connection with
the Barge Canal Work, and in New York City, in connection with building
foundations.

[Illustration: FIG. 32.--Sinking a well by means of a water-jet.]

Sometimes, when a shallow dug well does not furnish the required
quantity of water, the amount of water can be increased by driving pipe
wells down into water strata below the one from which the dug well takes
its supply, so that water will rise to the strata penetrated by the dug
well. This has been done to increase the public supplies at Addison and
Homer in New York State. Unfortunately, much uncertainty exists in the
matter of the yield of driven wells, and an individual undertakes a deep
well usually with great reluctance on account of the expense involved
and the uncertainty of successful results. In level ground, conditions
are not likely to vary in the same valley, so that if one well is proved
successful, the probabilities are that wells in the vicinity will be
equally so, and yet, at some places, the contrary has proved to be true.

One may estimate the cost of putting down four-inch driven wells as
approximately one dollar per foot besides the cost of the pipe, which
will be about fifty cents per foot. The cost of one-and-one-half-inch
pipe would be considerably less than fifty cents, the cost of driving
varying not so much with the size of the pipe as with the soil
conditions. The writer recently paid ninety dollars for driving two
one-and-one-half-inch wells to a depth of about one hundred feet, the
above cost including that of the pipe; the soil conditions,
however, were very favorable. In Ithaca the cost of driving
one-and-one-quarter-inch pipe is fifteen cents per lineal foot up to
about fifty feet deep with the cost of the pipe fifteen cents per foot
additional. Below fifty feet deep the cost increases, since the labor
and time required for pulling up the pipe is largely increased, and at
the same time the rate at which the pipe will drive is notably
diminished.

The question of pumping from wells will be considered in a later
chapter, together with methods of construction and operation.

_Springs._

Springs should be the most natural method of securing water-supply for a
detached house, since no expense is involved except that of piping the
water to the building. In Europe, spring water-supplies have been
greatly developed in furnishing water for large cities. Vienna, for
example, with its population of nearly two millions, obtains its
water-supply from springs in the Alps mountains, and many smaller cities
do likewise.

But in this country springs have been little used for water-supplies,
partly because of the uncertain quantity furnished and partly because of
difficulty in acquiring title to the water rights. If an individual,
however, has on his farm, or within reach, a spring furnishing a
continuous supply of water, it would seem quite absurd not to make use
of such a Heaven-sent blessing. Care must be taken always that a spring
is not contaminated by surface drainage, and for this reason, as with
shallow wells, the wall surrounding the inclosed spring should be
extended above the ground and made impervious to water for at least six
feet below the surface. In some cases it may be wise to convert an open
spring into an underground one, putting a roof over all and then
covering with earth and sod. Figure 33 shows a type suggested by the
French engineer, M. Imbeaux.

[Illustration: FIG. 33.--An inclosed spring.]

Very often a larger supply from a spring may be obtained by collecting
into one basin a number of separate and smaller springs. A swampy or
boggy piece of ground is often the result of the existence of a number
of springs, and if drains are laid to some convenient corner of the
field, and a well dug there, into which the drains will discharge, not
only will the swamp be drained, but an ample supply of water in this way
be obtained. It would, of course, not be wise to have cows pasture in
this part of the field, nor, even when the ground has been dried out,
should this field be manured or cultivated. It should rather be fenced
and left to grow up in underbrush, dedicated to the farm water-supply.

_Extensions of springs._

[Illustration: FIG. 34.--A spring extension.]

Again, if the water comes from a stratum W-W, as shown in Fig. 34, a
large additional yield can be obtained by extending the spring from the
point where it breaks out along the edge of the water-bearing stratum on
each side. This extension or gathering conduit can be made by building
rough stone walls on each side of the ditch, covering with flat stones
so as to form a pervious channel to intercept the water and lead it to
the chamber from which the supply pipe to the house leads out. The
ground-water level will then be altered as shown by the broken line in
the draining.

More simply it may be made by digging a trench along the hillside at the
same level as the spring, or into the spring if necessary to find the
water, and then laying draintile surrounded by coarse gravel or broken
stone in the trench.

In the western part of the country much knowledge has been gained by
investigating and experimenting on this kind of spring water
development, only there the springs have been made artificially by
digging down to meet the underground flow of water. For example, in the
Arkansas River Valley, California, where it was suspected that water was
flowing underground, a trench was dug transversely across the valley,
and at a depth of six feet sufficient water was found to amount to
200,000 gallons per day for each one hundred feet of trench. On the
South Platte River, near Denver, much the same thing has been done, and
in a trench eighteen feet deep, water is collected at the rate of a
million and a quarter gallons per day for each one hundred feet of
trench. Other examples of the same sort might be given.

For a single house, the spring need usually only be extended by means of
a short trench, and three-inch terra-cotta tile should be laid in the
trench and surrounded by gravel and then covered over. The spring
receiving water from these tiles should be inclosed, as will be
described in a later chapter.

_Supply from brooks._

Whenever a spring is not available and at the same time a supply of
running water by gravity is determined on for a house, recourse is
generally had to brooks which may find their way down the hillsides in
the vicinity. In many instances the water in such brooks is practically
spring water and is the overflow of actual springs. Where the brook is
not subject to contamination between the spring and the point at which
the supply is taken, the latter is as truly spring water as the former,
and if a long length of pipe is saved, there can be no objection to the
brook supply. On the other hand, it is suggestive, at least, of
misrepresentation for a summer hotel or boarding house to advertise that
their water-supply comes from springs when really it comes from an open
brook miles away from the spring which may be indeed the origin of the
brook, but with so many intervening opportunities for contamination that
the pure original source is unrecognizable.

There are two obvious drawbacks to the use of brooks: (1) that the
quality of the water is, in many cases, objectionable, and (2) that
brooks are very apt to dry up in summer on account of their limited
watersheds. The discussion on the first point will be postponed to a
later chapter, and we have now to consider the question of quantity
only.

The wisest plan before deciding on a brook supply is to measure the
volume of water which flows in the brook at the time when it is lowest,
probably about the middle of August. The actual volume of water needed
for the household is not large, although its required rate of flow may
be high and, as already pointed out, a stream which furnishes water at
the rate of one quart in five minutes is sufficient for a family of
three persons, a rate which is almost a drop-by-drop supply. Such a
stream would require a reservoir somewhere in order to supply the
faucets at the proper rate, and for a single family a small cistern or
even a barrel sunk in the ground would be sufficient for this purpose.
An objection to the utilization of so small a flow in connection with
the smaller storage is that the temperature of the water in summer is so
raised that vegetation and animal growths take place easily and freely,
so that the taste and smell of such water is most disagreeable. These
consequences can be avoided even with the low flow by increasing the
storage, since the larger quantity of water has been found to resist the
bad effects of the low flow and high temperature. Figure 35 shows a
small reservoir actually in use to supply water for a single house.

[Illustration: FIG. 35.--A reservoir for home use.]

_Storage reservoirs._

But even if the stream actually dries up for two or three months, it is
still possible to use it for water-supply, provided a suitable location
for a dam and pond can be found where storage, as described in the
preceding chapter, can be secured. For this reason as well as for the
greater benefit to the quality of the water, brooks flowing through
rough, wooded, and uninhabited country are to be preferred as a source
of water-supply to brooks flowing through flat agricultural land, and in
many cases, where their flow is largely due to springs, the brooks
themselves may compare favorably with springs in quality.

_Ponds or lakes._

Water may be properly taken from ponds or lakes whenever the danger from
pollution is negligible. No better source of supply can be imagined than
a pond in the midst of woods, far away from human habitation, presumably
furnishing an unlimited supply of pure soft water. Sometimes water from
such ponds contains large amounts of vegetable matter, the result of
decomposition of swampy or peaty material, as, for instance, from the
ponds in the Dismal Swamp of Virginia, so that the water has a yellow,
coffee-colored appearance. The appearance of such water is suspicious,
but it need not be feared unless something more pernicious than the
coloring matter is present.

As the country becomes more settled, ponds are more and more likely to
become contaminated and hence unfit for a water-supply, and this
possibility must be taken into account in planning for a water-supply.
It would be most shortsighted to carry a long line of pipe from a house
to a pond several miles away, only to have the pond made unfit for use
within a few years by the growth of the community around the pond. The
possibility of coöperation ought not to be overlooked, however. It is
quite possible that half a dozen householders might be so located with
respect to each other and to a pond that an arrangement could be made
whereby the owner of a small pond would agree to fence it around and
dedicate it to the purposes of a water-supply, doing this as his share.
The others might then well afford to pipe the water to one house after
another, including that of the owner of the pond.

Water from a pond or lake has one great advantage over water from a
brook, namely, that contaminating substances in the pond settle out, so
that pond water, especially if the pond is deep, is always of much
better quality than running water. For this same reason, water taken
from a reservoir on a stream is much better water than that in the
stream above the reservoir indicates, and pollution is much less to be
feared where the reservoir exists.

_Pressure for water-supplies._

The value of a high pressure in the water-pipes of a house has been much
overestimated. For a number of years the water-supply in the writer's
residence came from a tank in the attic, the pressure in the bath-room
being not more than ten feet, and while the water flowing through a
three fourths inch pipe was noticeably slow, it was not so slow as to
discredit the supply.

A height or head of twenty feet above the highest fixture in the house
would be better and ought to be secured whenever possible. This head is
obtained by having the source of supply higher than the highest fixture,
not merely the twenty feet mentioned, but also an additional height
necessary to offset the frictional losses caused by the running water.
The loss from this source in case of fire supply has already been
referred to, but for purely domestic supplies the loss is appreciable.
The maximum rate as already indicated is not more than 7000 gallons per
day, whereas the fire rate both for single houses and for a small hamlet
is about a million gallons a day. For the lower rate, as well as for
rates one half and twice this rate, the friction loss in vertical feet
per 100 feet run in small pipes is shown in the following table:--

TABLE X. SHOWING LOSS OF HEAD BY FRICTION, FOR DIFFERENT QUANTITIES OF
FLOW, AND IN DIFFERENT SIZES OF PIPES

========================================================================
Rate of Flow |           |           |           |         |
 in Gallons  |           |           |           |         |
  Per Day    | 1/2" Pipe | 5/8" Pipe | 3/4" Pipe | 1" Pipe | 1-1/4" Pipe
-------------+-----------+-----------+-----------+---------+-------------
   3500      |   13.95   |    4.81   |    2.35   |  0.66   |      0.25
   7000      |   47.17   |   17.30   |    7.45   |  2.04   |      0.74
  14000      |  163.09   |   57.8    |   25.00   |  6.64   |      2.41
========================================================================

The table shows how much additional elevation is needed over the 20 feet
already referred to. For example, suppose it is decided that a rate of 1
quart in 10 seconds is to be maintained from three faucets or a rate of
7000 gallons per day. Suppose that a pond 4000 feet away is found to be
50 feet above the highest faucet in the house, and it is a question what
size pipe ought to be used. By the table a 1-inch pipe loses 2.6 feet
per 100 feet or 104 feet in the 4000 feet, an impossible amount when
only 50 feet are available, although the size would be entirely proper
if the difference of level was 124 feet or anything greater. A
1-1/4-inch pipe, however, loses only 0.74 foot in 100 or 39 feet per
mile, so that the 1-1/4-inch pipe would be necessary, although that size
would answer even if the pond were a mile and a quarter away.

When water from a well is pumped to an elevated tank there is the same
necessity of providing about 20 feet difference in level between the
tank and the highest fixture, but the length of pipe involved being
small, the friction losses are not great. It should be noted even here
that too small a pipe may reduce the pressure, a 1/2-inch pipe causing a
loss of 47 feet in a 100-foot pipe line. If a tower is built by the side
of the house, the distance down to the ground, across to the house, and
up to the second floor would hardly be less than 50 feet, and this is a
loss of 23-1/2 feet, which means that the tank would have to be set
higher in the air by this amount. With a 3/4-inch pipe, it should go 3.7
feet, and with a 1-inch pipe but a foot higher than the level necessary
to make the water flow out of the faucet at the rate already specified.




CHAPTER VII

_QUALITY OF WATER_


A pure water-supply has always been regarded as desirable and its value
can hardly be overrated, from the standpoint of health, happiness, or
economy. From the earliest history, no crime has been so despicable as
that of deliberately poisoning a well from which the public supply was
obtained, and in the past no charge more quickly could stir the populace
to riot. In Strassburg in 1348 two thousand Jews were burned for this
crime charged against them; and as late as 1832 the Parisian mob,
frantic on account of the many deaths, insisted that the water-carriers
who distributed water from the Seine, shockingly polluted with sewage as
it was, had poisoned the water, and many of the carriers were murdered
on this charge.

Yet no water, as used for drinking purposes, is absolutely pure,
according to the standards of chemistry. Distilled water is the nearest
approach to pure water obtainable, and it is said by physicians that
such water is not desirable as a habitual and constant beverage. The
human body requires certain mineral salts particularly for the bones and
muscles, and while these salts are provided in a large measure by food,
a number are also furnished by drinking water. On the other hand, a
wonderful natural process is accomplished by distilled or approximately
pure water in that the water tends to dissolve, to add to itself, and to
carry away whatever excess of solids may exist in the body. For certain
kidney diseases, for example, pure water is prescribed, not merely as a
means of preventing further accretions, but for the purpose of
dissolving and removing the undesirable accumulations already existing.

Practically, considerable latitude is possible in the matter of the
purity of drinking water, and no particular harm is to be apprehended by
the constant use of either a water containing as little as ten parts per
million of total solids or of water containing as much as three hundred
parts per million of total solids. The human body, in this as in so many
other ways, is so constituted as to be able to adjust itself to varying
conditions of food, and, until an excessive amount of ingredients are
absorbed, no great harm is done. There are, however, certain definite
substances--animal, vegetable, and mineral--which, when found in water,
are decidedly objectionable, and it is not the amount of foreign matter
in a water-supply, but its character, which is of importance in a water
to be used for drinking.

_Mineral matter in water._

The mineral matter is the least objectionable as it is also the most
common, since all water is forced to partake, more or less, of the
nature of the rocks and soil over which it passes. Good waters contain
from twenty to one hundred grains per gallon of mineral salts; that is,
of various chemical substances which are able to be dissolved by water.
If the amount is much in excess of one hundred parts, the water is
noticeably "hard," and this may increase to a point where the water
cannot be used. For example, the writer once superintended the locating
and drilling of a well which passed through a bed of sodium sulphate or
gypsum, just before reaching the water, so that as the latter rose in
the well it dissolved and carried with itself a large amount of this
salt, so much that the water was useless. Water containing more than one
hundred grains per gallon of such salts as magnesium sulphate or sodium
phosphate is a mineral water rather than a good drinking water, and
while an occasional glass may do no harm or may even have desirable
medicinal effects, such a water is not fit for constant drinking.

It is worth noting that many attempts have been made to show the
relative effect of various hard waters on the health. A French
commissioner reported that apparently people in hard-water districts had
a better physique than in soft-water districts. A Vienna commissioner
also reported in favor of a moderately hard water for the same reason.
It is to-day believed by many that children ought to have lime in water;
that is, ought to drink hard water to prevent or ward off "rickets" or
softening of the bones. An English commissioner, on the other hand, has
concluded that, other things being equal, the rate of mortality is
practically uninfluenced by the softness or hardness of the
water-supply. This same commissioner has also shown that in the British
Isles the tallest and most stalwart men were found in Cumberland and in
the Scotch Highlands, where the water used is almost invariably very
soft (Thresh's "Water-supplies").

It has been asserted that certain diseases, not necessarily causing
death, are caused by hard water, as calculus, cancer, goiter, and
cretinism; but, as already pointed out in Chapter II, no satisfactory
proof has ever been established. One must conclude that within
reasonable limits there is little to choose between a hard and soft
water for drinking purposes, although a change from a soft water to a
hard, or _vice versa_, usually produces temporary derangements.

_Loss of soap._

For washing purposes the value of a soft water is more marked. When a
hard water is used, a certain amount of soap is required to neutralize
the hardness before the soap is effective, and this takes place at the
rate of about 2 ounces of soap to 100 gallons of water for each part of
calcium carbonate per gallon, or about 3 ounces of soap to 10,000
gallons for each part per million increase in hardness.

The village of Canisteo, New York, has a hard spring water, the hardness
being recorded by the State Department of Health as 162.8 parts calcium
carbonate in a million parts of water. Clifton Springs water has a
hardness of 208. Catskill, New York, which gets its water from a stream
running down from the hillside, has a hardness of 22.1 or 140.7 parts
less than Canisteo. Mr. G. C. Whipple says ("Value of Pure Water") he
has found that 1 pound of soap is needed to soften 167 gallons of water
when that water has a hardness of 20 parts per million, and that each
additional part requires 200 pounds of soap to soften a million gallons.
If Clifton Springs and Catskill should each use 100,000 gallons per day,
the additional cost of the hard water, at five cents a pound for soap,
would be 20 × 140.7 × 0.05 = $140.70, provided all the village water
were neutralized with soap. Probably not over one fiftieth part of the
water is so neutralized, so that the added cost of soap is actually
about $2.80 a day. Whipple expresses this cost as _H_/100 = _D_, where H
is the hardness in parts per million and _D_ is the cost in cents for
every 1000 gallons used for all purposes. Thus Canisteo water costs
162.8/100 = 1.6 cents per 1000 gallons used, while Catskill costs only
22.1/100 or 0.2 cent on account of soap.

This discussion is intended to suggest a comparison between a well of
hard water and a surface supply of soft water, when both are available.
It should arouse an interest in securing a soft water as well as a clear
water, and the advantages of the softer water, in so far as soap
consumption alone is concerned, are seen to be not inconsiderable.

_Vegetable pollution._

The vegetable and animal matter is organic in its origin and nature, and
their effect on water may be taken up together.

Vegetable pollution is generally the result of decayed leaves, roots,
bark, and such other vegetable tissue as would be likely to be found
where the water-supply flows through a swamp or accumulates in hollows
and depressions. This sort of water is likely to have a brownish or
yellowish brown color, to have a slightly sweetish taste, and to be
soft, that is, free from mineral solids. Usually such water can be used
for drinking purposes without serious consequences. Æsthetically, it is
objectionable because of its color, and the city of Boston has expended
many thousands dollars in building channels around swamps and in
providing artificial outlets for swamps, so that the color of the water
collected on the watershed shall not show the color induced thereby.
Water from the Dismal Swamp of Virginia is so discolored as to look like
coffee, and yet, in the vicinity, it is much prized for drinking, and
formerly great pains were taken to fill casks with this water when in
preparation for a long sea voyage.

Such matter always has a marked influence on a chemical analysis of the
water, shows large amounts of nitrogenous matter, and apparently
indicates a polluted supply; but, if the reason for this apparent
pollution lies in the presence of a swamp, no danger to health therefrom
is to be apprehended. Such water also is less subject to decay or
putrefaction, and if a water-supply for a house is to be taken from a
small pond, a gathering ground containing swamps is likely to furnish a
more satisfactory water, color alone excepted, than one free from such
swamps.

_Pollution of water by animals._

Animal pollution usually comes from the presence on the watershed of
domestic animals, that is, cows, sheep, and horses, or from manure
spread on fields draining into the brook, or from barns or barnyards
close by the water. It is the presence of this sort of pollution that
furnishes the other kind of organic matter not to be distinguished by
chemical analysis from the organic matter just referred to, but vastly
more objectionable.

Drainage from houses and barns is responsible for the same kind of
animal pollution, and while it is difficult to prove by statistics that
such pollution is always dangerous to health, it is sufficiently
repulsive from an æsthetic standpoint to be done away with whenever
possible. Such pollution applies only to surface water, such as brooks
or lakes, and the best method of detecting and evaluating this pollution
is to make a careful inspection of the watershed.

If it is proposed to use the water from a certain stream for drinking
purposes, the first step should be to examine carefully the area
draining into the stream, to detect, if possible, all opportunities for
animal wastes to find their way directly into the stream and to note
whether fields sloping rapidly to the streams are manured; to see
whether the stream flows through pasture land in which cows are kept,
and especially to note whether houses with their accompanying
outbuildings are near enough the brook so that water may at any time
wash impurities down into the stream. Whenever a brook flows through
woodland free from all animal pollution and not subject to pollution
before entering the wood, the water is probably as pure as that in any
spring or well.

On the contrary, when the water in a brook flows through a meadow used
for pasture or through gullies, the sides of which are manured, or in
the vicinity of houses and barns, the water is probably unfit for
drinking purposes. This can be realized by standing at the edge of a
barnyard and watching the rain falling first on the roof of the barn,
then in larger quantities from the eaves on to the manure pile into the
yard below, then accumulating in pools of reddish black concentrated
liquid, until the volume is sufficient to form small rills which
gradually assemble into a fair-sized stream. Similarly, the pig-pen
drainage is washed out from under or even through the building, and,
after combining with the barnyard drain, is carried into the stream near
by. The very idea of drinking such filth is nauseating in the extreme.
It is common for small slaughter-houses to be built on the side of a
stream, so that the offal, carrion, and refuse of the place may be
carried off without effort on the part of the owner, and there are a
number of such places where brooks, used as places of deposit for
slaughter-house refuse, discharge directly into the reservoirs of water
works.

But this sort of animal refuse is not the most serious pollution. The
leachings and washings from privies and cesspools, carrying, as they do,
germs of contagious diseases, are most to be dreaded, and when a privy
(with no vault underneath) is built on the side of a steep ravine and is
so located that the natural drainage of the sidehill on which it is
built cannot help but run around and through the building, then the
pollution of the stream in the gulley is not only direct and inevitable,
but of a deadly sort (see Fig. 36). Fortunately, the germs thus carried
into the stream suffer the vicissitudes of all life exposed to the
attacks of hostile forces.

At the time of freshets the streams carry mud in abundance, which mud is
continually settling out of the water as opportunity offers, and with
this settlement of mud there occurs also the settlement of the germs.
Also the pathogenic or disease-producing germs are usually weaker and
more susceptible than the putrefactive and other organisms which are
found in the water in great abundance after any rain storm, and which
tend to inhibit or destroy the pathogenic germs. But some will survive,
and, with favoring conditions, may pass through the water-pipe to the
house, causing sickness, if not death.

[Illustration: FIG. 36.--Stream draining a privy.]

Any inspection of the watershed, therefore, should look to the
elimination of the dangers above described, and to the location of barns
and barnyards, pig-pens and poultry yards, privies and cesspools, so
that no direct drainage into the stream shall be possible.

It is out of the question for any surface water-supply to be pure, since
the mere fact of the passage of water over the soil inevitably results
in the collection of organic matter; and it is no exaggeration to say
that the time will inevitably come in this country, as it has already in
Germany, when no surface supply will be considered satisfactory unless
the water is filtered. The only alternative is water gathered from areas
that are owned by the individual and on which, therefore, all dwellings
may be prohibited, all cultivated land avoided, and where the primeval
forest may be restored, making the watershed equal to that from which
forest streams emerge.

But usually, in the case of a single house, it will not be possible
entirely to eliminate the dangers of surface pollution, although an
inspection will show the dangers, and possibly some of them may be
avoided. Certainly any direct drainage into the streams should be cut
out, as well as the drainage from barnyards in the immediate vicinity of
the point where the water is taken out. Just what percentage of
pollution may be eliminated in this way it is impossible to determine,
but it is not too much to say that no brook or pond should be used for a
water-supply of a house unless _every known pollution_ of an organic
nature has been removed. Under the most favorable circumstances there
will be enough accidental contamination to make the water at times
dangerous, and no added risks ought to be assumed.

In looking over a watershed the possibility of sewage entering the
stream is, of all pollutions, the most to be avoided. To adequately
investigate the quality of a stream, the inspector must satisfy himself
as to the point of discharge of the sewer of every house on the
watershed, and this must be done personally, without apparently
reflecting on the statements of the owner of the house. If any such
points of discharge are found, the sewage should be either diverted into
some other watershed, or spread out over the ground away from the
stream, or purified by some artificial treatment before discharge, or
else the creek water cannot be used.

The next point to be noted in the source of the water-supply is the
presence and location of privies. These nuisances should be as far back
from the banks of the streams as possible to eliminate all danger since
the surface of the ground always slopes toward some stream, and
pollution may be carried for considerable distances over or through the
soil. Water-tight boxes can be provided so that no possible pollution of
the surface-wash can occur, and if periodically the contents of these
boxes be hauled away and buried, the privy loses its dangerous
character. The city of Syracuse has installed on the watershed of
Skaneateles Lake a most admirable system of collection of privy wastes,
and the lake water is thoroughly protected, although there are several
hundred privies on the watershed.

Cesspools, in general, are not dangerous if they are located fifty feet
or more from the stream and if no overflow occurs.

Barnyards ought not to drain directly into streams, but when, as in so
many cases, the stream flows through the barnyard, the only remedy is to
move either the stream or the barnyard, and it is difficult to persuade
even a well-disposed neighbor to do either. It is sometimes possible to
appeal to his sense of right; but, too often, the neighbor feels that it
is his land, his barn, his drain, even his brook, and he will do
whatever he pleases with them, whether the water further down stream is
to be used for drinking purposes or not. The question resolves itself
into an inspection of the watershed and a determination of the existing
conditions. If those are tolerable, the water may be used. If evident
contamination is present, the water must usually be given up, and some
other source of supply sought.

_Well water._

The pollution of wells, if it exists at all, is usually very pronounced,
and it is probably safe to say that, except where buildings, drains, or
cesspools have been crowded too close to wells, or where some manifest
and gross cause of pollution exists, a well water is safe to drink.

To protect properly a well from gross pollution, two precautions should
be observed. The wall of the well should be built up in water-tight
masonry, so that surface wash cannot enter the well except at a depth of
at least six feet, and second, this water-tight masonry should be
carried above the surface of the ground at least six inches and the well
then covered with a water-tight floor so that no foreign matter can drop
through the floor into the well or can be washed in by the waste water
from the pump (see Figs. 28, 29, 30). If these precautions are taken, it
is safe to say that nine tenths of the pollution occurring in isolated
wells would be stopped.

Besides the above, a well may be polluted by a stream of underground
water washing the contaminating matter through the soil. Experiments
have been made to show this very plainly. A large number of bacteria
were placed six feet below the surface just in the top of the
underground stream of water. Within a week they were found in
considerable numbers in the water of the soil one hundred feet distant,
but when the same number of bacteria were placed in the soil four feet
below the surface above the level of the ground water, none of them
found their way into the water of the soil. This experiment shows the
folly of building a cesspool in the vicinity of a well when they both go
down to the same water level, since the contents of the cesspool will be
carried into the well if the underground stream flows in the proper
direction. A shallow cesspool, however, would not be open to the same
objection.

It is always difficult to detect the direction or flow of underground
water, and various technical and delicate methods have been selected to
make this determination. A very simple test, however, is to dig a hole
at the point where pollution is suspected, carrying the hole down to
where ground water is reached, and then to throw a gallon of kerosene
oil into the hole, and if the ground-water flow is toward the well, the
presence of kerosene in the well water will make the fact known. This
would not, however, prove that the actual contamination would produce
disease, since a liquid like kerosene can find its way through the pores
of the soil to much greater distances than bacteria can be carried. But,
to be on the safe side, water from such a well should not be used.

To make sure of the quality of the water proposed for a water-supply, it
is wise to have such water examined by a chemist. The chemist will make
certain determinations of ammonia and other chemical combinations, and
will report his findings with an interpretation or explanation of the
result. What he finds is not the presence or absence of disease or
disease germs, but substances that suggest or involve the presence of
organic pollution. A test is made for the number of bacteria, and a well
of spring water which contains more than about fifty in a cubic
centimeter is a suspicious water. Surface water, on the other hand, may
contain two or three hundred without being necessarily bad, the types of
bacteria being harmless. Generally, a chemist will also determine the
presence of the colon bacillus which is found in the intestinal tract of
man or warm-blooded animals. Wherever this is found, in even such a
small quantity as one cubic centimeter of water or less, there is strong
presumption that the water has been polluted by human wastes and is
therefore not fit to drink.

_Dangers of polluted water._

Since no evidence of the danger of drinking polluted water can be so
graphically expressed as by a direct reference to epidemics caused by
the unwise use of such water, it will not be out of place to refer
briefly to some of the instances in which a direct connection has been
traced between a specific pollution of a certain water and disease or
death resulting from it.

Although, as has already been explained, an infected water causes
various kinds of intestinal disorders, particularly among children, the
most characteristic evidence of pollution occurs when the noxious
material comes directly from a typhoid fever patient, so that this same
disease can be recognized as transmitted to another individual or
family. This transmission of typhoid fever, while in some cases very
plainly due to other agencies than water, as, for example, milk,
oysters, and flies, yet, by far the largest proportion of the
transmitted cases comes through the agency of polluted drinking water,
and there are many examples both of contaminated wells and streams which
emphasize this possibility beyond all question.

Two historic investigations of epidemics which have thoroughly convinced
sanitarians that typhoid fever is a communicable disease and that water
is the vehicle for its transmission may be briefly cited.

In 1879 Dr. Thorne reported an epidemic in the town of Caterham,
England, which he had investigated, and disclosed the following facts:
The population of the village was 5800. The first case of fever appeared
on January 19. Others followed in rapid succession, until the number
reached 352, of whom in due time 21 died.

The possibility of infection was carefully looked into. The influence of
sewer air was ruled out because there were no sewers. The milk supply
was proved unobjectionable. No theory of personal or secondary infection
could account for the widespread prevalence, particularly as only one
isolated case had occurred during the preceding year, and this had been
imported.

Of the first 47 persons attacked, 45 lived in houses supplied with the
public water-supply, and the other two were during the day in houses
supplied with public water. Further, in the Caterham Asylum, with nearly
2000 patients, not a single case appeared, their water coming from
driven wells. Investigation of the water-supply showed the undoubted
cause of the epidemic. The public water-supply was derived from three
deep wells, connected by tunnels in the chalk. In one of these tunnels,
from January 5 to the end of the month, a laborer worked, who, though
unattended by a physician, was evidently suffering from mild typhoid
fever, the symptoms of the disease being carefully detailed by Dr.
Thorne. The laborer at the time of his going to work had a severe
diarrhoea, and while in the tunnel was obliged to make use of the
bucket, in which the excavated chalk was hauled to the top. He admitted
that at times the bucket, in being hauled up, would oscillate in such a
way as to spill part of its contents and thereby pollute the water of
the well below. Two weeks from this accidental pollution the epidemic
began, and there can be little doubt of the relation of this mild case
of typhoid to the epidemic which followed.

A second illustration may be cited at Butler, Pennsylvania, which
occurred in 1903. The water-supply of Butler, a borough of 16,000
people, comes from a reservoir on the creek which flows through the
phase. On account of the gross pollution of the water at the
pumping-station, a long supply pipe has been laid from the reservoir
directly to the pumps. The water also was filtered through a filter of
the mechanical type. Through some accident the filter was thrown out of
service for eleven days, between October 20 and 31, 1903, and
unfortunately, on account of the failure of the reservoir dam, the water
was at that time being taken directly from the creek at the pump well,
and had been since August 27. Only ten days after the filter was shut
down, the epidemic broke out in all parts of the town. Between November
10 and December 19 there were 1270 cases and 56 deaths. In the
subsequent investigation it developed that not only was the stream
generally polluted by the sewage at various points above the intake, but
that there had been several cases of typhoid fever on the watershed,
some on a brook that enters the creek within one hundred feet of the
filter plant. As at Caterham, the inference is patent that the
introduction of some specific infection into the drinking water was the
direct cause of the general epidemic.

The occasional outbreaks of typhoid fever which occur in single families
are not so easy to explain, particularly since the small number of
persons affected does not usually call for a widespread interest on the
part of those experienced in such epidemics. In the Twenty-seventh
Annual Report of the New York State Department of Health, the following
description of an outbreak in a small hamlet, where the cause seems to
have been the use of a pond for a wash tub by some Italian laborers,
thereby transmitting the disease germs from their clothes to the water
afterwards used in a creamery, is given. The diagram, Fig. 37, shows
that the creamery secured its water for the purpose of washing cans from
a small pond by means of a gravity pipe line. The foreman of the
creamery, who boarded at the residence marked _A_, first contracted
typhoid fever. A week later an employee at the creamery also contracted
the fever, the residence of the latter being marked _B_ on the diagram.
About six weeks later the railroad station agent, living at the point
marked _C_, contracted the fever, and two weeks later his wife was
attacked with the same disease. The residences at _B_ and _C_ are only
about three hundred feet apart, both families taking their
water-supplies from a spring between the two, but nearer _B_. During the
summer previous to this outbreak a gang of Italian laborers, engaged in
double-tracking the Central New England Railroad, were housed in box
cars standing on one track of the railroad. One of the members of the
gang was reported to have been taken ill with a fever and was at once
removed, it was supposed, to a hospital in New York. It was the practice
of the Italian laborers to bathe and wash their clothes in the upper of
the two ponds from which water is supplied to the creamery by the pipe
line. All the persons who contracted the fever were supplied with milk
from the creamery. The foreman, who was the first to contract the fever,
used water from the creamery and from the well at the house where he
boarded. The other families, as already mentioned, used water from the
spring. The conclusions, therefore, are that the creamery in some way
became infected with typhoid fever, probably through the water-supply
from the pond, and that the first two cases were due directly to this
cause; that the station agent and his wife contracted the fever because
of the infection of the spring, either from some small stream which is
the outlet of the ponds or from some infection due to the illness of the
owner of the house _B_ near by. The report concludes as follows: "The
use of water for creamery purposes from a pond exposed to such
unwarranted and unchecked pollution as is shown here, or the permitted
abuse of a water-supply for a creamery, appears little less than
criminal negligence on the part of those responsible for the management
of the creamery."

[Illustration: FIG. 37.--Contamination of a creamery from the
water-supply.]

Another report in this volume of the New York State Department of Health
illustrates very well how a spring or well may be contaminated, and is
taken from a report on an outbreak at Kerhonkson, Ulster County. The
report reads as follows: "The village of Kerhonkson is built mainly on
the side of a mountain of solid rock covered by a thin top soil of
variable depth. Owing to its rocky nature, only one or two wells exist
throughout the whole place; such a thing as a drilled well has never
been seriously considered.

"The inhabitants obtain their drinking water from a well on the property
adjacent to and above the present school building, and known as the
"Brown" well, and from a clear spring at the bottom of the hill in the
rear of the village store and known all over the region as the
Loundsbury spring.

"The school building is an old-fashioned two-story ramshackle affair
with overhanging eaves, especially designed to obstruct light and darken
the upper schoolroom. The building is in the center of a pine grove 250
× 150 feet in size, which also obstructs the light and tends to dampen
the building. At the extreme ends of this school lot are two privies for
the boys and girls, built on loose stone foundations, innocent of mortar
or cement, which allows the water in heavy storms to wash out the fecal
contents of from nearly a hundred pupils down upon the habitations
below. Were the wells existing in the village as carelessly constructed
as the Brown well and the various privy vaults which I have inspected,
the loss of life from typhoid fever would be terrible indeed.

"Obtaining the names of all the patients who had suffered from this
disease, I found that all but three were Kerhonkson public school
pupils, and all had drunk the water of the before-mentioned well on the
Brown property. Two out of these three cases were mothers of pupils who
had been stricken with the fever and who had nursed the children through
their long and exhausting illnesses and afterward had been attacked by
the disease themselves, while the third and remaining case was a
puzzler. This boy had never been a pupil of the school in question, nor
had he partaken of any of the water of the suspected well. He was a
pupil of another school entirely and lived in an adjoining village a
considerable distance away. A special visit to him, however, developed
the fact that some time before his illness he had come to the village
store in Kerhonkson to purchase goods and had drunk water from the
Loundsbury spring.

"Two years ago two cases died of typhoid fever on the property on which
the Brown well is situated. Their stools were treated with lime and
buried on the hill behind the house. Three cases of the same fever have
occurred in the same house this season. The well in question is laid up
with stone and cement and was supposed to be tight and impervious to
surface water contamination. Investigation, however, proved that there
were openings in the stone work in the side toward the privy. On
examining the privy it was found that the foundation was composed of
loose stones without cement or mortar that would readily allow the fecal
contents to be washed down toward the well, the privy being about three
feet higher than the well, the natural descent of the land being about
one foot in twenty-five, the distance between privy and well being only
about eighty feet. Another factor favoring the well contamination from
this privy is that any filth washed downward from the privy toward the
well would be stopped by the wall of the house proper and carried
directly toward the well which lies close to the southeast corner of the
house. Thus all of the conditions point to privy contamination of this
well which should be at once cemented up on the inside, thoroughly
cleansed and purified, before its use should be permitted, while all the
privies in question should be provided with vaults of brick eight inches
thick with eight-inch brick floors all laid with cement, and their
inside surfaces lined with cement at least one inch thick, to prevent
any further possible contamination."

In view of the imminent danger always possible wherever human wastes are
directly discharged into streams, whether from privies or sewers, it is
obvious that water so contaminated should never on any account be used
as drinking water. It does not follow, because a stream so contaminated
has been used for months or years without producing any evidence of
disease, that the water is safe. Unless an excessive amount of organic
matter is so transmitted, no evidence will be found that such pollution
has existed through any outbreak of disease. But if once the discharges
become affected through a person having typhoid fever, then the result
of the infection is apparent immediately. If, therefore, an inspection
of the stream above the point where it is proposed to take the
water-supply shows the existence of privies, as shown by Fig. 36, the
water should not be used for domestic supply, although a number of
individuals may have been using the water for years without bad effects.
It is a case in which prevention is much wiser than cure, and while
economy and convenience may indicate such a polluted stream to be a
desirable source of supply, a proper regard for health conditions will
rule it out absolutely.




CHAPTER VIII

_WATER-WORKS CONSTRUCTION_


Construction methods and practices which lend themselves to the
development of the water-supply for an individual house may be divided
into three parts, namely:--

     (1) Construction at the point of collection, whether this point
     be a well, spring, brook, or reservoir;

     (2) The pipe line leading from the collection point to the
     buildings;

     (3) Constructions involved in the house, other than the
     plumbing fixtures.

Taking up these different points in order, we may note at the outset
that it is possible to employ either very simple or very complicated
construction.

_Methods of collection of water._

The common method is to lay a galvanized iron pipe in a ditch as far as
a spring and there to protect the end of the pipe with a sieve or a
grating and to leave it exposed in the water with no efforts expended on
the spring itself. In a brook with waterfalls or with good slope, it is
not uncommon to project a large pipe or a wooden trough into the stream
at the top of a waterfall and so carry a certain amount of the water
into a tub or basins from which the small pipe leads to the house. On
the shores of a lake or pond the galvanized iron pipe is laid out on the
bottom of the lake with the end protected by a strainer.

In all these cases the simplest method is the best, provided the supply
of water is not needed in the winter; but such simple methods as just
described fail when frost locks up the surface flow of the stream. Then
the pipe throughout its entire length must be in a trench below the
frost line at the entrance to the spring as elsewhere. To permit this,
the spring must also be deep, or else so inclosed that the pipe leading
into the spring can be covered by earth banked up against it. Not long
ago the writer saw a pipe taking water from a small lake recently
improved by a stone wall. Instead of conveying the water-pipe down under
the wall the unwise stone mason had built the wall around the pipe and
the pipe line was frozen up through the entire winter following.

Such simple methods also fail when the supply of water is not adequate,
since, in order to secure a large quantity from a stream whose flow is
periodic and irregular, some storage must be provided, and storage
usually requires more or less elaborate construction work at the
reservoir. Another reason for more elaborate construction at a spring is
to prevent surface contamination, and it is always desirable to roof
over a spring in order to protect it from surface flows. The writer has
seen, as an example of objectionable construction, a spring in the
bottom of a ravine or gully down which, in time of rain, torrents of
water passed, although in a dry season the spring was the only sign of
water in the vicinity. It could not but happen that this torrent of
water, which carried all kinds of pollution from the road above,
practically washed through the spring, destroying its good quality. In
such a case, another channel for the gulley water ought to have been
made, or else the spring dug out and roofed over, so that the torrential
water could pass above it.

In other cases, the spring is found at the lowest point in a general
depression, so that, while no stream passes through the spring, the
spring is a catch-all for the surface drainage in the vicinity. In such
cases the water should be protected by a bank of earth around the
spring, behind which the drainage should be led off through a special
pipe line if necessary.

_Spring reservoirs._

In protecting the spring and in building up around it in order to put it
underground, concrete is the most suitable material, although a large
sewer pipe or a heavy cask or barrel will answer the purpose. It is
usually sufficient to dig out the spring to a depth of four or five
feet, and with a pump it is possible to keep the water down, so that the
concrete walls may be laid. In building these walls, it is important to
notice from which side the spring water comes, and on that side holes
should be left in the wall. These openings may properly be connected
with agricultural tile drains laid out from the spring in different
directions, serving both to drain the ground and to add volume to the
spring. It is often possible instead of pumping out water during
construction to drain a spring temporarily, in places where the ground
slopes rapidly, by carrying out a drainpipe from the lowest level; this
drain is to be later stopped up.

The size of this spring reservoir depends on the average rate of flow
of the spring and on the quantity of water used. If there is always an
overflow from the spring, that is, if it always at all times of the year
furnishes more water than is required by the house at that time of day
when the greatest demand is made, then a two-foot sewer pipe is just as
good as a concrete chamber ten feet square. But if at times the spring
is low, so that the flow during the night must be saved to compensate
for the excess consumption during the day, or if the rate at which the
water is drawn at certain hours is greater than the average rate at
which the spring flows, then storage must be allowed for in preparing
the spring to act as a reservoir.

We have already estimated that a family of ten persons might use five
hundred gallons of water a day, and the most exacting conditions would
never require the spring to hold more than one day's supply. This would
mean a chamber four feet deep and in area four by five feet. If the
average supply of the spring is less than the average consumption of the
family, then the spring must become a storage basin for the purpose of
carrying water enough over the dry season, and the capacity of the basin
must be computed from the number of days' storage required. It may not
be out of place to suggest again the possibility of increasing the yield
of the spring by laying draintile in a ditch running along the permeable
stratum. These pipes may run fifty or one hundred feet each way from the
main spring, so long as they continue to find ground water.

The walls of such a spring reservoir as here suggested for depths of six
to eight feet need not be more than nine inches thick, whether built of
brick or concrete. For greater depths the thickness should be increased
to twelve inches.

[Illustration: FIG. 38.--A protected spring-chamber.]

The roof of the spring-chamber may be of plank, but this is temporary
and undesirable. It is far better, for all spans up to ten feet, to make
the roof a flat slab of concrete six inches thick, imbedding in the
concrete in the bottom of the mass some one-half-inch iron rods, spaced
about a foot apart each way and extending well into the side walls. The
size of these rods should increase with the size of the chamber, making
them three-quarter-inch rods up to a nine-foot span, and one-inch rods
up to a twelve-foot span. There should be some way of getting into the
spring, preferably by an opening in one corner so arranged as to carry
the side walls of the opening or manhole up above the ground, where it
may be protected with an iron cover locked fast (see Fig. 38, after
Imbeaux). Besides the outlet pipe from the spring, which will naturally
pass through the side walls about halfway between top and bottom in
order to get the best water, there should be a drainpipe from the lowest
part of the inclosure, the valve of which can be reached through a valve
box coming to the surface. In the figure the drainpipe is shown by the
dotted line, and the twofold chamber is for the purpose of allowing an
examination of the spring to be made at any time.

The concrete used in this work should be of good quality, one part of
cement to five parts of gravel or to four parts of stone and two parts
of sand. A concrete bottom, although sometimes used, is not necessary.
The position of the drain, of the house pipe, and of the several
collection pipes must not be overlooked when the wall is being built,
since it is much easier to leave a hole than to dig through the concrete
afterwards.

_Stream supplies._

If the volume of a stream is more than enough for the maximum
consumption, nothing is needed but to carry the intake pipe from the
shore out under water and protect the end with a strainer. In this case,
however, the stream may freeze down to the level of the strainer and
even around the strainer, so that the supply of water in winter would be
cut off. To avoid this possibility the intake pipe ought to be in a pool
of water so deep that it never freezes, and this means sometimes
creating a pool for this very purpose. If storage is to be provided, a
reservoir must be built, and this intake pipe would naturally be placed
at least two feet below the surface of the water.

_Dams._

If the stream is not deep, or if there is not a pool of satisfactory
depth, or if the minimum flow of the stream is not adequate for the
maximum needs of the consumers, a dam across the stream becomes a
necessity. There are two or three types of dams suitable for a reservoir
on a small stream, and they may be described briefly.

A dirt dam is not generally desirable, since in most cases the dam must
also be used as a waste weir; that is, the freshets must run over the
dam. This means that unless the crest of the dam is protected with
timber or masonry the dam will be washed out; as happened, indeed, in
the terrible flood at Johnstown, Pennsylvania, several years ago. If it
is possible to carry the overflow water of the stream away in some other
channel than over the dam, then a dirt dam is not objectionable,
although always a dirt dam is best with a masonry core. A very good dam
can be made by driving three-inch tongue-and-grooved planking tight
together across a gulley and then filling in on each side so that the
slope on each face is at least two feet horizontal for every foot in
height. This last requirement means that if the dam is ten feet high,
the width of the dam at the base shall be at least forty-five feet, the
other five feet being required to give the proper thickness to the dam
at the top.

[Illustration: FIG. 39.--Concrete core in a dam.]

In the second type of dam this central timber core is replaced with a
thin wall of concrete as shown in Fig. 39, from six to twelve inches
thick, sufficing to prevent small animals burrowing through the dam and
at the same time to make the dam more nearly water-tight. Sometimes
stone masonry is used, building a light wall to serve as the true dam,
and then holding up this light wall with earth-filling on each side. If
neither plank, stone, nor concrete can be used, the central core is
made of the best earth available, a mixture of clay and sand preferably,
and special pains are taken in the building to have this mixture well
rammed and compacted.

The writer has recently heard of a dam on a small stream being made by
the continual dumping of field stone from the farm into the brook at a
certain definite place. This stone, of course, assumed a slope at each
side and settled in place from year to year as the dam grew. The mud and
silt of the stream filled up the holes between the stones, so that the
dam was finally practically water-tight. This made a cheap construction
and had the additional value of serving to use up stones from the
fields. It was necessary, since the spring floods poured over the top of
this dam, to protect the top stones, and a plank crest was put on,
merely to keep the dam from being washed away.

The third type of dam is entirely of concrete or stone masonry, concrete
to-day being preferable because more likely to be water-tight. The
problem with a concrete dam is to get a foundation such that the
impounded water will not leak out under the dam, imperiling the very
existence of it. The ideal foundation, of course, is rock, and in a
great many locations can be found in the small gulleys where the
limestone and shale peculiar to this region will answer as well as more
solid rock for dams not more than ten feet high; but with gravel banks
on the sides or with soft sandy bottom, or where the clay soil becomes
saturated with water at times, the gulley offers great difficulties for
the construction of a dam. It will be wise, under such conditions, to
carry a cut-off wall, not necessarily more than twelve inches thick,
well into the bank, that is, about ten feet on each side, and under the
dam this cut-off wall ought to go down until it reaches another stratum
of sand or clay or rock. This cut-off wall, then, surrounding the main
dam, shuts off the leakage, and the dam itself can be built without
danger of undermining. In many large dams this cut-off wall is carried
down more than a hundred feet, especially where the depth of water
behind the dam is great. For small dams, a row of plank driven down
behind a timber sill across and in the bed of the stream will often be
sufficient.

[Illustration: FIG. 40.--Section of a flood dam.]

The cross section of the main dam, in cases where flood water in the
spring runs over the dam, should be such that the bottom thickness is
about one half the height, and Fig. 40 (after Wegman) shows a suitable
cross-section of a dam ten feet high. Figure 41 (after Wegman) shows a
cross-section intended to carry the water over the dam, especially in
times of flood, without danger of erosion.

Sometimes, in a narrow gorge with rock sides, it is possible to save
masonry by building the dam in the form of an arch upstream, the
resistance to the force of the water being then furnished by the
abutment action of the rock sides, instead of by the weight of the dam,
as in ordinary construction. For a dam ten feet high, the necessary
thickness of the curved dam would probably not be more than twelve
inches, while the ordinary gravity dam would be three or four feet
thick. The workmanship on the former, however, must be of a very
superior order.

[Illustration: FIG. 41.--Section of a flood dam.]

It is never desirable to allow the water flowing over the dam to fall
directly on the ground in front, since the falling water will rapidly
carry away this soil and undermine the front of the dam. For this
reason, the lower section of the dam is made curved, as shown in Fig.
41, giving the water a horizontal direction as it leaves the dam instead
of a vertical. A plank floor is often added to carry even further from
the dam any possible erosion (Fig. 40). Where it can be done, it is a
good plan to provide a small body of still water below the dam, so that
the force of the falling water may be distributed through the water on
to the soil below.

There are other forms of dams often used. For example, brush dams,
formerly common, are made by cutting off the tops of trees and dropping
them in place and loading them with stones so as to make a mass of
interwoven branches. These branches hold together particles of earth
which are dumped in and form a dam.

Another dam that has been much used in rural communities is the
old-fashioned crib dam, where logs are piled up crib fashion, held
together at the corners by iron pins, a bottom spiked on, and the crib
then filled with stone, a succession of these cribs across the stream
forming the dam. Dirt is filled in on each side of this crib work, and,
in some cases, cross timbers are set in, and both sides of the dam
covered with tongue-and-grooved planking. But such dams are not
permanent, and their construction involves an expense nearly equal to
that of a permanent structure, and consequently they are not to be
recommended.

_Waste weirs._

When the dam is made of earth with or without a core wall and when no
opportunity exists for carrying the waste water around the dam, a waste
weir of masonry through the dam must be provided, so that freshets may
be carried off without destroying or washing out the earth work.

The size of this weir is a matter of considerable concern, since its
ability to carry off the high water is fundamental. The capacity of such
waste weirs depends on the volume of flood-water, and this, in turn,
depends on the area of the watershed. This volume cannot be predicted
with any absolute certainty, but, in general, it may be said that the
maximum run-off in the eastern part of the United States, from small
areas not exceeding twenty-five square miles, will be about one hundred
cubic feet per second per square mile, so that the freshet flow for a
watershed of twelve square miles would be twelve hundred cubic feet per
second. Ordinarily, the height of the weir is taken to be from two to
four feet and the length made sufficient to care for the volume of
discharge.

If the depth of water flowing over the weir is taken at one foot, the
length of weir in feet necessary to carry the flood flow may be computed
by multiplying the number of square miles of watershed by thirty. Then
an area of twelve square miles would need a length of waste channel of
three hundred sixty feet; in most cases, for small dams, longer than the
dam itself.

If the depth be taken at two feet, then the number of square miles of
watershed must be multiplied by ten to get the length of weir, so that a
shed of twelve square miles would mean a weir one hundred twenty feet
long.

The factor for a depth of three feet on the weir is six, making for the
same area the length of weir seventy-two feet, and for four feet depth
the factor is four. There is no more important part of the construction
of a dam than that involved by a proper design of a waste weir, since a
failure either to provide proper area or to so build as to withstand the
erosive action of the running water will inevitably wash away the dam.

When the valley is narrow and the watershed large, the waste weir will
occupy the entire width of the dam, and then it becomes necessary to
construct the dam in masonry. On the other hand, when the watershed is
small and the width of the valley great, then it is proper to make the
waste weir only a certain portion of the entire width of the dam, making
the rest of the dam either masonry or earth, as may be convenient.

_Gate house._

In connection with a reservoir and at the back of the dam at the bottom
of the bank, it is convenient to have what is called, in larger
installations, a "gate house"; that is, a masonry or wooden manhole
through which the water-pipe leading out from the reservoir passes and
in which a gate is placed to shut off the water. In larger
installations, it is usually possible to admit water at this point from
different levels of the reservoir into the water-pipe, so as always to
get the best quality of water, but for a small plant that is not
necessary. A gate or valve, however, should always be provided, and
while this may be on the bank of the pond with the intake pipe extending
twenty or thirty feet into the pond, the valve should not be omitted.
The end of the pipe extending into the pond should be placed about two
feet above the bottom of the pond, instead of resting in the mud, in
order to get a better quality of water.

_Pipe lines._

In bringing the water from the spring or pond to the house, some kind of
a pipe line must be provided. Such a pipe line is made of various
materials; hollow wooden logs, vitrified tile, cast-iron pipe,
wrought-iron pipe, and lead pipe having all been used. The last-named
pipe is now too expensive for use in any great lengths. Hollow wooden
pipes are employed occasionally, but, except in unusual localities, they
also are more expensive than other forms, and are short lived on
account of their tendency to decay. Cast-iron pipe, commonly used for
municipal water-supplies, is not made in small sizes and may be excluded
from the possibilities for an individual house. There remains only tile
and wrought-iron pipe. Under certain conditions, the use of tile pipe is
to be recommended, since it may be installed even in large sizes at a
comparatively low cost, the objection to it being that it is very
difficult to make the joints water-tight, and practically impossible
when the pressure is greater than ten feet. It is more difficult to make
joints in a pipe line of small diameter water-tight than in a pipe line
of larger diameter, because the space for the cement in the former is so
small. The writer has tried both four-inch and six-inch pipe, and while
the four-inch line can be laid with tight joints, it requires much more
careful and conscientious effort on the part of the workman than with
six-inch pipe. The joints must be thoroughly filled with cement, not
very wet, so that it can be rammed or packed with a thin stick into
every part of the joint. Merely plastering the cement over the surface
of the joint will always result in a leaking joint.

It often happens that a water-supply coming from a distance of a mile or
so runs at first nearly level, so that, except for surface pollution,
the water might be carried in an open ditch. An open ditch is, however,
far better replaced by vitrified tile, six inches in diameter, which
entirely prevents surface pollution, and which costs only about ten
cents a running foot. When the slope of the ground exceeds the natural
fall of the water, so that a pressure inside the pipe is created, iron
pipe must be used. If vitrified pipe is used, the joints must be made
with the greatest care, and every precaution taken to prevent leakage.
Figure 42 shows a section of a joint in tile pipe.

[Illustration: FIG. 42.--A joint in tile pipe.]

In using iron pipe large enough to furnish the amount of water required,
due regard must be paid to friction in the pipe. In flowing through a
pipe of small size, water loses a great deal of head by friction. This
friction between the sides of the pipe and the water, which must be duly
considered in a pipe of small size, increases very rapidly as the
velocity of the flow increases. It is always a great temptation to use a
small pipe, since the cost of the pipe increases rapidly as the diameter
increases, but it is penny wise and pound foolish to lay a line of pipe
several thousand feet long to furnish water to a house and find when
completed that the amount of water furnished by the pipe is on account
of friction only a small dribble. In a previous chapter we estimated
that the flow of water, in order to furnish three faucets at a
reasonable rate, ought to be at least two thousand gallons a day or
about one and a half gallons a minute, and the effect of a reduced size
of pipe on the head necessary to carry a definite amount of water was
shown.

The cost of cast-iron pipe should not be more than thirty cents per
running foot for four-inch pipe and fifty cents per running foot for
six-inch pipe. To this must be added the cost of about seven pounds or
ten pounds respectively of lead for each joint and the cost of all the
labor involved. The price of terra-cotta pipe is much less, as already
indicated, so that it is quite worth while to expend some additional
effort on making the tile pipe joints water-tight, if it allows the
cheaper pipe to be substituted for the more expensive iron pipe.

_Pumping._

Although the present methods of securing water for isolated farm
buildings will not corroborate the statement it is safe to say that the
proper method of obtaining a water-supply is always to make use of a
pond or stream at such an elevation that water will flow to the house by
gravity, provided this is possible. Only when the conditions are such
that a gravity supply is impossible and water from a well or stream at
some lower elevation becomes inevitable is pumping properly resorted to.

The advantage of a gravity supply is twofold. First, the daily charges
for maintenance are practically nothing, so that when once the intake
and the pipe line have been installed, there will be no additional
charges. When pumping is resorted to, on the other hand, there must be a
daily expenditure which, even if small, in the course of a year amounts
to the interest on a large sum of money. For example, suppose that the
cost for supplies for a small pumping engine was only ten cents per day,
not counting in the cost of labor. This would amount to $36.50 a year,
which at 5 per cent is the interest on $730. It would be $200 cheaper,
therefore, to borrow $500, at 5 per cent, to pay for a gravity supply
rather than to pay $30 for a pump which costs ten cents a day to run.
This same reasoning may be applied to the cost of different kinds of
pumps. One pump may cost $200 more than another, but the saving in fuel
and repairs may be sufficient to more than justify this additional cost.

Second, a gravity supply is to be preferred because of its greater
reliability. It is hardly possible to imagine any excuse for a gravity
supply failing to deliver its predetermined quantity of water regularly
day after day. A pumping plant, on the other hand, both breaks down and
wears out. Valves are continually requiring to be repacked, nuts drop
off and have to be replaced, pieces of the machinery break and require
repairs, so that with the best machinery it is almost inevitable that
for many days in the year the water-supply is interrupted by some
failure of the machinery. In planning water works for cities, an
engineer weighs and estimates the value of a continuous service, and
even if the gravity supply costs somewhat more than the pumping system,
it is in many cases adopted because the greater cost is supposed to be
compensated for by the greater reliability of the supply.

_Windmills._

Perhaps the cheapest source of power for pumping water is a windmill,
and in many cases it proves entirely serviceable. It has two drawbacks
which are self-evident. Unless the wind blows, the mill will not work,
and, unfortunately, at those times of the year when a large supply of
water is most to be desired, that is, during the hot summer months, the
wind is particularly light. It is necessary, therefore, when using wind
as a source of power, to provide large storage which will tide over the
intervals between the times of pumping. Again, the wind may blow
frequently enough, but may be so light as not to turn the large vanes
necessary to pump rapidly and easily the large amount of water needed.
Nothing less than a twelve-foot mill ought to be erected, and, to be
efficient, the wind must blow at the rate of twelve to sixteen miles an
hour.

[Illustration: FIG. 43.--Windmill and water tank.]

A windmill of the best design is made entirely of steel with small angle
irons for posts for the tower, and with the mill itself made of
galvanized iron. It requires a good foundation and must be well anchored
to the masonry piers by strong bolts set well down into the masonry. If
the mill is set directly over the well and the storage tank supported on
the tower, a very compact arrangement is accomplished and the danger
from frost is the only difficulty to be apprehended. However, the tank
is often placed in the attic, some distance from the well, to which it
is connected by suitable piping.

The location of the windmill requires careful consideration in order
that it may receive the prevailing winds in their full force and at the
same time be properly located with reference to the well. It must be
remembered that the surface of the wheel is exposed to the full fury of
a storm, and both the wheel and the tower must be strong enough to
withstand such storms. Figure 43 shows windmill and water tank in the
vicinity of Ithaca, New York.

_Hydraulic rams._

A hydraulic ram is the cheapest method of pumping water, provided that
the necessary flow with a sufficient head to do the work is available.
It requires about seven times as much water to flow through the ram and
be wasted as is pumped, so that if it is desired to pump five hundred
gallons a day, the stream must flow at the rate of about thirty-five
hundred gallons per day to lift the necessary water.

The two disadvantages of a ram are, first, that a fall of water is not
always obtainable or that the stream flow is not always sufficient, and
second, that the action of the ram is subject to interruptions on
account of the accumulation of air in summer and on account of the
formation of ice in winter. In fact, in winter it is necessary to keep
a small fire going in the house where the ram is at work in order that
this interruption may not take place. Its great advantage is that it
requires no attendance, no expense for maintenance, and practically
nothing for repairs. It operates continuously when once started, and,
except for the occasional interruption on account of air-lock, is always
on duty.

[Illustration: FIG. 44.--Installation of ram.]

Usually the water is led from above the dam or waterfall in a pipe to
the ram and flows away after passing through the ram, back into the
stream. The water pumped is generally taken from the same stream and is
a part of the water used to operate the ram. This is not necessary,
however, and double-acting rams are manufactured which will pump a
supply of water from a source entirely different from that which
operates the ram. The following table from the Rife Hydraulic Engine
Manufacturing Co. gives the dimensions and approximate costs of rams
suitable for pumping against a head not greater than about thirty feet
for each foot of fall available in the drive pipe:--

TABLE XI

======+=======================+=======+=========+===============+
      |                       |       |         |  Gallons per  |
      |     Dimensions        | Size  |     Size|    Minute     |
      |-------+-------+-------|  of   |       of|   required    |
      |       |       |       |Drive- | Delivery|  to operate   |
Number| Height| Length| Width | pipe  | -pipe   |    Engine     |
------+-------+-------+-------+-------+---------+---------------+
  10  | 2' 1" | 3'  2"| 1'  8"| 1-1/4"|   3/4"  |  2-1/2 to    6|
  15  | 2' 1" | 3'  4"| 1'  8"| 1-1/2"|   3/4"  |  6     to   12|
  20  | 2' 3" | 3'  8"| 1'  9"| 2"    | 1"      |  8     to   18|
  25  | 2' 3" | 3'  9"| 1'  9"| 2-1/2"| 1"      | 11     to   24|
  30  | 2' 7" | 3' 10"| 1' 10"| 3"    | 1-1/4"  | 15     to   35|
  40  | 3' 3" | 4'  4"| 2'  0"| 4"    | 2"      | 30     to   75|
  80  | 7' 4" | 8'  4"| 2'  8"| 8"    | 4"      |150     to  350|
 120  | 8' 9" | 8'  4"| 2'  8"| 12"   | 5"      |375     to  700|
 120  | 8' 9" | 8'  4"| 2'  8"| 2-12" | 6"      |750     to 1400|
======+=======+=======+=======+=======+=========+================+

=======+===========+========+========+=======
       |Least Feet |        |Price   |Price
       |  of Fall  |        |Single- |Double-
Number |Recommended| Weight |acting  |acting
-------+-----------+--------+--------+-------
  10   |     3     |   150  | $  50  | $  65
  15   |     3     |   175  |    55  |    70
  20   |     2     |   225  |    60  |    75
  25   |     2     |   250  |    66  |    81
  30   |     2     |   275  |    75  |    90
  40   |     2     |   600  |   150  |   170
  80   |     2     |  2200  |   525  |   575
 120   |     2     |  3000  |   750  |   850
 120   |     2     |  6000  |  1500  |  1700
=======+===========+========+========+=======

If the length of the discharge pipe is more than a hundred feet, the
effect of friction is to reduce the amount of water pumped, but rams
will operate successfully against a head of three or four hundred feet.
The writer remembers an installation in the northern part of New York
State, where two large hydraulic rams furnish the water-supply supply
for an entire village, pumping every day several hundred thousand
gallons. Figure 44 shows an installation by the Power Specialty Co. of
New York, using the fall of some rapids in a brook to pump water into a
tank in the attic of a house.

[Illustration: FIG. 45.--Means of securing fall for hydraulic ram.]

In Fig. 45 are shown two methods of securing a fall for hydraulic rams,
recommended by the Niagara Hydraulic Engine Co. The first method shows
no drain pipe, but a long drive pipe; while the second method puts the
ram in an intermediate position, with considerable lengths of each.

There are other methods of utilizing the fall of a stream, but usually
they involve a greater outlay for the construction of a dam and other
appurtenances. An old-fashioned bucket water wheel may be used, which,
though not efficient, utilizes the power of the stream. The wheel may be
belted or geared to a pump directly or may drive a dynamo, the power of
which may in turn be transmitted to the pump. The objection to such
construction usually is that during the summer the small streams which
could be made of service at slight expense run dry or nearly so, while
the expense of damming and utilizing a large stream where the
water-supply is always sufficient is too great for a single house.

_Hot-air engines._

The simplest kind of a pump worked mechanically is the Rider-Ericsson
hot-air engine (see Fig. 46), which is made to go by the expansive force
of hot air. The fuel used may be wood, coal, kerosene oil, gasolene, or
gas, the amount used being very moderate and the daily expense of
maintenance very small.

[Illustration: FIG. 46.--A hot-air engine.]

For a number of years the writer used one of these machines to pump
water from a tank in his cellar to a tank in the attic, so that running
water could be had throughout the house. With an engine and pump costing
$100, it was necessary to pump twice a week for about an hour to supply
the attic tank and to furnish the necessary water for the family. The
following table shows the dimensions, the capacity, and the fuel
consumption of the different styles of pumps made by this company:--

TABLE XII

=========+===========+===========+=========+==========+============+======
         |  Suction  |           |         |          |            |
         |    and    |           |         |          | Anthracite |
Size of  | Discharge | Capacity  | Cu. Ft. | Kerosene |  Coal Per  |
Cylinder |   Pipe    | Per Hour  | of Gas  | Per Hour |    Hour    | Price
---------+-----------+-----------+---------+----------+------------+------
 5"      |    3/4"   |  150 gal. |   12    |   1 qt.  |    4 lb.   | $ 90
 6"      |  1"       |  300 gal. |   16    |   2 qt.  |    4 lb.   |  130
 8"      |  1-1/4"   |  500 gal. |   20    |   2 qt.  |    5 lb.   |  160
10"      |  1-1/2"   | 1000 gal. |   50    |   3 qt.  |    6 lb.   |  240
=========+===========+===========+=========+==========+============+======

_Gas engines for pumping._

During the last few years, on account of the great demand for gas
engines for power boats and automobiles, the efficiency and reliability
of these engines depending upon the explosive power of the mixture of
gas and air has greatly increased. To-day, probably no better device for
furnishing a satisfactory source of power in small quantities at a
reasonable cost can be found. One engine might readily be used in
several capacities, pumping water during the day or at intervals during
the day when not needed for running feed cutters; and possibly running a
dynamo for electric lights at night. It would be easy to arrange the gas
engine so that a shift of a belt would transfer the power of the engine
from a dynamo to a pump or to other machinery. In this case the pump is
entirely distinct and separate from the engine, and while the gas engine
may be directly connected with the pump and bolted to the same bed
plate, if the engine is to be used for other purposes than pumping, an
intermediate and changeable belt is desirable.

The term "gas engine" is properly restricted to engines literally
consuming gas, either illuminating gas or natural gas; but the term is
also applied to engines using gasolene as a fuel. The same principle is
used in the construction of oil engines where kerosene oil is the fuel
instead of gasolene, and it is probable that the latter engines are
safer; that is, less subject to dangerous explosion than the former.
Whichever fuel is used, the engine may be had in sizes ranging from one
half to twenty horsepower and are very satisfactory to use. Any
ordinary, intelligent laborer with a little instruction can start and
operate them, and except for occasional interruptions they may be
depended upon to work regularly. The cost of operation with different
fuels may be estimated from the following table, which also shows the
cost when coal is used as in an ordinary steam plant, the data being
furnished by the Otto Gas Engine Works:--

TABLE XIII

=================+=================+====================+===============
                 |                 |  Fuel Consumption  |  Cost of Fuel
                 |                 |  Per Brake H.-P.   |    Per Brake
Fuel             |  Price of Fuel  |     10 Hours       | H.-P. 10 Hours
-----------------+-----------------+--------------------+---------------
Gasolene         |  10c per gal.   |     1.25 gal.      |      12.5c
-----------------+-----------------+--------------------+---------------
Illuminating gas | $1.00 per 1000  |    180 cu. ft.     |       18c
                 |     cu. ft.     |                    |
-----------------+-----------------+--------------------+---------------
Natural gas      |  25c per 1000   | 130 to 160 cu. ft. |   3.25 to 4c
                 |     cu. ft.     |                    |
-----------------+-----------------+--------------------+---------------
Producer gas,    |                 |                    |
anthracite       |                 |                    |
pea coal         |  $4.00 per ton  |      15 lb.        |       2.67c
-----------------+-----------------+--------------------+---------------
Producer gas,    |                 |                    |
charcoal         | $10.00 per ton  |      12 lb.        |       5.35c
-----------------+-----------------+--------------------+---------------
Bituminous coal, |                 |                    |
ordinary         |                 |                    |
steam engine     | $3.00 per ton   |  80 to 100 lb.     | 10.7 to 13.4c
=================+=================+====================+===============

A photograph of a small (2 H.P.) gas engine made by the Foos Gas Engine
Co. with pump complete is shown in Fig. 47. This pump will lift forty
gallons of water per minute, with a suction lift up to twenty-five feet,
to a height of about seventy-five feet above the pump. The pump gear can
be thrown out of connection with the engine, so that the latter can be
used for other purposes where power is desired.

_Steam pumps._

[Illustration: FIG. 47.--A gas engine.]

The use of a steam pump would probably not be considered for a single
house unless a small boiler was already installed for other purposes.
Not infrequently a boiler is found in connection with a dairy for the
purpose of furnishing steam and hot water for washing and sterilizing
bottles and cans. Where silage is stored in quantity, a steam boiler and
engine are often employed for the heavy work of cutting up fodder. In
both these cases it may be a simple matter to connect a small duplex
pump with the installed boiler, as is done frequently in creameries, for
the sake of pumping the necessary water-supply for the house. Whenever
extensive improvements are contemplated, it is well worth while to
consider the possibilities of one boiler operating the different kinds
of machinery referred to. In Fig. 48 is shown a small pump, made by The
Goulds Manufacturing Co., capable of lifting forty-eight gallons of
water per minute against a head of a hundred feet. The diameter of
piston is four inches and the length of stroke is six inches. It is
operated by a belt from a steam engine used for other purposes as well.

[Illustration: FIG. 48.--Pump operated by belt.]

[Illustration: FIG. 49.--Duplex pump, operated directly by steam.]

TABLE XIV

==========+==========+========+=============+=============+=========+
Diameter  | Diameter | Length |             |             | Gallons
of Steam  | of Water |   of   | Gallons per | Revolutions |    per
Cylinders | Pistons  | Stroke | Revolution  | per Minute  |  Minute
----------+----------+--------+-------------+-------------+---------+
  3       |    3/4   |    3   |    0.019    |    80       |    1.5
  3       |  1       |    3   |    0.033    |    80       |    2.6
  4-1/2   |  1       |    4   |    0.044    |    75       |    3.6
          |          |        |             |             |
  4-1/2   |  1-1/4   |    4   |    0.064    |    75       |    4.8
  5-1/4   |  1-1/4   |    5   |    0.08     |    70       |    5.6
  5-1/4   |  1-3/4   |    5   |    0.18     |    70       |   12.7
          |          |        |             |             |
  6       |  1-3/4   |    6   |    0.22     |    65       |   14.0
  6       |  2       |    6   |    0.29     |    65       |   19.0
  6       |  2-1/4   |    6   |    0.38     |    65       |   25.0
          |          |        |             |             |
  7-1/2   |  2-1/2   |    6   |    0.38     |    65       |   25.0
  6       |  2-1/2   |    6   |    0.48     |    65       |   31.0
  7-1/2   |  2-1/2   |    6   |    0.048    |    65       |   31.0
          |          |        |             |             |
  7-1/2   |  2-3/4   |    6   |    0.056    |    65       |   36.0
  9       |  2-3/4   |    6   |    0.056    |    65       |   36.0
  9       |  3-1/2   |    6   |    0.079    |    65       |   51.0
==========+==========+========+=============+=============+=========+

==========+======================================+==================
          |        Size of Pipes for             |  Approximate
          |        Short Lengths To be           | Space Occupied
          | increased as Length Increases        | Feet and Inches
          +-------+---------+---------+----------+--------+---------
Diameter  |       |         |         |          |        |
of Steam  | Steam | Exhaust | Suction | Delivery |        |
Cylinders |  Pipe |  Pipe   |  Pipe   |   Pipe   | Length | Width
----------+-------+---------+---------+----------+--------+------
  3       |   3/8 |    1/2  |  1-1/4  |   1      |  2  9  | 1  0
  3       |   3/8 |    1/2  |  1-1/4  |   1      |  2  9  | 1  1
  4-1/2   |   1/2 |    3/4  |  2      |   1-1/2  |  2 10  | 1  1
          |       |         |         |          |        |
  4-1/2   |   1/2 |    3/4  |  2      |   1-1/2  |  2 10  | 1  1
  5-1/4   |   3/4 |  1-1/4  |  1-1/2  |   1      |  3  1  | 1  4
  5-1/4   |   3/4 |  1-1/4  |  1-1/2  |   1      |  3  1  | 1  4
          |       |         |         |          |        |
  6       | 1     |  1-1/4  |  1-1/2  |   1      |  3  5  | 1  5
  6       | 1     |  1-1/4  |  1-1/2  |   1      |  3  5  | 1  5
  6       | 1     |  1-1/4  |  1-1/2  |   1      |  3  5  | 1  5
          |       |         |         |          |        |
  7-1/2   | 1-1/2 |  2      |  4      |   3      |  3  6  | 1  6
  6       | 1     |  1-1/4  |  1-1/2  |   1      |  3  5  | 1  5
  7-1/2   | 1-1/2 |  2      |  4      |   3      |  3  6  | 1  9
          |       |         |         |          |        |
  7-1/2   | 1-1/2 |  2      |  4      |   3      |  3  7  | 1  9
  9       | 1-1/2 |  2      |  4      |   3      |  3  8  | 1 11
  9       | 1-1/2 |  2      |  4      |   3      |  3  9  | 1 11
==========+=======+=========+=========+==========+========+======

[Illustration: FIG. 50.--Raising water by means of compressed air.]

Figure 49 shows a cut of a small duplex Worthington pump which operates
by steam, not requiring any intermediate engine. To show the variety of
pumps made and the way in which the proportions vary with the capacity
of the pumps, the preceding table is given of pumps of small capacity
designed to work with low steam pressure.

_Air lifts for water._

Compressed air is also a source of power for raising water from a deep
well; but it is neither economical in first cost of apparatus nor in
operation. The principle is shown by the diagram of Fig. 23, and
explains without words how air pressure may be carried down into the
well through one pipe and thereby force the water of the well up into
another pipe far above its natural level. The machinery needed involves
an engine or motor and an air compressor, the latter taking the place of
the ordinary pump. It has the single advantage that it avoids the
maintenance of valves and similar deep-well machinery at a great
distance below the ground, the air pump not requiring any mechanism in
the well.

In Fig. 50 is shown a plant installed by the Knowles Pump Co. for a
hotel where the air compressor furnished compressed air to raise the
water from the deep well into a tank, whence a steam pump lifts the
water to a reservoir, not shown.

[Illustration: FIG. 51.--Wooden tank.]

_Water tanks._

The standard form of wooden tank in which water may be stored and from
which it may be delivered to the house fixtures is pictured in Fig. 51.
Figure 52 shows a galvanized iron tank for the same purpose. The tables
appended, taken from catalogues of firms building such tanks, show the
dimensions, weights, and costs of the two kinds of tanks.

TABLE XV. DIMENSIONS AND LIST PRICES OF WATER TANKS.

WOODEN STAVE TANKS

======+=======+=========+=====+======+=============+=============+=============
      |       |         |     |      |   1-1/2 In. |    2-In.    |    2-In.
Length|       |         |     |Price |    Cypress  |   Cypress   |    Pine
  Of  | Dia.  |         |  No.|Galv. +------+------+------+------+------+------
Stave,|Bottom,|Capacity,|of   |Hoops,|Weight|      |Weight|      |Weight|
  Feet| Feet  | Gallons |Hoops|Extra | Lb.  | Price| Lb.  | Price| Lb.  | Price
------+-------+---------+-----+------+------+------+------+------+------+------
 2    |  3    |   66    |  2  |$ .30 | 105  |$ 9.30| 127  |$12.00| 110  |$10.50
 3    |  3    |  108    |  3  |  .40 | 146  | 12.00| 182  | 15.00| 157  | 13.20
 2    |  4    |  125    |  2  |  .35 | 150  | 14.30| 186  | 17.50| 160  | 15.50
 4    |  4    |  283    |  4  |  .65 | 260  | 21.00| 321  | 26.00| 277  | 23.00
 2    |  5    |  207    |  2  |  .45 | 190  | 19.80| 240  | 24.00| 207  | 21.00
 2-1/2|  5    |  272    |  3  |  .65 | 247  | 21.30| 305  | 26.00| 263  | 23.50
 3    |  5    |  337    |  3  |  .65 | 267  | 22.80| 332  | 28.00| 287  | 25.00
 4    |  5    |  467    |  4  |  .85 | 342  | 25.80| 425  | 32.50| 367  | 28.50
 5    |  5    |  597    |  4  | 1.00 | 409  | 28.90| 508  | 37.00| 438  | 32.00
 2    |  5-1/2|  252    |  2  |  .50 | 233  | 22.50| 317  | 27.50| 251  | 24.00
 2-1/2|  5-1/2|  312    |  3  |  .75 | 275  | 24.00| 341  | 31.70| 294  | 28.00
 2    |  6    |  304    |  2  |  .50 | 265  | 23.50| 331  | 28.00| 284  | 25.00
 2-1/2|  6    |  400    |  3  |  .75 | 310  | 26.30| 387  | 31.00| 334  | 28.00
 4    |  6    |  688    |  4  | 1.25 | 443  | 31.80| 546  | 41.00| 473  | 35.00
 5    |  6    |  880    |  4  | 1.40 | 520  | 36.90| 645  | 48.00| 557  | 41.00
 6    |  6    | 1072    |  5  | 1.60 | 600  | 42.00| 744  | 55.00| 642  | 47.00
 2-1/2|  7    |  550    |  3  |  .85 | 381  | 29.00| 475  | 38.00| 409  | 32.00
 5    |  7    | 1210    |  4  | 1.60 | 630  | 45.00| 780  | 58.00| 675  | 50.00
 6    |  7    | 1474    |  5  | 2.00 | 738  | 51.50| 910  | 66.00| 789  | 56.50
 7    |  7    | 1738    |  6  | 2.35 | 829  | 58.00|1028  | 74.00| 889  | 63.00
 2    |  8    |  551    |  2  |  .80 | 408  | 31.00| 506  | 40.00| 436  | 35.00
 2-1/2|  8    |  725    |  3  | 1.20 | 472  | 35.00| 587  | 45.00| 507  | 39.00
 6    |  8    | 1943    |  5  | 2.60 | 880  | 61.00|1083  | 78.00| 938  | 68.00
 8    |  8    | 2639    |  7  | 3.50 |1113  | 76.00|1363  | 97.00|1193  | 84.00
 9    |  9    | 3825    |  8  | 5.20 |      |      |1770  |124.40|1539  |108.00
 6    | 10    | 3093    |  5  | 4.30 |      |      |1458  |107.00|1266  | 91.00
 8    | 10    | 4200    |  7  | 6.20 |      |      |1867  |131.00|1630  |113.00
10    | 10    | 5308    |  9  | 8.10 |      |      |2277  |155.00|1994  |135.00
12    | 10    | 6516    | 11  |10.00 |      |      |2653  |179.00|2323  |157.00
 6    | 12    | 4494    |  5  | 6.30 |      |      |1930  |138.00|1685  |120.00
10    | 12    | 7714    |  9  |11.35 |      |      |2910  |200.00|2555  |174.00
12    | 12    | 9324    | 11  |14.00 |      |      |3393  |231.00|2984  |201.00
======+=======+=========+=====+======+======+======+======+======+======+======

GALVANIZED IRON TANKS

=====+========+==========+==========+========+========
     | Height | Diameter | Capacity | Weight |
No.  |   Ft.  |    Ft.   |    Bbl.  |   Lb.  |   Price
-----+--------+----------+----------+--------+--------
150  |    5   |     8    |     60   |   475  | $ 47.50
151  |    6   |     6    |     41   |   340  |   35.00
152  |    6   |     8    |     72   |   530  |   52.50
153  |    8   |     6    |     54   |   430  |   43.00
154  |    8   |     8    |     96   |   640  |   65.00
155  |    8   |    10    |    150   |   875  |   85.00
156  |   10   |     8    |    120   |   750  |   73.00
157  |   10   |    10    |    180   |   970  |   95.00
158  |   10   |    12    |    270   |  1400  |  128.00
159  |   12   |    12    |    324   |  1600  |  150.00
=====+========+==========+==========+========+========

There are many combinations and forms of these structures, and a
detailed description of their characteristic construction and cost would
occupy too much space for this present work. By referring to the pages
of any agricultural, architectural, or engineering magazine,
advertisements may be found of firms who build such towers and who may
be depended upon for satisfactory work.

[Illustration: FIG. 52.--Iron tank.]

If the tank is to be placed inside a building, it may be built of steel
or of wood, although a lining of lead, copper, or galvanized iron is of
advantage in the latter case. If the tank is out of doors, protection
against frost must be carefully attended to, both to prevent an ice cap
forming in the tank--the cause of many failures of tanks--and to
prevent standing water in the connecting pipes being frozen. If the tank
is to be placed inside the building, care must be taken to have it
water-tight and to have the supports of the tank ample for the excessive
weight which will be thereby imposed. Wooden tanks are likely to rot,
and if left standing empty, become leaky. They are, therefore, less
worth while than iron tanks.

[Illustration: FIG. 53.--Hand pump applied to air-tank.]

_Pressure tanks._

A simple and very satisfactory method of storing water, and at the same
time making provision for pumping water, is to place in the cellar or in
a special excavation outside the cellar a pressure tank similar in shape
to an ordinary horizontal boiler. The water in this tank is forced up
into the house through the agency of compressed air, pumped in above
the water, either by hand or by machinery, and in some cases
automatically regulated so that the air pressure in the tank remains
constant, no matter whether the tank contains much or little water. The
village supply of Babylon, Long Island, is on this principle, the tanks
there being eight feet in diameter and one hundred feet long,--much
larger, of course, than is needed for a single house.

[Illustration: FIG. 54.--Engine applied to air-tank.]

The accompanying diagram and figures show the method of installing this
system, which is known generally as the Kewanee system, although a
number of other firms than the Kewanee Water Supply Co. are prepared to
furnish the outfit necessary.

[Illustration: FIG. 55.--Windmill connection with tank.]

How the air-tank may be used in connection with a hand force pump is
shown in Fig. 53. The water is pumped from a well into the tank, usually
in the cellar, whence it flows by the pressure in the tank to all parts
of the house. Figure 54 shows the tank with a gas engine and a power
pump substituted for the hand pump. Figure 55 shows the using of a
windmill in connection with the tank and also shows the relation of the
tank to the fixtures in the rest of the house.




CHAPTER IX

_PLUMBING_


A generous supply of water for a house brings with it desires for the
conveniences necessary to its enjoyment. As soon as running water is
established in a house, the kitchen sink fails conspicuously to fulfill
all requirements, and a wash-tub seems a sorry substitute for a modern
bath-room. A single pipe supplying cold water only, no matter how pure
the water or how satisfactory in the summer, does not afford the
constant convenience which an unlimited supply of both cold and hot
water offers, and the introduction of running water is usually followed
by an addition to the kitchen stove whereby running hot water may be
obtained as well as running cold water. The next step is the equipment
of a bath-room, affording suitable bathing facilities and doing away
with the out-of-door privy.

_Installation of the plumbing._

These things are reckoned as luxuries, not among the necessities of
life, and it must be understood at the outset that such conveniences
cost money, both for original installation and for maintenance; the
water-back in the stove will become filled up with lime if the water is
hard, the boiler will become corroded and have to be replaced, the
plumbing fixtures will certainly get out of repair and need attention,
and there will be, year by year, a small but continuous outlay.

Again, it is idle to propose installing plumbing fixtures unless the
house is properly heated in winter time, and this calls for a furnace
for at least a portion of the house. Usually the kitchen is kept warm
enough through the winter nights, so that running water may be put in
the kitchen without danger from frost; although the writer knows of a
house where it is the task of the housewife each winter night to shut
off all water in the cellar and to clean out the trap in the sink drain
in order to prevent freezing in both the supply pipe and drainpipe.
Usually a water-pipe may be carried through the cellar without danger of
freezing, but in most farmhouses heated by stoves, except in the kitchen
and sitting room, water-pipes would, the first cold night, probably
freeze and burst.

Various makeshifts have been employed to secure the convenience of a
bath-room without adding to the expense by installing a furnace. In one
house the bath-room was placed in an alcove off from the kitchen, with
open space above the dividing partition, so that the kitchen heat kept
the bath-room warm. This is not an ideal location for a bath-room, but,
in this case, it avoided the necessity for an additional stove or
furnace. In another house the bath-room was placed above the kitchen,
with a large register in the floor of the former, so that the kitchen
heat kept the room warm; and in still another case the bath-room was
over the sitting room, and a large pipe carried the heat from the stove
below into the room above. The stovepipe also went through the bath-room
and helped to provide warmth. It is better, all things considered, to
defer the installation of a bath-room until a furnace can be provided,
since then there is no danger of frozen water-pipes at intermediate
points where the cold reaches the pipes. A full list of fixtures and
piping required is as follows:--

1st. A tank in the attic to store water in case the main pipe-flow or
pump-capacity is small. This tank, of course, is not needed if the
direct supply from the source is at all times adequate for the full
demand.

2d. A main supply pipe from the outside source or from the attic tank
connecting with and supplying the kitchen sink, the hot-water boiler
through the kitchen stove, the laundry tubs, the bath-tub, the
wash-basin, and the water-closet tank. It is wise, in order to save
expense, to have all these fixtures as close together as possible; as,
for instance, the laundry tub in the basement directly under the kitchen
sink and the bath-room fixtures directly over the kitchen sink.

3d. A hot-water pipe leading out of the hot-water boiler to the kitchen
sink, to the laundry tubs, and to the bath-tub. Although not essential,
it is desirable to carry the hot-water pipe back to the bottom of the
hot-water boiler, so that the circulation of hot water is maintained.
This will avoid the necessity of wasting water and waiting until the
water runs hot from the hot-water faucet whenever hot water is desired.

4th. The necessary fixtures, such as faucets, sinks, tubs, wash-basins,
kitchen boiler, water-back for the stove, water-closet, tank, and
fixtures. These may be now taken up in order and described more in
detail.

_Supply tank._

The attic tank may be of wood or iron, and its capacity should be equal
to the daily consumption of water. Its purpose, as already indicated, is
to equalize the varying rates of consumption from hour to hour and
between day and night. The minimum size of this tank would be such that
the flow during the night would just fill the tank with an amount of
water just sufficient for the day's needs. Of course, the additional
supply entering the tank during the day would reduce the size somewhat,
but the basis for computation given is not unreasonable.

Several accessories must be provided for such a tank. An overflow is
essential, and this is best accomplished by carrying a _pipe out through
a hole in the roof_. This must be ample in size, provided with a screen
at the inside end, and be examined frequently to make sure that the
overflow remains open. A light flap valve to keep out the cold in winter
is also a desirable feature for the overflow pipe. The tank must be
water-tight, and while it is possible to make a wooden tank water-tight,
it is wiser to line a wooden tank with lead or sheet iron. The latter
can be painted at intervals, so that it will not rust, and is safer than
wood alone to prevent leakage.

Care must be taken to give sufficient strength to the wooden tank; it
should never be made of less than two-inch stuff, and should not depend
upon nails or screws alone for holding the sides together. Figure 56
shows a suitable way to put together such a tank. Certain firms that
make windmills and agricultural implements generally can furnish
wrought-iron tanks, warranted to be water-tight, of suitable size to go
in an attic. Such a tank, as we have already said, should hold about
five hundred gallons and should therefore be a cube four feet on a side
or its equivalent. It needs to be very carefully placed in the house, or
else its weight will cause the attic floor to sag. A tank of the size
named will weigh a little more than two tons, and such a weight, unless
special precautions are taken, cannot be placed in the middle of an
attic floor without causing serious settlement, if not actual breaking
through, of the floor.

[Illustration: FIG. 56.--Construction of a wooden tank.]

A good way of placing such a tank is to nail the floor joists onto the
bottom of the rafters, so that a truss is formed, and the box or tank is
properly supported on the floor and also hung from the rafters by iron
straps bolted both to tank and rafters. If possible, this tank should be
placed directly over a partition carried through to the cellar, in which
case no settlement is possible.

_Main supply pipe._

The main supply pipe, except when pressure is very great, is most
satisfactory when made of three-quarter-inch galvanized iron pipe. Even
with a high pressure, half-inch pipe is unsatisfactory because of the
great velocity with which the water comes from the faucets and because
the high pressure causes the packing in the faucets to wear out rapidly.
This three-quarter-inch pipe should have a stop-and-waste, as it is
called, just inside the cellar wall, so that if the house is not
occupied at any time, the valve may be shut and the water in the pipes
drawn off, to prevent possible freezing. The pipe should never be
carried directly in front of a window or along the sill of the building
unless protected by some kind of wrapping. The laterals and the
different fixtures are taken off from this main supply pipe as it rises
through the house, and the pipe is capped at the top.

_Hot-water circulation._

To provide hot water, a branch must be taken off at the level of the
kitchen stove and run into the hot-water boiler at or near the bottom.
The circulation in the tank and through the house is then provided for
by a separate circuit running from the bottom of the hot-water tank to
the water-back and back into the tank at a point about halfway up. The
house circuit is then run from the top of the boiler around through the
house, and if a return pipe is provided, it comes back and enters at the
bottom. This hot-water pipe is also of galvanized iron and should be of
the same size as the main supply pipe (see Fig. 57).

[Illustration: FIG. 57.--Hot-water attachment to the kitchen stove.]

The fixtures may be as elaborate as the purse and taste will allow, but
some general instruction may not be out of place. There are many types
of faucets, all good, and differing from each other only in some minor
detail of construction. Experience with the so-called self-closing
faucets or bibbs has not been entirely satisfactory, since, with high
pressure, the packing very quickly wears out. Similarly, experience with
those faucets that open and shut by a single turn of a handle shows that
frequent renewals of packing are necessary. The simplest, most reliable,
and the easiest faucets to repair are those in which the valve is
screwed down onto the valve seat, which is a plane, and where the
water-tightness is made by the insertion of a rubber or leather washer
that can always be cut out with a knife from a piece of old belting or
harness. The faucets may be nickeled or left plain brass, and the
advantage of the added expense of nickel is in the appearance alone. If
the faucets themselves are nickel, then the piping also should be
nickel; that is, brass nickel-plated. Galvanized iron piping and brass
faucets do not, to be sure, have the same satisfactory appearance as
highly finished nickeled faucets, but the one is quite as serviceable as
the other.

_Kitchen sinks._

In providing a sink for the kitchen, choice lies between plain iron and
enameled iron. For special work, sinks have been made of galvanized
iron, of copper, slate, soapstone, and of real porcelain. There is
hardly any limit to the cost of a porcelain sink, and while an enameled
iron sink with fittings costs from $30 to $60, a cast-iron sink of the
same size will cost only $3 or $4. A good quality of white enameled iron
sink, of size suitable for a kitchen, with white enameled back and a
drainboard on the side, costing $30, is very attractive as an ornament,
but it serves no more useful purpose than a $3 sink and a fifty-cent
drainboard. Figure 58 shows an enameled iron sink, containing sink,
drainboard, and back all in one piece. This is pure white, and when
fitted with nickel faucets makes a very attractive fitting.

_Laundry tubs._

If running water is to be put in a house, stationary tubs for the
laundry, into which water runs by a faucet and which can be emptied by
pulling a plug, are certainly worth their cost over movable wooden tubs
in the labor saved. Stationary tubs may be made of wood, of enameled
iron, or of slate.

[Illustration: FIG. 58.--Enameled iron sink.]

Wooden tubs are not as desirable as the others because in the course of
time they absorb a certain amount of organic matter and have a
persistent odor. They are, however, very inexpensive, a man of ordinary
ability being able to build them himself at the cost of the wood only.
Enameled iron tubs of ordinary size cost, with the fixtures, from $20 to
$40 apiece, and a set of three slate tubs costs $25. To these figures
must be added the expense of the piping to bring both hot and cold water
to the tubs, together with the two faucets and the drainpipe
connections necessary. Figure 59 shows three white enameled iron laundry
tubs costing about $75 installed.

_Hot-water boiler._

The kitchen boiler is to-day almost always made of galvanized iron and
is placed on its own stand, usually back of the kitchen stove, although
it may stand in an adjoining room,--the bath-room, for instance,--and
aid in keeping that room warm. Such a tank costs about $12, to which
must be added the necessary piping, and it is always desirable to put a
stop-cock on the cold-water supply entering the tank. Then if the tank
bursts, the cold water may be shut off without doing harm.

[Illustration: FIG. 59.--Enameled laundry tubs.]

A drainpipe from the bottom of the tank is also desirable to draw off
the accumulations of sediment.

_Water-back, wash-basin, bath-tub._

The water-back is merely a hollow box made to fit the front of the fire
box in the stove, usually shaped so as to replace the front fire brick.
The cold water comes in at the bottom of the box, is heated by contact
with the fire, and the hot water goes out through the other pipe into
the boiler.

The wash-basin in the bath-room is either marble, enameled iron, or
porcelain. The marble basins with a slab can be had for about $7.50,
while the enameled iron basins cost from $6 to $40. To this must be
added the cost of faucets and piping, together with the drain and the
trap that belongs with the drain. The enameled iron basins which are
being used to-day more than ever before have proved very satisfactory,
have but little weight, can be fastened to the wall without difficulty,
and take up less room than the old marble basin. A fancy porcelain basin
costs about $75, and is no better for practical use than either of the
others.

Much the same kind of material may be used for bath-tubs, although
warning ought to be given to avoid the use of the old-fashioned
tin-lined bath-tub. This lining will easily rust or corrode, is very
difficult to keep clean, and while the first cost is less than the
enameled iron tub, it has no other advantage. An enameled iron tub five
and a half feet long will cost from $20 to $100 without fixtures.

_Cost of plumbing installation._

A fair estimate of the cost of the plumbing in a house, including all
the fixtures mentioned except the tank in the attic, including also the
plumber's bill, is $150. This requires very careful buying, and implies
an entire absence of brass or nickel-plated piping. If a high grade of
fixtures, including nickel fittings and nickel piping, wherever it
shows, is used, the cost of the fixtures alone, not including labor or
piping other than mentioned, will be from $150 up.

_House drainage._

The term "plumbing" is generally used to include both the water-supply
in the house, with all the fixtures pertaining thereto, and the carrying
of the waste water to a point outside the house; it remains, therefore,
to discuss the waste pipes connected with the plumbing fixtures.

[Illustration: FIG. 60.--Leveling the drain.]

The house-drain, or the pipe which carries the wastes from the house to
the point of final disposal, is generally made of vitrified tile, and in
ordinary practice is five inches inside diameter. The lower end of this
drain discharges into a cesspool, or settling tank, or into a stream, as
local conditions permit. This house-drain should be carefully laid in a
straight line, both horizontally and vertically, for two reasons. In the
first place, the velocity of flow in a straight pipe will be greater,
and therefore the danger of stoppage will be decreased, and in the next
place, if a stoppage does occur in the pipe, it can be cleaned out
better if the pipe is straight than if it is laid with numerous bends.
Such a pipe should have a grade of at least one quarter inch to a foot,
and this is conveniently given by tacking a little piece of wood one
half inch thick on one end of a two-foot carpenter's level and then
setting the pipe so that with this piece of wood resting on the pipe at
one end and the end of the level itself on the pipe at its other end,
the bubble will be in the middle. Figure 60 shows the carpenter's level
in position on a level board, which rests on the hubs of three pipes.
The joints of this pipe should be made with Portland cement mixed with
an equal part of sand, and the space at the joint completely filled.
When nearing the house, it is very desirable that a manhole should be
built so that if a stoppage occurs, it may be cleaned out without taking
up the pipe. In city houses a running trap is always inserted just
outside the house with a fresh-air inlet on the house side of the trap,
as shown in Fig. 61. But for a single house this is not necessary, and
it is wiser to omit the running trap.

The soil-pipe begins at the trap or at the cellar wall and runs up
through the roof of the house, so that any gas in the drain or soil-pipe
may escape at such a height as not to be objectionable. Through the
cellar wall and up through the house the soil-pipe should be of
cast-iron, which comes in six-foot lengths for this special purpose. Y's
are provided by which the fixtures are connected to the soil-pipe, and
the top of the pipe is covered with a zinc netting to keep out leaves
and birds. This soil-pipe weighs about ten pounds per foot and is almost
always four inches inside diameter. The length necessary is easily
computed, since it runs from the outside cellar wall to the point where
the vertical line of pipe rises and from that point in the cellar
extends to the roof. Such a pipe may be estimated at two cents a pound
with something additional for the Y's.

[Illustration: FIG. 61.--Water-supply installation.]

The soil-pipe must be well supported along the cellar wall on brackets
or hung from the floor joists by short pieces of chain or band iron.
Special care must be taken to support the pipe at the elbow, where it
turns upward, since a length of thirty feet of this pipe, weighing three
hundred pounds, has to be provided for. It is a good practice to build
a brick pier from the cellar bottom up to and around the elbow to
support it firmly in the masonry.

The joints in this drainpipe should be made with lead, ramming some
oakum into the joints first and then pouring in enough lead melted to
the right degree to provide an inch depth of joint. After the lead
cools, it must be expanded or calked by driving the calking tool hard
against it.

To prevent rain finding its way between the soil-pipe and the roof, a
piece of lead is generally wrapped around the soil-pipe for a distance
of twelve inches or so above the roof, and then a flat piece of lead
extending out under the shingles is slipped over and soldered fast to
the other lead piece.

The fixtures are connected to the iron pipe usually by lead pipe, the
lead pipe being first wiped onto a brass ferrule, the ferrule being
leaded into the Y branch. These Y branches are usually two inches in
diameter and the lead pipe usually one and one quarter inches. Between
the soil-pipe and the fixtures a trap must be provided with a water-seal
of about an inch.

_Trap-vents._

In city plumbing it is customary to vent traps; that is, to carry
another system of pipes from the top of the trap nearest the fixture up
to and through the roof. On most roofs, where modern plumbing has been
installed, are seen two pipes projecting, one the soil-pipe and the
other the vent-pipe, indicating the location of a bath-room below (see
Fig. 61). In a single house, however, and particularly in view of
experiments made recently on the subject of trap siphonage, these
trap-vents seem hardly necessary. They were formerly insisted upon
because of the feeling that by the passage of a large amount of water
down the soil-pipe, sufficient suction might be induced to draw out the
water from some small trap on the way, thereby opening a passage for
sewer gas into the room. Experiments have shown that it is practically
impossible to draw off the water from a trap in this way, and that the
system of vent-pipes does little more than add to the cost.

The traps themselves, however, are essential, and great care should be
taken to see that each trap is in place and has a seal of the depth
already mentioned. The best trap to use in any fixture is the simplest,
and a plain S trap answers every purpose. It is always wise to have a
clean-out at the bottom of the trap; that is, a small opening which can
be closed with a screw plug, so that when the trap becomes clogged, it
can be easily opened and cleaned (see Fig. 62).

[Illustration: FIG. 62.--A trap.]

_Water-closets._

A great many kinds of water-closets have been made and used, with
various degrees of success. The old-fashioned pan-closet becomes easily
clogged, allows matter to decompose in the receptacle under the valve,
and, in spite of its being cheaper, should not be used. The long-hopper
closet is also objectionable, for the same reason. A recent bulletin of
the Maine State Board of Health, which gives the relative merits of the
different forms now available, very directly and briefly, is here
repeated:--

"The choice of a water-closet should be made from those which have the
bowl and trap all in one piece, which are simple in construction, are
self-cleansing, and have a safe water-seal. None should be considered
except the short-hopper, the washout, the washdown, the syphonic, and
the syphon-jet closets.

"Short-hopper closets not many years ago were considered desirable, but
other styles costing but little more are better.

[Illustration: FIG. 63.--Washout water-closet.]

"The washout closet (Fig. 63) has too shallow a pool of water to receive
the soil, and the trap below and the portion above the trap do not
receive a sufficient scouring from the flush.

[Illustration: FIG. 64.--Washdown water-closet.]

"The washdown closet (Fig. 64) is an improvement over the washout.
Having a deep basin, a deep water-seal, smaller surfaces uncovered by
water, and a more efficient scouring action, it is more cleanly. The
washdown closet is really an improved short hopper.

[Illustration: FIG. 65.--Syphonic closet.]

"Of late years the principle of syphonic action has been applied to the
washdown closet. Figure 65 shows the outline of a syphonic closet. It
will be seen that the basin, as in the washdown closet, has considerable
depth and holds a considerable quantity of water; but it differs in
having a more contracted outlet. When the closet is flushed, the filling
of this outlet forms a syphon, and then the pressure of the air upon
the surface of the water in the basin drives the water into the
soil-pipe with much force. At the breaking of the syphon, enough water
is left in the trap to preserve the seal.

[Illustration: FIG. 66.--Syphon-jet closet.]

"In the syphon-jet closet (Fig. 66) there is added to the mechanism of
the syphon closet a jet of water which helps to drive the contents of
the bowl more rapidly into the outlet. These two closets, syphon and the
syphon-jet, are preferable to those of any other style. Among other
advantages they are more nearly noiseless than any other kinds.

"Recapitulating, it may be said, while the short-hopper and the washout
closets may not deserve absolute condemnation, the advantages of the
washdown, syphon, and the syphon-jet closets are so much greater that
they should be chosen in all new work."

Properly to flush out the closet, a water-pipe connection must be made
from the supply main. It would be quite possible to connect directly to
the closet rim where the flush enters, but there are two objections
urged against this. Sometimes, when the pressure is low and water is
being drawn in the kitchen, if a faucet in the bath-room is opened, not
only will no water come, but air is drawn into the pipe by the force of
the running water below. A direct connection with a water-closet, it is
conceivable, might allow filth to be drawn up into the water-pipe under
certain conditions. The other objection is that the small pipe generally
used in a house does not deliver water fast enough for effective
flushing.

It is common, therefore, to put in, just back of or above the closet, a
small copper-lined wooden tank which holds about three gallons and which
can be discharged rapidly through a one-and-a-quarter-inch pipe. This
tank with fittings costs about $10, and in a great many cases is
probably unnecessary. It has the advantage, however, of allowing a small
flow to enter the tank whenever emptied, to be automatically shut off by
a float valve when filled. If the house has a tank supply or if the
pressure is strong enough to insure a positive flow at all times, there
can be no objection in a single family, where the flushing action will
be insisted on by the mistress of the house in the interests of
cleanliness, to making a direct connection between the closet and the
house supply pipe. An automatic shut-off bibb would then be used on the
water-pipe, allowing the water to flow freely as long as the bibb was
opened, but closing automatically when released.




CHAPTER X

_SEWAGE DISPOSAL_


The subject of sewage disposal for a single house in the country does
not at all present the elaborate problem that is suggested when the
disposal of sewage of a city is under discussion. In the first place,
the amount of sewage to be dealt with is moderate in quantity; and in
the second place the area available on which the sewage may be treated
is in almost all cases more than ample for the purpose. Nor is there the
complication that arises with city sewage, due to the admixture of
manufacturing wastes. The material to be handled is entirely domestic
sewage and varies only according to the amount of water used in the
house, making the sewage of greater or less strength according as less
or more water is used. Sewage from a single house differs only in one
respect disadvantageously from city sewage, namely, in the fact that the
sewage, not having to pass through a long length of pipe, comes to the
place of disposal in what is known as a fresh condition; that is, no
organic changes have taken place in the material of which the sewage is
composed.

_Definition of sewage._

The great bulk of sewage is water, and, in quantity, the amount of
sewage to be cared for is about equal to the amount of water consumed
in the household, although this will depend somewhat on the habits of
the family. If, for example, part of the water-supply is used for an
ornamental fountain in the front yard, or if in the summer time a large
amount of water is used for sprinkling the lawns, that water is not
converted into sewage, and the amount of the latter is thereby
diminished; but, ordinarily, it is safe to say that the quantity of
water supplied to the house and the quantity of sewage taken away from
the house is identical, and since it is much easier to measure the
water-supply than the sewage flow, the former is taken as the quantity
of sewage to be treated.

In the course of its passage through the house, however, the water has
added to it a certain amount of polluting substances, largely derived
from the kitchen sink, where dirt from vegetables and particles of
vegetable material, together with more or less soap, are carried by the
waste water from the sink into the drain. In the bath-room, also, some
small amount of organic matter is added to the water, but the proportion
of such matter to the total volume of water used is very small, probably
not exceeding one tenth of one per cent. This small proportion is
nevertheless sufficient to become very objectionable if allowed to
decompose, and the problem of sewage disposal for a single house is to
drain away the water, leaving behind the solids so disposed that they
shall not subsequently cause offense by their putrefaction.

The process of decay is normal for all organic matter and is due to the
agency of certain bacteria whose duty it is, providentially, to
eliminate from the surface of the earth organic matter which otherwise
would remain useless, if not destructive, to man. It is impossible to
leave any vegetable or animal matter exposed to the air without this
process of decay at once setting in. Apples left in the orchard at the
end of the season inevitably are reduced and disappear in a short time.
Dead animals, whether large or small, in the same way succumb to the
same process of nature, and it has been pointed out that, unless this
provision did exist, the accumulation of such organic wastes since the
settlement of this country would be so great as to make the country
uninhabitable. Fortunately, however, this inevitable process breaks down
the structure of all organic material, partly converting fiber and pulp
into gas, partly liquefying the material and converting the remainder
into inorganic matter which is of vast importance as food for plant
life. A cycle is thus formed which may be best illustrated in the case
of cows which feed on the herbage of a meadow, the manure from the cows
furnishing food for the grass which otherwise would soon exhaust the
nutriment of the soil.

_Stream pollution._

The first fundamental principle of sewage disposal, therefore, is to
distribute the organic matter in the sewage so that these beneficent
bacteria may most rapidly and thoroughly accomplish their purpose.
During the last fifty years, a great deal of study has been expended on
this problem, and while it has not as yet been entirely solved, certain
essential features have been well established.

The most important factor promoting the activity of these agents of
decay is the presence of air, since in many ways it has been proved that
without air their action is impossible. Thus it has been shown that
discharging sewage into a stream, whether the stream be a slow and
sluggish one or whether it be a mountain stream churned into foam by
repeated waterfalls, has little other power to act on organic matter
than to hold it for transportation down stream, or to allow it to settle
in slower reaches until mud banks have been accumulated which will be
washed out again at the first freshet. Experiments have shown that the
agencies to which certain diseases are attributed, commonly known as
pathogenic bacteria, are frequently, if not always, found in sewage, and
that when these bacteria are discharged into streams they may be carried
with the stream hundreds of miles and retain all their power for evil,
in case the water is used for drinking purposes. No right-minded person
to-day will so abuse the rights of his fellow-citizens as deliberately
to pour into a stream such unmistakable poison as sewage has proved
itself to be. The fact is so well known that it is not worth while
pointing out examples. It is enough to say that some of the worst
epidemics of typhoid fever which this country has known have been traced
to the agency of drinking water, polluted miles away by a relatively
small amount of sewage.

In a number of states, laws have been passed which expressly prohibit
the discharge of sewage, even from a single house, into a stream of any
sort, even though the stream is on the land of the man thus discharging
sewage and where it would appear as if he alone might control the uses
of that stream. Unfortunately, the machinery of the law does not always
operate to detect and punish the breakers of the law, but any law which,
as in this case, has so positive a reason for its existence, and
violation of which is so certain to bring disaster on persons drinking
the water of the stream below the point where the sewage is discharged,
any law which appeals for its enforcement so directly to the common
sense and right feeling of all intelligent people, seems hardly to need
legal machinery for its enforcement. It must depend, as indeed all laws
must depend, upon the intelligent support of the community, and surely
no law would commend itself more urgently than this one forbidding the
pollution of drinking water.

In spite of the fact that the lack of air in the water will prevent
bacterial action, there are, nevertheless, many cases where the
discharge of sewage into a stream may be permitted as being the best
solution of the disposal problem, provided always that the stream is not
used and is not likely to be used for drinking water. Such cases occur
where the stream is relatively large and where the level of the stream
is fairly regular, so that there is no likelihood of the deposit of
organic matter on the banks during the falling of the stream level.
Examples of this sort might be cited in the vicinity of the Mohawk or
Hudson River, or in the vicinity of any of the larger rivers of any
populous state, since although the water of the Mohawk is used by the
city of Albany for drinking purposes, yet the amount of organic matter
which inevitably finds its way into such rivers precludes its use for
drinking without filtration. Into the Hudson below Albany there can
hardly be any question of the propriety of discharging sewage from a
single house.

Again, houses in the vicinity of large bodies of still water may without
question be allowed to discharge into those lakes. For example, houses
in the vicinity of Lake Ontario or Lake Michigan, or even of much
smaller lakes, should not contribute any offensive pollution to the
waters of the lake. In New York State, some of the smaller lakes are
used as water-supplies for cities, as, for example, Owasco Lake for the
city of Auburn and Skaneateles Lake for the city of Syracuse, and,
acting under the statutes, special laws have been passed by the State
Department of Health, forbidding any discharge of any kind of household
wastes into these lakes. The same is done in other states. Here, again,
it is a question of the drinking supply which is being considered, and
not a question of the possibility of any nuisance being committed.

_Treatment of sewage on land._

If no stream suitable for the reception of sewage is available, then the
sewage must in some way be treated on land before it passes into the
nearest watercourse. For the second fundamental principle about the
treatment of sewage is that of all places the action of putrefactive
bacteria is most energetic in the surface soil and that it is there that
the organic matter of sewage can be most rapidly accomplished.
Experiments already referred to have shown not only this, but also that
their activity is most noticeable in the surface layers of the soil and
that their action continues for scarcely two feet downward, and it is
customary to assume that the largest amount of work done is accomplished
in the top twelve inches. Further than this, it has been established
that in order to persuade the bacteria involved to do their work as
promptly as possible, the application of sewage to any particular
locality should be made intermittent; that is, that a resting period
should be given to the bacteria between successive applications of
sewage.

For example, one can recall without difficulty the conditions on the
ground at the back of the house where the kitchen sink-drain commonly
discharges. At the beginning of summer perhaps a rank growth of grass
starts up vigorously in the vicinity, and the path of the surface drain
can be traced by the heavy vegetation along the line of the drain. If
the slope of the surface away from the house is considerable, no other
effect may be noticed through the season, since the surface slope
carries away the sewage, spreading it out over the ground so that the
soil really has a chance to breathe between successive doses. But if the
ground is flat, it will be remembered that before many weeks the sewage
ceases to sink into it; the ground becomes "sewage-sick," as they say in
England, and a thick, dark-colored pool of sewage gradually forms, which
smells abominably. If a piece of hose a dozen feet long had been
attached to the end of the drain and each day shifted in position so
that no particular spot received the infiltration two days in
succession, it is probable that no such pondage of sewage would occur,
but that the mere intermittency of the application thereby secured would
permit the successful disposal of this sink waste throughout the season.

The same effect is to be noted in some cesspools where, because of the
great depth to which they are dug and because no overflow into the
surface layers of the soil is provided, the pores of the ground around
the cesspool become clogged and choked, and the cesspool becomes filled
with a thick, viscous, dark-colored, objectionable-looking, and
evil-smelling liquid.

The three principles which will avoid these conditions are, as already
stated, plenty of air, presence of bacteria normally found in the
surface layers of the soil, and intermittency of application.

In order to secure the operation of these three principles in the
application of sewage onto land, the sewage must be made to pass either
over the surface of the land in its natural condition in such a way that
the sewage may sink into the soil and be absorbed and at the same time
give up its manurial elements to whatever vegetation the soil produces;
or, as a modification of this principle, the sewage may be required to
pass through an artificial bed of coarse material by which the rate of
treatment may be considerably increased. In the latter case, although
probably the greater part of the action of the bacteria takes place in
the top twelve inches, it is customary to make the beds about three feet
thick, chiefly in order to prevent uneven discharge of the sewage
through the bed. Finally, wherever, for æsthetic reasons, it is
desirable that the sewage should not be in evidence, either before
passing through the natural soil or exposed in an artificial bed, the
practice may be resorted to of distributing the sewage through
agricultural tile drain laid about twelve inches below the surface. In
this way, the sewage is scattered through the top soil, where bacteria
are most active, without being apparent, and a front lawn thus treated
would not give any indication of its use.

Taking up now in order these three methods of treatment, we may consider
some of the details of construction. In spreading the sewage over the
lawn or in distributing it on the surface, due regard must be paid to
the kind of soil. Clay soils and peaty soils are useless for the
purpose of sewage disposal unless as the result of continuous
cultivation a few inches of top soil may have accumulated on the clay.
This top soil is adapted to sewage purification, provided the quantity
applied is not excessive.

_Surface application on land._

Two methods of operation may be pointed out. The sewage (and this is the
simplest method of disposal possible) may be brought to the upper edge
of a small piece of ground, usually sowed to grass, and allowed merely
to run out over the surface of the ground. There should be, however,
some method of alternating plots of ground, one with another, so that
the sewage is turned from one to the other every day. Each plot will
then have one day's application of sewage and one day's rest, and this
would complete the disposal, were it not for the interference of rain
and cold. The winter season practically puts a stop to this method of
treatment, and rainy weather reduces the power of the soil to absorb
sewage. For these two reasons, it is desirable to have one plot in
reserve, or three in all, and the area of each plot should be based on
the amount of sewage contributed. For a family of ten persons using
twenty-five gallons of water per day the total area provided should be
one tenth of one acre, or an area seventy feet square divided into three
plots. Figure 67 shows six beds arranged to care for the sewage of a
public institution in Massachusetts. As a guide to the amount of land
needed, it will be safe to provide at the rate of one acre for each
forty persons where the soil is a well-worked loam but underlaid with
clay. The effect of this irrigation on the grass will be to induce a
heavy, rank growth which must be kept down by repeated cutting or by
constant grazing. Both methods are practiced in England, and it may be
said in passing that no injury to stock from the feeding of such
sewage-grown grass has been recorded. The grass cut from such areas (and
the cutting is done every two weeks through the whole summer) is packed
into silos and fed to cattle through the winter with advantage. Or, if
grazing is resorted to to keep the grass down, the herd is alternated
with the sewage from one field to the other, so that the bed which has
received sewage one week is used for pasture the next week, and the
number of head which can thus be fed is astonishing. In order to secure
an even flow of sewage over such grass land as is here contemplated,
there must be a gentle slope to the field, and the ditch or drain
bringing the sewage to the field should run along its upper side.
Openings from the drain, controlled by simple stop planks, are provided
at intervals of about ten feet, and no attention is needed further than
the opening and closing of these admission gates.

[Illustration: FIG. 67.--Sewage beds.]

Another method of applying sewage to the surface of the ground is to
lead it in channels between narrow beds on which vegetables have grown.
These beds are made about eight feet wide with two rows of root crops,
such as turnips or beets, set back about two feet from the edge. The
beds are made by properly plowing, the channels between the beds being
back-furrowed. Here, again, the principle of intermittent application is
essential, and the area to be provided is the same as already given for
the surface irrigation. Three beds should be provided, as before; but,
in general, no provision need be made for carrying off the sewage at the
lower end of the beds, since it may be safely assumed that all of the
sewage will be absorbed by the soil. Of course, a sandy soil will
absorb more water than a clay soil, and if the soil is entirely clay, it
is not suitable for such treatment. Sewage passed over the surface of
clay soil, however, will, in the course of a few months, so modify the
clay as to convert it into a loam, and in this way increase its
absorptive power.

When possible, it is desirable to have a plot of plowed ground over
which the sewage may pass before reaching the beds, so that the grosser
impurities may be left behind and harrowed in or plowed under. If proper
regard is paid to intermittent application, no danger from odors need be
feared, and the repeated plowing in will increase immensely the
fertility of the soil. Nor need one be afraid that all of the manurial
elements will be left behind on this plowed ground. About two thirds of
the organic matter in sewage is in solution, and this will be carried
onto the beds just as if passage over the plowed ground had not
occurred.

_Artificial sewage beds._

In order to secure a higher rate of discharge of sewage through the soil
it is best to arrange an artificial bed which shall be made of coarse,
sandy material which will allow a rate of at least 10 times that already
given. The best material out of which to make such an artificial bed is
a coarse sand; that is, a sand whose particles will not pass through a
sieve which has 60 meshes to the inch and which would pass through a
sieve of 10 meshes to the inch. Such an ideal sand will purify sewage at
the rate of 50,000 gallons per acre per day, or an acre will take care
of the sewage of at least 1000 persons. This means that it is necessary
to provide about 50 square feet for each person in the family, or a
family of 10 persons could have all the sewage taken care of on an area
25 feet square. The same principle of intermittency of application,
however, must be observed by dividing the bed into three parts, so that
the sewage may be alternated from one bed to another. Practice has
indicated that it is better to shift from bed to bed about once a week
and to deliver the sewage onto each bed intermittently; that is, to
discharge a bucketful at a time with short intervals between, rather
than to allow a small stream to flow continuously onto a bed. Such a bed
should be about 3 feet deep, as already stated, and preferably should
have light concrete side walls and bottom, as shown in the sketch (Fig.
68). Ordinarily, the surface of the sand will be level, and the dose of
sewage applied to the bed will cover it a fraction of an inch deep, and
in the course of an hour or so will disappear into the sand and reappear
in the underdrains as clear water.

[Illustration: FIG. 68.--Sewage beds.]

In cold weather a thin sheet of sewage spread out over the surface of
the sand would freeze before penetrating the bed; therefore, in the
winter time, it is usual to furrow the beds; that is, dig furrows across
the beds 2 or 3 inches wide at the bottom and about 10 inches deep, so
that in the bottom of these furrows the sewage may be, partly at least,
protected against frost. It has been found that, if sewage is discharged
intermittently,--that is, in bucketfuls into such furrows,--the beds
open and allow the filtration of the sewage. To be sure, the
purification effected in cold weather is not quite that accomplished in
warm weather, but the results are sufficiently satisfactory, and no
nuisance ensues.

_Subsurface tile disposal._

The other method of distributing sewage over land is by means of
draintile placed in shallow trenches, so that the sewage may leach out
into the soil through the open joints of the pipe. These draintiles
receive the sewage intermittently, and by the constant rush of water are
presumably filled throughout their length. The sewage then gradually
works out of the joints into the surrounding soil, and the pipes are
empty and ready to receive another dose when next delivered.

Two essential points must be considered in the successful operation of
such a plant: the grade of the tile and the length of the tile.

The grade of the tile must be properly adjusted to the porosity of the
soil; that is, in open, porous, and gravelly soils a grade must be
steeper than in loamy and dense soils. The reason is manifest. In a
gravel soil, the sewage is at first rapidly absorbed, so that as the
sewage goes down the pipe line the first joints take up the water and
deliver it to the soil, where it disappears, and probably no flow
reaches the end of the line at all. This means that the soil surrounding
the first joints does the work which the entire pipe line was intended
to do and thus becomes overworked. When overworked, the soil always
refuses to do anything, so that when the succeeding joints take up the
sewage and in their turn become overworked, the line is useless. If, on
the other hand, the grade had been steep enough to carry the sewage down
the pipe line gradually so as to secure a uniform distribution, then the
same or approximately the same amount of sewage would be taken out of
the pipe at each joint, securing a long life for the system. In loamy
soil, on the contrary, there is not the same absorption at the joints,
and so on a steep grade there is the tendency for all the sewage to
follow down the pipe line to the lower end and there escape to clog the
soil and thus spoil the system. As a general average, it may be said
that the proper grade for such a subsurface distribution pipe line in a
fairly good sandy loam should be 5 inches in 100 feet; less than this as
the loam becomes clay and more as the loam becomes gravel.

The other essential point for the successful operation of this method
of distribution is to provide a proper length of pipe for the number of
persons contributing sewage. The soil itself will absorb about the same
amount as when the sewage is spread over the surface, so that a family
of ten persons would require, as before, an area about 70 feet square.
The pipe lines may be laid in different sections, provided the different
lines of pipe are not nearer together than 10 feet. On an area 70 feet
square there would be, therefore, 7 lines of pipe each 70 feet long, or
490 lineal feet of pipe in all, or 49 feet per person. The writer
generally allows 40 feet in well-cultivated soil as a reasonable length
of pipe for each person in the family. If the soil is sandy, this may be
reduced one half, but need not be increased under any conditions, since
a soil requiring a greater length of pipe than 40 feet per person would
be so dense as to be unfit for use. To properly arrange the lines of
pipe on a sloping ground requires careful study of the inclination of
the ground and of the relation of direction of lines of pipe to slope.
Usually the slope of the ground is greater than the 5 inches per 100
feet just referred to, but by laying out the lines of pipe across the
slope instead of with it any grade desired may be obtained. Nor is it
necessary that these lines of draintile be run in straight lines; they
may very properly follow the curving slope, the proper grade being
always carefully maintained.

[Illustration: FIG. 69.--Plan of subsurface irrigation field.]

Common agricultural tiles three inches in diameter and costing about two
cents per running foot are suitable material for these distribution
lines. The sewage enters these distribution lines from a larger pipe,
usually six inches in diameter, and a difficult adjustment is presented
that each branch tile line shall receive its own proportionate share of
the sewage. If only one line of tile is provided, say 200 feet long for
5 members in the family, then all the sewage goes into that line with no
question of distribution arising, but if a number of short parallel
lines must be used, as shown in the sketch (Fig. 69), the difficulty of
subdividing the sewage properly among the different branch lines becomes
very great. For that reason the writer prefers to use not more than two
lines, with the possibility of delivering the sewage alternately in the
one and the other. In this way, the bed not receiving sewage is resting,
while the other bed is acting, and also the outlet for the sewage is
always definitely known. And particularly in the case of these
subsurface tile, the necessity for the intermittent dosing is apparent,
since with small, constant trickling discharges the difficulty of
distribution through the long length of tile is gradually increased, and
usually saturation of the soil occurs from joint to joint, as already
described. Therefore it becomes most necessary, in this case, for the
best results on the soil not merely to alternate the beds receiving
sewage, but also to effect the intermittent discharge onto the beds or
through the pipes although the sewage itself may flow very uniformly in
volume.

_Automatic syphon._

This intermittent discharge is accomplished by constructing on the pipe
line from the house and before it reaches the beds an "automatic
syphon," as it is called, the operation of which may be described as
follows: As the sewage enters the tank containing the syphon and rises
outside the syphon-bell, air is compressed between the water surface
inside the bell and the water left inside the syphon-leg. With greater
and greater height of water outside, this compression inside becomes
greater and forces the water in the syphon-leg lower and lower. Finally,
the water sinks so low as to allow the compressed air to escape suddenly
around this bend, instantly relieving the compression, and the water
outside rushing in to fill up the space occupied by the air starts the
syphon (see Fig. 70).

[Illustration: FIG. 70.--Section of "Miller" syphon.]

This syphon, in size suitable for a single house, costs about $12
delivered, and will always be available to secure an intermittent dosing
of the bed or pipe line. Usually the chamber in which this syphon is
placed holds about one hour's flow, so that it may be estimated that
this syphon will discharge on the bed every sixty minutes. The exact
interval of time is not essential nor, perhaps, important, although it
may be noted that the coarser the material,--that is, the nearer uniform
all the sand particles are to the largest size passing the ten-mesh
size,--the smaller must be the dose applied, but the more frequently
must the application be made. This has been very thoroughly studied in
Massachusetts, and the views of experts on this subject may be found in
the report of that Board.

Such an intermittent discharge may be made and often is made by a hand
valve leading out from this chamber in institutions or in private houses
where some one constantly is available for the purpose. Thus it becomes
the duty of the man in charge every hour or perhaps three times a day to
pull the valve and allow the sewage to discharge (see Fig. 71). An
overflow pipe should always be provided, so that if he forgets to pull
the valve, the sewage will still find its way into the system rather
than out on the ground.

[Illustration: FIG. 71.--Plan and section of a septic tank with valve.]

_Sedimentation._

As a matter of economy of operation, it has been found desirable to take
out from the sewage before the treatment already described as much of
the solid matter as may be reasonably done, and for this purpose
sedimentation is made use of. Most of the solids in sewage are slightly
heavier than water, so that if they be allowed to stand in the water for
a short length of time, they will settle to the bottom of the tank and
allow the liquid above to pass on, considerably clarified. It has been
found worth while to do this, since all three processes described are
interfered with if the solids taken out by sedimentation are allowed to
be deposited either upon the surface of the ground, giving rise to odors
as well as to objectionable appearances, or onto the surface of the sand
beds, which they clog up, or in the three-inch tile drain, which may be
filled in a short time.

It has been further found by experience that if these sedimentation
tanks are made large, really larger than necessary for sedimentation, in
some way a large proportion of the matter accumulating in the tank will
disappear, so that the amount of sediment to be taken out of the tank is
not as large as might be expected. In fact it is usual for such tanks to
run one or two years without cleaning, although the amount of solids
shown by chemical analysis to have been removed from the sewage would
fill the tank twice over.

It has been found that a tank, in order to do successful work in
separating solids and in eliminating as much as possible of the
sediment, needs to be of a capacity to equal about one day's flow of the
sewage, and this is a good basis for computation. Here, again, the fact
that the sewage from a single house is considerably fresher than the
sewage from a city must be remembered, since, while many cities build
tanks holding only one third or one fourth of their daily flow with good
results, in the case of a single house this is not possible, and the
tanks, if built at all, ought to hold at least the full day's flow. Ten
persons, at 25 gallons each, furnish 250 gallons per day or 33 cubic
feet. The tank, then, must be large enough to hold this volume, and
suitable proportions generally require that the tank be at least 5 times
as long as wide. A certain allowance must always be made for deposit in
the bottom and for the accumulation of scum on the top, so that an extra
foot or more of depth is desirable. The tank, then, to furnish the
required 33 feet, might be made 3 feet wide, 3 feet deep, and 5 feet
long, and probably in no case would a tank much smaller than this be
used.

[Illustration: FIG 72.--Section of a septic tank with syphon chamber.]

There are two or three details of tank construction which may be
suggested, although almost any kind of tank will answer the purpose. It
is desirable in order that the surface scum may not be disturbed, and in
order that the inflowing sewage may distribute itself as uniformly as
possible across the tank, to attach an elbow to the entering pipe so
that the sewage enters about halfway between the top and bottom of the
tank (see Fig. 72). Similarly, at the outlet or weir an elbow should be
provided because it is not desirable to allow the floating matter of the
surface to be carried onto the bed, and a pipe taking off liquid, open
halfway between top and bottom, will carry away but little of either the
surface scum or bottom sediment. Such a tank must be built of concrete
or masonry or timber, although the latter is not to be recommended
because of its short life. The walls of an ordinary tank may be built 6
inches thick at the top and 12 inches to 18 inches thick at the bottom,
the latter being necessary if the depth is over 8 feet. The tank should
have 6 inches of concrete on the bottom, and the roof may be made of
flagstone or of concrete slabs in which some wire mesh has been buried.

It is not necessary to ventilate this tank, although it is desirable to
have perhaps a foot of air-space between the water level and the roof of
the tank. During the first few months of its operation such a tank is
very likely to smell badly, and, if ventilators are provided, the
presence of the tank will be well known by the odors sent off. After the
tank has been in operation two or three months these odors gradually
disappear, due presumably to the fact that the surface of the water in
the tank has become coated with a thick blanket through which odors
cannot penetrate. On the other hand, there have been a few cases
recorded where the production of gas in a septic tank was so great that
an explosion occurred, tearing off the roof and otherwise doing
considerable damage.

The full plant, therefore, will consist of the settling tank, receiving
the raw sewage from the house and discharging it into a small tank
holding about one hour's flow and containing the automatic syphon
apparatus for intermittent discharge. This dosing tank must provide for
one hour's flow at the maximum rate of flow, and should hold about one
fourth of the total daily flow. Then the ground area, either natural or
artificial, which receives the intermittent discharge from the dosing
tank, completes the installation (see Fig. 73).

[Illustration: FIG. 73.--Plan of sewage disposal for single house with
details of receiving tank.]

_Underdrains._

The question of installing underdrains will arise only in cases where
the ground water, always to be found below the surface somewhere, comes
up so high as to affect the disposal of sewage. Usually no underdrains
will be needed unless the ground water gets up to within three feet of
the surface, and, in a number of cases, underdrains have been laid under
a sewage filter at considerable expense, only to find when the filter
was in operation that they were never in use. In clay soils the
underdrain is not necessary. In fact, it may be noticed that the
underdrain is not for the purpose of taking care of the sewage, but
rather of draining off the soil-water and preventing its interference
with the action of soil on sewage. This principle will indicate where
underdrains are necessary and where not.

When used, underdrains should be laid from three to four feet below the
surface in parallel lines about fifteen feet apart and on grades of not
less than one foot in one hundred. It is always better to have the
underdrains too large than too small, and drains less than three inches
in diameter should not be used, and they should increase in size to four
inches and then to six inches as the separate drains are brought
together. The writer has seen a six-inch underdrain running full of
ground water collected within a distance of a hundred feet, but this was
in gravel soil through which the water passed very freely. No exact
rules can be given for the size of the underdrains, but it will be
noticed that, since water passes through clay soil slowly and through
gravel soil rapidly, larger pipes must be used where the soil is
coarse.




CHAPTER XI

_PREPARATION AND CARE OF MILK AND MEAT_


Milk has long been considered to be one of the most important human
foods, particularly for the young, combining within itself all the
essential elements necessary for the production of cell tissue and for
animal vitality. In composition, it is about 87 per cent water, the
remaining 13 per cent being divided between fat, casein, and sugar in
equal parts, with a small addition of salt.

As is well known, milk is the sole food upon which it is possible to
sustain life for long periods, and while this applies directly to
infants, it is by no means confined to them. Many examples can be given
of men and women of mature life who, either on account of some digestive
disorder or some mental bias, have confined themselves absolutely to a
diet of about two quarts of milk a day and have lived thereon for months
and years without suffering from lack of nutrition.

In recent years, due to the advocacy of the eminent scientist,
Metchnikoff, who asserts that researches in the Pasteur Institute have
shown that certain diseases of advanced age are due to auto-intoxication
from the larger intestine and that the consumption of fermented milk
acts as an antiseptic, neutralizing this bacterial intoxication, the
consumption of fermented milk, or buttermilk, or koumiss, has very
largely increased. It is, in fact, rather remarkable to find that in
large cities, business men whose digestions have been ruined are
devoting themselves to unlimited quantities of buttermilk in the hope
that their former excesses and absurdities in the way of food may be
counteracted and health restored.

Between these two extremes--the use of milk for the very young and for
the aged and infirm--milk plays an important part as food. The
consumption of milk in New York State, according to statistics, amounts
to about a pint a day for each person for that part of the country. As
an article of food, milk has the advantage already referred to, namely,
that besides its nutritive power it has a curative effect greatly
augmented by fermentation, the modification so vigorously advocated by
Metchnikoff. Another advantage which milk possesses as an article of
food is that, by sterilization and storage in closed vessels, it may be
kept for days and even months in good condition. At the time of the
Paris Exposition, milk was sent from America and exhibited alongside of
French milk with no preservatives except heat used for removing the
bacteria in the milk and then cold storage for keeping others out, and
two weeks after the original bottling the milk was in good condition. To
meet the need of ailing babies, advantage was taken of this valuable
property of milk, by which it could be shipped from dairies near New
York to the Isthmus of Panama, and used continually with good results
although more than a week old.

_Bacteria in milk._

The great disadvantage which milk sustains as an article of food is that
the same composition that makes it so useful as a diet for man, also
renders it a most admirable culture medium for the rapid development of
all kinds of bacteria. Some of these bacteria are, without doubt, benign
in their effect upon man; as, for example, the particular species used
to produce koumiss and other varieties of fermented milk now recommended
by physicians. But there are many other kinds of bacteria that find life
in milk congenial, whose effect upon the human system is not salutary,
and, if milk infected with those varieties is used for feeding infants,
the result is quite likely to be a disturbance of their digestive
system, producing diarrhea and cholera infantum and possibly death.

It was at one time common to add to milk certain antiseptics for the
purpose of preventing the growth of bacteria, and, except that the
preservatives acted quite as injuriously upon man as upon the bacteria,
the results, so far as merely keeping the milk went, were all that could
be desired. The chemicals added were borax, boracic acid, salicilic
acid, sodium carbonate, and other similar disinfectants. Gradually,
however, it has come to be known that, inasmuch as the milk when first
drawn from the cow's udder is sterile, that is, contains no bacteria,
and since it is quite possible to prevent the introduction of bacteria
into milk during the processes of milking, straining, and bottling,
there is no need of the addition of preservatives, provided particular
care is exercised in handling the milk.

_Effects of bacteria._

Since this care involves the expenditure of both additional time and
money, questions at once arise whether such expenditure is necessary,
whether the introduction of a few bacteria into the milk is
objectionable, and what the results are upon the persons drinking milk
containing bacteria. For our present purpose, the kinds of bacteria
which find their way into milk may be divided into two classes, namely,
those that are normally in milk and which tend to produce souring, and
those which accidentally enter and are able to produce disease in
persons drinking the milk. The first kind probably enter the milk from
the air or from the surface of the milk-pail, and in the milk increase
in numbers very rapidly and have the same effect in the milk and on
persons drinking the milk as any large amount of organic matter.

The second kind of bacteria are known as pathogenic; that is, are the
direct cause of disease when taken into the human system. Under ordinary
circumstances, this latter class will not be found in milk, since these
kinds of bacteria must come from some infected person, and if no such
person is in contact with the milk at any stage, then it is impossible
for the milk to become so polluted. However, those interested in
preventing the spread of disease through polluted milk argue that if the
conditions in a stable and dairy are so unclean that large numbers of
the normal milk bacteria can enter the milk and increase in numbers
there, then conditions would be favorable for the introduction of
pathogenic bacteria whenever the milker or bottle-washer or the strainer
or any of the helpers became sick.

To show the difference in the effect of a clean stable and dairy as
compared with an ordinary one, it is only necessary to say that in
investigating the quality of the milk supply of a certain city
recently, the writer found one stable where the milk analyses showed
from half a million to a million bacteria per c.c.,[2]--that is, per
half-teaspoonful,--and this was occurring in the dairy regularly from
month to month as the analyses were made. Another stable in the same
city showed just as regularly a bacterial count in the milk of from 1000
to 5000 per c.c., the difference being due solely to the way in which
the stables and dairies were kept,--in the one case with no regard to
cleanliness and in the other with the very best attention paid thereto.
Certainly, if dirt is so much in evidence that a million bacteria can
enter the milk in every c.c., no particular pains can be taken in such a
stable to keep out disease germs; while in the clean stable, where so
few germs enter, disease germs could hardly find any opportunity for
lodgment.

[Footnote 2: c.c. = cubic centimeter, or centister. A centimeter is
about 2/5 of an inch (.3937). 1 cubic inch is about 16-1/2 c.c.]

The following example may be given to indicate the effect of impure milk
upon a community. The vital statistics of the city of Rochester,
including the deaths of children under five years, show that from 1889
to 1896, during the summer, infants died at the rate of 109 per 100,000
population. The health officer of the city undertook to improve the
quality of the milk, and from 1896 to 1905, statistics show that the
number of children dying, under five years, was only at the rate of 54
per 100,000,--a manifest saving due, without doubt, to the improvement
in the quality of the milk. By repeated examinations of the dairies, by
rigid enforcement of certain rules governing the distribution of milk,
and by detailed lessons to mothers in the tenement-house districts on
the care of milk, the quality of the milk was so improved as to make the
reduction in the death-rate already pointed out.

The Honorable Nathan Strauss, of New York City, has taken up the same
idea, and, by supplying the poor with milk properly heated so as to
destroy the bacteria which may have been introduced by careless
handling, has also saved hundreds of thousands of children from
premature death.

_Diseases caused by milk._

Many infectious diseases are propagated by milk, not only among
children, whose chief food is found in this supply, but also among those
of more mature age who, though drinking only a small quantity, are
apparently more easily affected. Four diseases are particularly to be
noted in connection with the consumption of milk, namely, typhoid fever,
scarlet fever, diphtheria, and tuberculosis.

_Typhoid fever from milk._

One of the most striking illustrations of the spread of typhoid fever
through milk occurred this last year in the city of Ithaca, New York.
The city proper lies in a valley between two hills, the milkmen having
their farms on both sides of the valley to the east and west, on the
hill slopes. One milkman on the west, with a large route, delivered his
own milk only in part and bought an additional supply from a farmer on
the east. In the family of the latter occurred a case of typhoid fever
in September, pronounced by the local physician to be sunstroke, but
evidently typhoid fever, since other cases of secondary infection
developed in the same family and were then pronounced typhoid. The milk
from this east-side farm was taken down the hillside and turned over to
the west-side farmer, who distributed his own milk in his trip from his
farm across the valley, his route being so timed as to allow him thus to
dispose of all his own milk. Having then loaded up with the east-side
supply, he started back across the valley, distributing the milk which
was evidently polluted, since on his return route house after house
developed typhoid fever, with no cases on the first part of the route
and with no other cases in town except those on this milk route.
Forty-four cases developed in all, with two deaths.

The Reports of the Massachusetts State Board of Health give a number of
cases of the same sort, all showing that milk is easily infected by
persons suffering from even mild attacks of typhoid fever, attacks so
slight as perhaps not to be recognized or to be worth submitting to a
physician, but which are responsible for bacteria passing from the hands
or mouth to a can cover or ladle, and so to the milk.

_Diphtheria._

Diphtheria seems to be well established as a disease transmissible by
milk, although its occurrence is not so frequent as that of typhoid
fever. Not long since, the writer was much interested in an epidemic of
this sort described by a physician who was convinced that the bacteria
responsible for the mild form of the disease occurred largely in the
nose and throat passages. He noted that as the result of these growths a
constant exudation from both passages was present, and that a man with
this disease, working over the milk, might easily allow the milk to be
polluted by this exudate dropping from his nose.

The result was a general distribution of a mild form of diphtheria among
those using the milk.

_Scarlet fever._

Many examples have also been given of the distribution of scarlet fever
through the agency of milk, the specific contagion probably being
discharged by the patient from his nostrils, mouth, or from the dry
particles of skin so characteristic of this disease. Unfortunately, mild
cases of scarlatina are very apt to occur, so mild that a physician is
not called in, and the only positive proof of the disease consists in
the subsequent "peeling," although the nasal passages may have been
alive with germs.

_Tuberculosis._

So far as tuberculosis is concerned, nothing seems to be definitely
proved. There is little fear of milk becoming infected from tuberculous
patients or of the disease being transmitted through milk from one
person to another, as with the three other diseases mentioned. The
possibility of infection here lies in the fact that a cow, like man, is
susceptible to tuberculosis as a disease, and undergoes the same course
of prolonged suffering and death. The interesting question is whether
the disease may be transmitted from a cow to a man through the cow's
milk. With all the refinements suggested by science as to the virulence
of the disease thus transmitted, with a study of the comparative
symptoms of the two diseases, of the progress of the disease in the cow
when the germs are found in the milk, and of the possibility of
eliminating these germs by heating or otherwise, the danger from
diseased cows is still unsettled.

So far as present knowledge goes, it is probably conservative to say
that although tests made on cows by inoculation with tuberculin show
that a large proportion of the animals in the various dairy herds are
more or less affected by tuberculosis, yet only a small proportion of
the milk from such cows shows the presence of the tuberculosis bacillus.
So far as statistics can be given on this subject, it seems probable
that not more than ten per cent of the cows reacting under the
tuberculin test would show tubercular bacilli in the milk, or would
develop tubercular reactions if the milk were used in inoculations. The
reason for this is probably that the tubercular growth in the cow does
not naturally attack the milk glands until the disease is well advanced,
and when the general appearance of the cow indicates severe illness, so
that any careful milkman would not use the particular milk, even if the
milk flow did not cease. It is not reasonable to assume that all milk
from tubercular cows is itself infected, nor yet that all children
drinking milk so infected will contract the disease. But the mere
possibility of demonstrating that a small percentage of tubercular cows
will cause human tuberculosis is sufficient to justify all possible
precautions against tubercular animals and against the distribution of
tubercular milk. In this connection it is worth while noting that the
cows most affected by tuberculosis are those confined in small crowded
stables, with no fresh air, with no exercise, and with insufficient or
improper food. Unfortunately it is not possible to trace the connection
between the particular animal responsible for the disease in a human
being, since the period required for the development of the disease is
so great that the possible time of onset is forgotten and the cause of
the disease entirely out of mind.

It can only be said, therefore, that laboratory experiments have
demonstrated the presence of the tuberculosis bacillus in milk from
tubercular cows, and that this bacillus is known to produce tubercular
lesions in man. It is wise, therefore, to eliminate the milk of
tubercular cows if healthy milk is to be provided.

_Methods of obtaining clean milk._

Aside from the infection of milk by specific disease-producing bacteria,
the milkman of to-day must be very careful to avoid a milk which shall
contain large numbers of bacteria of any type which, while not producing
any specific disease, nevertheless causes changes in the chemical
composition of the milk, which make it at the same time unfit as an
article of food for individuals and shows the possibility of other kinds
of infection.

There are two axioms to be followed if good clean milk is to be
produced, and those are that the milking and straining shall be done in
clean stables, from clean cows, by clean persons; and the other that the
milk shall be cooled to a temperature of fifty degrees or less as soon
as received from the cow. Neither of these requirements is difficult to
attain, but they constitute the sole reason why some milk contains a
million or more bacteria and other milk less than a thousand; and it is
quite possible by enforcing these two requirements to change the number
of bacteria in milk from the large figure to the small one.

Probably it is in the stable where the cows are milked that the most
important factor in producing large numbers of bacteria is to be found.
Not long ago the writer saw a number of stables, the ceilings of which
were poles on which the winter supply of hay was stored and the
atmosphere was noticeably dust-laden. A good milk could not be
furnished from such a stable, and therefore it may be set down as the
first requirement that the ceiling of the stable should be entirely
dust-tight. Some of the best stables in the country for this reason have
no loft of any sort above the cattle, but if the ceiling is tight,--that
is, made with tongue-and-groove boards and then painted,--there can be
no objection to the storage of hay in the loft. Hay should not be taken
from the loft or fed to the cows just before milking, because the very
moving of a forkful of hay through the air of the stable stirs up so
large a number of bacteria in the air that quantities of them will later
fall into the milk-pail.

_Light and air_ in a stable are both important, not so much for the
quality of the milk as for the health of the cows that furnish the milk.
Ventilation and sunlight are both excellent antiseptics. The ordinary
rule for the amount of window area per cow as given by the United States
Department of Agriculture is four square feet of window surface. But it
is not easy to definitely state any fixed amount of window area, since
the value of the window is in its disinfecting power on the bacterial
life of the stable, and this is greater or less as the windows receive
the direct sunlight or are hidden under eaves where no sunlight reaches
them.

The next factor in the production of good milk is the condition of the
_walls of the stable_. Like the ceiling, they should be absolutely free
from dust, and should be smooth, so that they may be brushed or even
washed clean. For this reason, walls with ledges are objectionable, and
all horizontal surfaces in a stable are undesirable. Tongue-and-groove
sheeting should never be laid horizontally, but rather vertically, and a
smooth brick or concrete wall is better than wood in any case. The same
care must be taken to have the floor clean and dry. A floor of saturated
wood, containing millions of bacteria which are stirred up by the milker
moving around, causes many of those millions to be deposited in the
milk-pail. A concrete floor for the stalls and drains is the ideal
construction, and both should be thoroughly cleaned morning and night,
so that no dried refuse may remain as the living place for bacteria. Nor
should the manure thrown from the stalls be left in the vicinity of the
barn, but carried away at least 200 feet, in order that the barnyard may
be kept dry and clean, that no smell from the manure may reach the milk,
and that the flies which come from manure piles may be kept at least
that distance from the cows.

The next factor in the production of clean milk is the _condition of the
cow herself_, not in the matter of her actual health, but in the matter
of the cleanliness of her skin at the time the milking is done. If the
udder and sides of the cow have been coated with manure, it is certain
that more or less will fall into the milk-pail at the time of milking,
and the "cowy taste" of the milk is easily accounted for in this way. In
a modern stable, the milkman is careful to clean the cow ten or fifteen
minutes before the milking is done by sponging or washing her belly,
sides, and udder with a damp cloth or with a cloth moistened with a
disinfecting solution. In one set of experiments, for instance, 20,000
bacteria per c.c. were found in the milk when the cow was rubbed off
before the milking and 170,000 when the preliminary cleaning was
omitted. In another case, milk from four dirty cows gave an average of
90,000 bacteria, while other cows of the same herd, milked by the same
man, but carefully cleaned before milking, gave only 2000 per c.c. The
care involved brings its own reward, and it is in most cases a lack of
knowledge or an indifference to results which causes the malign effects
above noted.

Only a few weeks ago, the writer watched the hired man start the milking
and was disgusted to see the old-fashioned practice followed of
squeezing a little milk onto the man's filthy hands and then the handful
of milk rubbed around on the cow's teats to drip filthy and
bacteria-laden into the milk-pail along with the milk itself.

One other factor is involved which, while scoffed at by some of the
old-time farmers, has nevertheless proved its value, and that is the use
of the _narrow-topped milk-pail_. It is startling when tested by
bacterial growths under the two conditions to see how many more bacteria
will be found in the wide open pail than in the narrow-topped one, and
while, of course, some milkers may not be able to use a pail the top of
which is only six inches in diameter, it is quite worth while for
milkers who do not know how to use a narrow-topped pail to learn.

The size of the opening is not the whole consideration in the matter of
the milk-pail. The way it is washed is even more important. If it is
merely rinsed out in cold water and then washed in warm water, it is far
from clean, and milk poured into such a pail and then poured out will by
that process have gathered to itself thousands of bacteria. For example,
some experiments have shown that milk in well-washed pails had, on the
average, 28,600 bacteria per c.c., while that collected in pails of the
same sort under identical conditions, except that the pails had been
steamed, contained only 1300 bacteria per c.c.

Perhaps the most important factor in the care of these utensils is the
necessity of killing the bacteria left in them by the milk itself.
Ordinary washing will not do this. Either the washing must be done with
some sterilizing agent, like strong salsoda, which must then, of course,
be thoroughly rinsed out, or else the inside of the pail must be filled
with absolutely boiling water or with steam. The advantage of the latter
is that no contamination is possible by the water itself, whereas in
washing out the disinfectant the water, unless pure, contaminates the
surface again. To show the effects of clean pails, an experiment was
made in which milk was drawn from a cow and found to have 6000 bacteria
per c.c. It was then poured rapidly from one to another of six other
apparently clean pails. At the end of the sixth pouring, the milk was
found to be so changed that the number of bacteria had increased to
98,000 per c.c.

The strainer for a milk-pail is preferably made of cheesecloth, since
this can always be easily boiled between milkings, and so sterilized. A
wire strainer through which the milk has to pass, and where the milk is
often stirred by the finger of the milker to make it pass through more
rapidly, is in no sense as satisfactory as cheesecloth.

The straining should be performed as soon as each pail is filled with
milk, and pails of milk should never be allowed to stand around in the
barn back of the cows, but rather should be taken at once to the
milk-room, where it can be strained before any further contamination
takes place.

Then the milk should be cooled, and this, to be effective, must be done
in such a way that the temperature of the milk shall at once fall to
fifty degrees or less. It is well known that a forty-quart can of milk
lowered into spring water cools slowly on the outside, but that hours
will pass before the inside of the can has its temperature lowered
appreciably. Meanwhile, bacterial growth has started, and that milk can
never be as good as when cooled quickly throughout. Special apparatus is
made in which the milk is spread out in very thin sheets over a surface
cooled by ice or cold water to a low temperature. In this way all the
milk is at once lowered in temperature and may then be kept in spring
water until time for shipment. Many examples can be given of the value
of this kind of cooling. A few years ago, the Cornell University
Agricultural Experiment Station determined that a certain milk when
fresh contained, about 4000 bacteria per c.c., and fifteen hours later
at room temperature had 270,000, and twenty-seven hours later had soured
with an innumerable number of bacteria. Another part of the same milk,
however, kept at fifty degrees Fahrenheit, showed absolutely no increase
in bacteria for twenty-seven hours, and was still sweet with only 12,000
bacteria at the end of three days.

_City milk._

The value of pure milk is not a matter of individual opinion on the part
of the farmer, but it is a vital point with thousands and millions who
are dependent upon the farmer for this life-giving food. Unfortunately,
to-day the relation between the consumer and the milkman is so remote
that it is almost lost sight of, and in place of the personal
relationship which formerly existed, which made the milkman proud of
his milk and the consumer proud of her milkman, there is to-day an
absolute disregard of the interests of the other side in almost all
cases. Even in the smaller cities, consolidated milk companies are being
established by which the former independent milkmen are bringing milk to
the central station in large cans, where it is dumped into vats along
with the milk from a dozen other milkmen. Some may be good and some bad,
but what is the use, each one says, of my taking particular pains when
my neighbor produces milk of such poor quality? The result is that it is
all far from good and likely to deteriorate rather than to improve. To
be sure, at the central station it is bottled and distributed to the
consumer in apparently clean glass jars, but this is not the same
cleanliness that one gets when the bottling is done five minutes after
the milk comes from the cow.

When the milk supplied to the larger cities is furnished as in New York,
the impossibility of controlling the quality of the supply becomes
apparent. The farmer brings to the shipping station his two or three
large cans of milk, representing the night's and morning's milkings.
These are loaded on a train along with hundreds of others, a few chunks
of ice are thrown on top, and the train is started for New York, from
points as far as two hundred and fifty miles away, reaching the city in
the early evening. There it is received and hauled to milk stations,
where it is distributed in different-sized cans and bottles, and the
next morning, thirty-six hours old, distributed to the babies of the
city as fresh milk. Thanks to the energetic inspection practiced by the
officers of the Department of Health of New York City, who have emptied
hundreds of quarts of milk into the city gutters merely because the
temperature of the milk was higher than that prescribed, the quality of
the milk is not so bad as it might be. In fact, the writer has bought
apparently good milk on Long Island, shipped down from New York City,
because the local supply was deficient in quantity and inferior in
quality, although the latter would naturally be supposed to be fresh and
the other was certainly forty-eight hours old on its receipt.

Cleanliness and care are the two watchwords for good milk, and both
practices ought to be observed faithfully by the milk producer, whether
he has in mind the health of his own family or the health of the
dwellers in the city hundreds of miles away.

_Dangers of diseased meat._

Next to milk, the product of the farm which has most to do with the
health of those to whom farm products are sent is the meat which comes
from the cows, sheep, and pigs, and makes a large part of the farmer's
produce. To be sure, the amount of meat thus sent to market from the
farm is by no means as great as in former years, since even the smallest
village to-day has representatives of Swift and Co., Schwartzman and
Sulzenberger, Jacob Dold, and others of the great western packing
houses. There is still, however, a great deal of local butchering, and
it is important that the farmer himself should know the characteristics
of meat and should be so impressed with the dangers of diseased meat
that the temptation to unload a bad carcass on the unsuspecting public
may be overcome. There is nothing more certain in sanitary science than
that the application of heat destroys animal parasites and
micro-organisms, so that, except for diminishing the nutritive value,
there is comparatively little real danger in eating diseased meat when
cooked, and the fearful ravages of bad ham have been largely due to
occasions where the ham has been eaten raw or semi-raw.

There are two points to be noted in an animal about to be killed,
namely, whether the animal is healthy, that is, free from disease,--and
whether it is in proper condition, neither too young nor too old, is
well-grown and well-nourished. Among the diseases to which animals are
subject, some are objectionable because of the possibility of the direct
transmission of their disease to those eating the flesh, while others
are objectionable because the flesh is spoiled and so causes irritation
in the stomach and intestines of those eating it. Among the former
diseases may be mentioned trichinosis, tuberculosis, and measles of
pigs. In the latter category are animals suffering from such diseases as
epidemic pneumonia, foot-and-mouth disease, Texas fever, anthrax, hog
cholera, and others in which a general toxic condition of the animal's
system results from the disease. Toxins are thus formed in the body
which may pass to the human being eating the flesh, and in this way
poisons called ptomaines are produced, resulting in so-called toxic
poisoning. It is not the function of this book to describe the symptoms
peculiar to each of these diseases, and it is here sufficient to say
that the flesh of no animal apparently suffering from any disease should
be used for food.

The unhealthy animal can usually be recognized by a casual examination,
without undertaking to define the specific disease from which the animal
is suffering, characterized by such an examination. When sick,
according to Parkes, the coat of the animal is rough or standing, the
nostrils are dry or covered with foam, the eyes are heavy, the tongue
protrudes, the respiration is difficult, the movements are slow and
uncertain, and the various organs of the body perform their functions
abnormally. On the other hand, the healthy animal moves freely, has a
bright eye and moist nostril and a clear skin, the respiration is not
hurried and the breath has no unpleasant odor, the circulation is
tranquil, and the appetite good, thirst not excessive, and, if ruminant,
when in repose, chews the cud.

There is, however, one exception to this general rule, and that is in
the case of tuberculosis, since the most scientific observations have
failed to trace any connection between the inception of tuberculosis in
man and the eating of meat from tuberculous animals, or to show any evil
effects to man from eating the flesh of cows affected in the first
stages of tuberculosis. The regulations of the United States Department
of Agriculture on this point are as follows:----

"All carcasses affected with tuberculosis and showing emaciation shall
be condemned. All other carcasses affected with tuberculosis shall be
condemned, except those in which the lesions are slight, calcified, or
encapsulated, and are confined to certain tissues ... and excepting also
those which may ... be rendered into lard or tallow."

The regulations referred to say in substance that when the lesions occur
in a single part of the body, as in the neck, liver, lungs, or in
certain specified combinations, the meat may be used; but that where the
lesions affect more than one or two parts of the body, the carcass must
be rendered at a temperature of not less than 220 degrees Fahrenheit
for four hours into lard or tallow.

This really means that an animal only slightly affected with
tuberculosis, where the lesions are slight and are confined to the
tissues of certain organs only, may be used for food. This has been
decided only after very careful reading of all known facts, and is
particularly important in view of the opposition to the use of milk of
tuberculous cows. The tuberculin test, on which depends the
determination of tuberculosis in cows, is so delicate that a very slight
lesion is sufficient to cause a reaction. The lesions are so slight as
in many cases to be entirely overlooked by the ordinary butcher. The
United States regulations allow such a carcass to be butchered and used
for food after the cow has been condemned by the tuberculin test as a
milk-producing animal. This does not mean, of course, that those parts
of the body affected by the tuberculosis lesions shall be used, but,
since these lesions are usually segregated, they can readily be cut out
without reference to the rest of the body.

The other point to be noted in selecting or rejecting animals for
slaughter is their general condition. This means that they should be of
the proper weight,--that is, not emaciated, but with a proper amount of
fat,--that the flesh should be firm and elastic and the skin supple. Nor
should they be either too young or too old. A prominent example of the
first error is in the sale of calves under three weeks old, known as
"bob-veal," and while some sanitarians will not object to eating calves
under three weeks old, the consensus of opinion is that to be fit for
food a calf should be at least that age. Fortunately, it is for the
interest of the butcher to hold the calf until it has arrived at a
certain weight, and the stringent laws of most states prohibiting the
sale of bob-veal make it dangerous and expensive for the farmer to
slaughter young calves unless they are of the right age.

The most common example of the direct transmission of disease from
animals to men is through the development of the parasite in a pig,
known as "trichinosis." This disease is due to a minute worm scarcely
visible to the naked eye which lives in the muscles of men, dogs, swine,
and other animals, and also under other conditions in their intestines.
Millions of the young trichinæ may live in the flesh of a pig without
producing any particular difference in the appearance of the flesh.
After four or five weeks, they become incased in small white spherical
capsules which later, after a year or so, become entirely calcified. In
this form they live for years in the flesh of the pig and do no harm in
that condition. If, however, this flesh be eaten by man without being
cooked so thoroughly as to destroy the little worm (about one
twenty-fifth of an inch long) which has been living in these capsules,
then they become distributed around the stomach of the person eating
that flesh, enter the intestines, and attach themselves to the membranes
there. They grow very rapidly, and broods of from 500 to 1000 young
worms are produced from each one of the entering worms, and, since there
may be a quarter of a million or more in an ounce of pork, it is not
surprising that the total number deposited in the intestines from a
single meal of raw pork is enough to produce great distress,
characterized by vomiting and diarrhea. Fortunately, the disease is not
necessarily serious, since after the development of the young worms (and
it is at this period when the suffering of the human patient is at its
height), the worms begin to form capsules again, as in the pig, and when
inclosed, are again inocuous. Professor Sedgwick says that persons in
robust health may be able to survive the attack of half a million or
more of these flesh worms and recover, but there is a limit to human
endurance, and the numbers often contained in the muscles of man from
this source are almost incredible. In some severe cases, the numbers
contained in human bodies have been estimated by reliable authorities to
be as high as forty to sixty millions. Not long ago, the writer was
impressed with the severity of this disease by having brought to his
attention an epidemic in a herd of swine caused, presumably, by feeding
waste which contained rinds of Western pork, infected with trichinæ and
many examples may be found of regular epidemics caused by persons eating
raw ham infected with this disease. Fortunately the means of prevention
is very simple and implies merely the thorough cooking of the meat. If
persons will avoid eating raw or underdone swine flesh in any of its
varieties, no danger need be apprehended.

In general, it should be remembered that any animals dying of diseases
are not fit for food, and this applies to all animals, from the largest
to the smallest. Animals dying by accident, of course, are exceptions,
but if diseased animals, animals dying a natural death, and animals out
of condition are eliminated, the quality of food supplied from any
individual farm may be approved so far as the animal itself is
concerned.

_The slaughter-house._

There is, however, the further question of the sanitary condition of the
slaughter-house and the care of the meat after being dressed. It may be
that one gets accustomed to the sight of the filthy barns or out-houses
so often used for slaughtering. Places infected with flies and other
insects, overrun with rats, and the effluvia of which is easily
noticeable at a distance of half a mile, are not uncommon and suggest
their own condemnation. While it is not possible to directly associate
any particular disease with such a condition of the slaughter-house, yet
such conditions must result in a rapid development of putrefactive
bacteria, in the deposit by flies of different micro-organisms brought
from the festering heaps of offal and manure in the vicinity, and must
prevent the maintenance of the flesh in the clean and wholesome
condition in which it may have been up to the time of hanging in such a
place. A well-kept slaughter-house will have the ceilings, side walls,
and partitions frequently painted, or else scrubbed and washed. The
floor of the building, particularly, should be made water-tight, with
proper drains so that the blood shall not remain on the floor to
saturate the wood and develop decay. An abundance of clean water should
be provided, so that the area may be thoroughly washed as often as used,
with proper drains provided for carrying away the dirty water. The
ventilation of the building should be complete, and provision should be
made for lifting and moving carcasses without handling.

In most small slaughter-houses, the obnoxious practice prevails of
maintaining a herd of swine to consume the entrails of the slaughtered
animals, and a more fearsome and disgusting spectacle than a dozen
lean, active hogs fighting over recently deposited entrails and
wallowing up to their bellies in filth can hardly be imagined. Nor is
this any fanciful picture. The writer has seen it over and over again,
the income from the hogs thus fed being one of the principal assets of
the establishment. Such hog meat is not fit for food. The refuse from
the slaughter-house ought to be carried away and buried; its fertilizing
value will not be lost if it be put in the garden, and the effect of the
prompt removal of this refuse will be to improve the character of the
entire slaughter-house.




CHAPTER XII

_FOODS AND BEVERAGES_


Before discussing the question of suitable foods for individual needs or
the ill-health which is so likely to follow an unrestrained or unwise
diet, it will be well to trace briefly the passage of food through the
human body, with the various changes which take place in its mass from
the time it enters the mouth _until_ it is absorbed by the stomach.

_The human mechanism._

In a little book by Hough and Sedgwick entitled "The Human Mechanism,"
the authors point out that in many respects the human body is like any
machine developing energy by the conversion of certain kinds of raw
material. Thus, as the steam engine will use up coal in the development
of mechanical energy, so the human body will absorb food and convert it
into vital energy, and it is quite as important that the human body
shall have its source of energy properly adjusted to its needs as that
the steam engine shall be fired with coal possessing a reasonable amount
of heat-producing particles.

The human body requires this supply of raw material for several
different purposes. In the first place, the very fact of living uses up
each minute a number of cells of various kinds in various organs. Each
breath taken, each heart beat, each muscular motion, all tend to the
destruction of tissue and involve its reconstruction. Violent exercise
uses up cell tissue very rapidly, so much so that a football player will
commonly lose from five to ten pounds in weight during a well-contested
game. It is a fundamental principle of training for any athletic event
involving hard exercise, that suitable food in large quantities must be
provided, and a young man training for football or rowing will eat
beefsteak, eggs, and other hearty food to an astonishing amount, all of
it going chiefly to repairing worn-out and used-up tissue.

In the second place, food is needed to supply material for growth, and
so it is that a growing boy eats out of all proportion to his size, and
the fact that he seems to be, as it is said, hollow clear to his feet,
is only his rational endeavor to supply the material needed for his
growing body.

In the third place, food must be supplied for the work to be done by the
body, as distinguished from the loss of tissue due to the performance of
the work, and finally, food must be provided in order to maintain the
bodily temperature, a larger amount being naturally required where the
difference between the temperature of the body and the outside air is
very great, as in the Arctic regions.

The human body being a special kind of machine, the raw material
supplied must be adapted to the needs of the machine, and while a lump
of coal admirably supplies energy for a steam boiler, no one would think
of feeding a lump of coal to a human being, simply because, by
experience, we know that suitable energy is not thereby developed. In
the matter of suitability of foods, much depends upon the local supply.
It is not to be supposed, for example, that the Eskimos eat meat and fat
altogether because it is the best article of food for them, but rather
because it is the only food available. It would be foolish to prescribe
fresh fruit or even white bread for the Eskimos because it is out of the
question for them to get such food. But, in general, it is possible for
the average individual to choose his supply of raw material in
accordance with the needs which his experience has pointed out and with
the teachings of scientific investigators on this subject. Raw material,
however, is not converted into energy by any simple operation. The human
body is made capable of taking raw material of most varied kinds and
transforming it into nutriment capable of being absorbed by the system
and made over into cell tissue. It will be worth while to indicate the
steps of this complex process.

_Digestive processes._

The mouth plays the first part in the scheme of transformation, and here
two operations are performed. First the food is crushed and ground by
the teeth, exactly as when, in some chemical processes, a fine grinding
is essential for the subsequent transformation. In this country, this
preliminary process is often sadly neglected, so much so that a
distinguished investigator, named Horace Fletcher, has, within the last
few years, established a school for the cultivation of the habit of
chewing, with the idea that if this practice could be encouraged and at
least twenty chews taken with every mouthful, the health of the
individual would be vastly improved and sick persons even cured merely
through this practice.

The other function of the mouth is to mix with the food the saliva
which drops from small glands in the back of the mouth into the food.
The action of the saliva is partly to lubricate the food, so that it
will slip down easily, and no better proof of this can be found than
trying to eat a cracker rapidly without chewing. But it also acts on
starch which is not digested easily unless mixed with this ferment. The
action of the saliva on starch is to convert it into sugar, which is
easily absorbed later on. Curiously enough, most persons would be more
apt to chew a piece of meat thoroughly than to chew a piece of bread,
and yet the meat contains practically no starch and therefore does not
need the action of the saliva, whereas bread is chiefly made up of
starch and therefore needs the saliva as an essential for digestion.

The food then passes down into the stomach, which is a sort of
storehouse, preparatory to the really important steps in digestion.
Here, the food is acted upon by another element known as gastric juice,
which is supplied by small glands found in the membrane of the stomach.
The mixture of food and gastric juice is made very thorough by the
continual agitation of the food, so that the mass is softened as well as
thoroughly mixed. The effect of the gastric juice is to act upon that
portion of food known as proteids. Examples of almost pure proteids are
found in the fiber of beef and other meat, in the yolk of eggs, and in
cheese. Some vegetables, such as peas, also contain large quantities,
and coarse flour and oatmeal contain considerable percentages. The
effect of the gastric juice on this proteid matter is to break up the
complex molecules into small molecules which then pass into solution,
making the mass leaving the stomach a uniformly mixed semiliquid
substance of about the consistency of thick pea soup. The food then
enters the smaller intestine, at the beginning of which the juices from
the pancreas are added. The pancreas is a gland which furnishes a
strongly alkaline liquid neutralizing the acid of the gastric juice, so
that the gastric agent, pepsin, loses its power. From this gland comes a
material which can act on all kinds of food and which is by far the most
important of the digestive juices.

When thoroughly mixed with the bile and pancreatic juice, the contents
of the intestine are gradually absorbed, in so far as their condition
allows, by the surface of that organ and are carried away by the ducts
designed for that purpose to the various organs, while that part not
suited for absorption is eliminated.

_Teachings of the digestive operations._

The matter of hygienic eating, therefore, consists in supplying the
various organs, the mouth, the stomach, and the smaller intestine with
proper food in proper quantity, so that the body itself may be properly
nourished from the food supplied. A great deal of scientific
investigation in this connection has been made to ascertain any relation
which may exist between the different kinds of food and their
availability for the body. Scientists have divided all food into four
classes, namely, proteids, carbohydrates, fats, and inorganic salts, and
they have agreed on the following general statements with reference to
these four classes. Examples of almost pure proteids have already been
given, and it may here be added that carbohydrates are typically shown
by the starchy particles found in potatoes or wheat. Chemically, the
difference consists in the fact that proteids contain nitrogen whereas
carbohydrates do not. Fats are self-explanatory, and the group of
inorganic salts includes such material as salt, lime, phosphates, and
other minerals needed by the body but not requiring digestion.

Just what function each one of these four groups plays in the nutrition
of the human body is not definitely understood, but it seems that the
proteids are particularly useful in building up cell tissue, that the
carbohydrates are particularly useful in providing for muscular energy,
that the fats are particularly useful in keeping up the normal warmth
rather more by laying on a blanket of fat over the bones than in
actually consuming the food in the creation of heat. These statements
are not absolute, since experiments have shown that some tissue-building
can go on even if proteids are rigorously excluded from the diet, and on
the other hand that muscular work, while accompanied by a large
consumption of carbohydrates in the body, may come from proteids
entirely. This may explain why men can live and even do a reasonable
amount of work eating meat and fat altogether, as in the Arctic regions,
or dry bread and fruit in other regions, the above facts being
complicated by the influence of muscular exercise on the activity of the
digestive system.

No principle of hygiene is better established than that men undergoing
hard physical exercise need and will take care of a larger amount of
coarse food than those occupied in sedentary work. In cold weather what
is required is not really more fat as food, but more food. It has been
found that there is a limit to the amount of meat food which the body
can absorb, and, further, that the excess is not easily disposed of, as
with starchy food, and tends to load up the liver and other organs with
the waste products, resulting in general disturbances of the whole body.
It is commonly known, for instance, that high-livers, as they are
called, are likely to be troubled with diseases like indigestion,
rheumatism, or gout,--diseases which are the result of overburdening
those organs just mentioned.

_Balanced rations._

TABLE XVI

==================================+======================================
                                  |          WEIGHT IN GRAMMES
CONDITION                         +-----------+-----------+--------------
                                  |  Proteid  |    Fat    | Carbohydrates
----------------------------------+-----------+-----------+--------------
Child up to 1-1/2 years (average) | 0.71-1.27 | 1.06-1.59 |  2.12-3.18
Child from 6 to 15 years          |           |           |
  (average)                       | 2.47-2.82 | 1.30-1.76 |  8.82-14.10
Man (moderate work)               |    4.16   |    1.98   |    17.63
Woman (moderate work)             |    3.24   |    1.55   |    14.10
Old man                           |    3.53   |    2.40   |    12.34
Old woman                         |    2.82   |    1.76   |     9.18
Atwater (man, light exercise)     |    3.70   |    3.70   |    13.3
Chittenden (man, light exercise)  |    2.16   |    2.83   |    13.0
==================================+===========+===========+==============

A well-designed food ration, therefore, will be one which will provide
the body with the proper amount of food material wisely adjusted to the
occupation and the digestive ability of the individual. It has been, in
the past, a matter of very exact computation to determine how many
ounces of proteid food, how many ounces of starchy food, and how many of
fatty foods should be consumed during the day, and experiments have been
made in asylums, prisons, and on companies of soldiers with a view to
proving the theoretical figures.

It has always been found that an overdose of proteids results in
inability to absorb the excess, and it has been assumed that a ratio of
proteids to carbohydrates of one to four is approximately the proper
proportion. For instance, Koenig (1888) shows the minimum daily need of
food stuffs at different ages and two American authorities, Atwater and
Chittenden, have also laid down standards; all three being shown in the
preceding table.

The following table taken from Rough and Sedgwick's book, already
referred to, gives the percentage composition of some of the more common
foods:--

TABLE XVII

============+=======+=========+========+=======+======+======
            | Water | Proteid | Starch | Sugar | Fat  | Salts
------------+-------+---------+--------+-------+------+------
Bread       |   37  |    8    |   47   |   3   |  1   |  2
Wheat flour |   15  |   11    |   66   |   4.2 |  2   |  1.7
Oatmeal     |   15  |   12.6  |   58   |   5.4 |  5.6 |  3
Rice        |   13  |    6    |   79   |   0.4 |  0.7 |  0.5
Peas        |   15  |   23    |   55   |   2   |  2   |  2
Potatoes    |   75  |    2    |   18   |   3   |  0.2 |  0.7
Milk        |   86  |    4    |   --   |   5   |  4   |  0.8
Cheese      |   37  |   33    |   --   |   --  | 24   |  5
Lean beef   |   72  |   19    |   --   |   --  |  3   |  1
Fat beef    |   51  |   14    |   --   |   --  | 29   |  1
Mutton      |   72  |   18    |   --   |   --  |  5   |  1
Veal        |   63  |   16    |   --   |   --  | 16   |  1
White Fish  |   78  |   18    |   --   |   --  |  3   |  1
Salmon      |   77  |   16    |   --   |   --  |  5.5 |  1.5
Egg         |   74  |   14    |   --   |   --  | 10.5 |  1.5
Butter      |   15  |   --    |   --   |   --  | 83   |  3
============+=======+=========+========+=======+======+======

It will be noted that meats, cheese, and such vegetables as peas are
high in proteids, while certain other vegetables, as rice and white
flour, are high in starch or carbohydrates. According to the table given
above, a man at moderate work requires 4.1 ounces of proteids and 17.5
ounces of carbohydrates per day. If, then, the carbohydrates were to be
made up entirely from potatoes, 18 per cent of which is starch and he
should need 17.5 ounces, he must have 100/18 of 17.5 or 97 ounces of
potatoes per day, an amount equal to about 6 pounds. If, however, with
the potatoes, he should eat half a pound of bread, of which about half
is carbohydrates or 8 ounces, the amount of potato necessary would be
cut down, and so on with as many combinations as one might choose to
make.

It is curious, however, that when different kinds of food are available,
one naturally combines different articles of food, so as to make up the
well-balanced daily ration, so that the different parts may have the
proper proportion. For instance, butter is always used with bread in
order to add to the proteid and starch of the bread the necessary fat.
With potatoes or rice, either butter or gravy or meat is always used
because potatoes and rice are lacking in proteids as well as in fats
which the meat supplies. Bread and cheese are well known to make up a
good combination, and the table shows why: the bread furnishing the
starch and the cheese the proteid and fat. Eggs alone are a very poor
article of diet since no starch at all is present, and therefore it is
that when eggs are eaten for breakfast, as is so generally the custom
to-day, either a generous helping of cereal ought to be given with the
egg or else a generous supply of bread or toast ought to be included in
the breakfast. Milk is generally considered an ideal article of food,
and yet it contains no starch, and it is undoubtedly because of this
fact that milk and bread is more palatable as well as more nutritious
than milk alone.

_Human appetite._

One other factor needs to be considered in this matter of selecting
one's daily food, and that is the respect which must be paid to the
appetite. The most carefully balanced ration will fail to satisfy the
ordinary human being unless it is served attractively and unless
sufficient variety is provided. To be sure, soldiers in the army are
furnished a carefully computed ration consisting of so much meat, either
fresh or salt, so much bread, and so much vegetable food, and the
variety being small, the soldier has to put up with his dislike to the
same food day after day. The need of fresh vegetables has been proved by
the results of a continuous diet of salty food on certain classes of
men, such as sailors.

It is well known that a failure to provide fruit or fresh vegetables
results in the disease known as scurvy, for which, practically, the only
cure is a changed diet. The writer has no doubt but that in many
farmhouses a very similar condition, perhaps not so pronounced, exists
on account of this very lack of variety in the daily menu. He remembers
to this day a week's experience in the house of a well-to-do farmer in
the early spring when the winter vegetables were exhausted and before
summer vegetables appeared, when the dishes offered three times a day
throughout the week were salt pork in milk sauce and boiled potatoes.

Providence intended the different digestive organs of the human body to
work, and there is no possibility of condensed or concentrated foods
taking the place of ordinary victuals, as has been suggested. The
stomach must have some bulky material on which to work, and similarly
the intestine must be comfortably filled in order to exert its forward
movements. It is in the same way intended that each organ shall supply
the necessary digestive juices to take care of the different kinds of
foods taken into the system. It is just as important that the liver
should be called upon to act on a certain amount of fat as that the
gastric juice should break up the molecules of the proteid, and just as
important as both of these is the fact that the saliva should flow
freely to decompose the starch before it enters the stomach. It is not
intended, however, that the healthy individual should deliberately
overload any part of the digestive system.

If a child, in a hurry to get to school, swallows bread and milk without
chewing and without allowing the starch to be acted upon in the mouth,
then an overburden is placed on the pancreatic gland, making that organ
less capable of its regular work. And if, again, the food is drenched in
fat, if everything is fried, or if butter is used in large quantities,
the liver becomes overworked and cannot keep up with the demands, and
digestive troubles follow.

_Effect of individual habits._

Assuming that the amount and quality of food have been properly
adjusted, that each of the several constituents is in proper proportion,
and that a suitable variety is maintained, there are still other phases
to be considered before the nourishment of the individual may be
considered satisfactory. Nature has furnished man with a guide both to
the quantity and quality of food that should be taken into the
system,--that is, his desire for food, or his appetite,--and, in
general, this guide may be safely trusted both as to the quantity and
quality, although, in the latter, the appetite is not so trustworthy as
that of the lower animals.

Unfortunately, the appetite is easily distracted by the general
conditions of health, and when once the healthy tone of the system has
been relaxed, the appetite becomes misleading. For instance, a person
not indulging in muscular exercise, but sitting still all day and eating
candy or other sweets, has no desire for food, and the lack of appetite
in this case indicates, not a failure of the need of food, but abnormal
conditions of the system. Also the conditions of housing, lack of
ventilation, excessive heat, excess in the use of stimulants or of food,
all affect and interfere with the guidance of a normal appetite. Some
persons go to the other extreme, and, having been in their earlier years
accustomed to heavy exercise and generous feeding, forget that in a more
quiet life, less breaking down of the tissue occurs and therefore less
food is required. Their appetite is a poor guide since it leads them to
immoderate eating, resulting in time in an overloading of the organs and
the probable poisoning of the system.

_Cooking._

Good cooking is as important as any other part of the process of
digestion, and, in fact, cooking may be said to be the first step, since
there the breaking down of the food tissue occurs, whereby subsequent
action by the juices of the body is made easier. For instance, beef may
be cooked so long and in such a way as to dry and harden the fibers,
making it almost impossible for subsequent digestion; and on the other
hand, it is possible to so stew or boil or steam tough meat as to make
it quite easily absorbed by the stomach. Cereals, if properly boiled at
the right temperature, and for the right length of time, will have the
starch granules so broken up that the saliva will act easily on the
broken granules. Raw vegetables containing starch are not acted upon in
the mouth and are digested afterwards only with great difficulty, while
cooked vegetables are a most desirable article of diet.

A great deal is said nowadays about overeating, and Horace Fletcher
affirms that the average man would be much healthier and much stronger
if he ate not more than two meals and generally only one meal a day. The
relation between the amount of food eaten or the amount of food absorbed
or utilized and the need for food cannot be determined for the average
but only for the individual. There is no doubt but that men or women
doing muscular work require greater amounts of food than those not so
engaged. It is a common practice to increase the amount of oats which a
horse consumes when the horse has hard work to do and to cut down the
amount of grain when the horse stands in the stable. It is curious that
this practice, so well known to give good results, is not applied to the
human animal as well. But very few men will be found voluntarily to
diminish the amount of their breakfast or dinner because on that day or
on the following day they are going to stay in the house instead of
engaging in vigorous outdoor labor.

No discussion on foods would be complete without a repetition of the
frequently given warning, against fried meats and vegetables. Frying
coats the outside of the food with a layer of fat not easily penetrated
by the digestive juice and not acted on in the stomach. Therefore, all
fried food, unless thoroughly chewed and then only when the frying is
done in very hot fat so that it remains on the outside of the whole
piece, will pass through the stomach without being acted upon. Frying is
a quicker process than roasting, an advantage which appeals to the
American notion of haste, but it is better to begin the preparation of
the meal earlier and cook the meat by roasting or stewing and the
vegetables by boiling or baking rather than to postpone the preparation
of the meal until ten minutes before the hour and then fry everything.

_Muscular and psychic reactions._

Another factor in the power of the body to utilize the food values is
the condition of the body at the time of the meal. If the individual is
exhausted or even tired, no complete digestion is possible, and
particularly is this true if the exercise has involved excessive
perspiration. So in hot weather, a heavy meal should not be eaten until
after a half hour's rest and after copious water drinking to compensate
for that loss of perspiration.

Studies on the digestion of foods and on other matters pertaining
thereto have shown that the smell of food, or the mere suggestion of
food, stimulates the organs for the production of the digestive juices.
It is directly and literally correct, therefore, to say that one's mouth
waters for this or that food because the thought or anticipation of the
food, if pleasant, will actually cause the saliva to form and flow in
the mouth. This is true of the other digestive juices as well, so that
an appetizing fritter, for instance, showing the rich, brown crust will
stir up the bile, and when the fried cake reaches the opening into the
intestine, the bile will be there ready to act. This has been
demonstrated by putting into the stomach of sleeping dogs various kinds
of foods and finding that no digestive juices whatever were produced,
although with the dog awake and seeing the food before eating, the
juices began to flow in the usual fashion.

It follows, then, that the enjoyment of food is quite as important as
any other digestive function, and on the contrary, the eating of all
sorts of foods with no interest or attention is the best way to induce
subsequent indigestion. The fact, then, that a business man eating at a
quick-lunch counter does not get the full enjoyment and benefit from his
meal as compared with those who sit leisurely over a well-appointed
table does not result altogether from the difference in the viands, but
rather in the different attitude toward the meal. It would undoubtedly
be a great gain in every household if more attention could be given to a
cheerful intercourse at meal times--not for the better relationship
which would follow, but merely for the effect on the digestion.

After meals, violent exercise is not desirable because thereby vitality
is taken away from the muscles of the stomach and intestines and is used
up in the other muscles; but it is vigorous exercise after heavy meals
only that is condemned, since moderate exercise after ordinary meals is
not objectionable. Nor is there any evidence, unless the meal has been
excessive, that mental exercise after a meal does any harm. The amount
of mental tissue used up in the ordinary processes of mental work is not
great enough to call for any large diminution of the supply of blood to
other parts of the body.

_Consumption of water._

A move in the right direction to-day undoubtedly is the tendency to
increase the quantity of water to drink. The body is nine-tenths per
cent water, and while a large part of the water in the tissues is made
chemically by combinations of hydrogen and oxygen, there must be a
constant replenishing of the liquids of the body.

The ordinary person ought to drink, or consume with his food in some
way, at least two quarts of water a day, and many difficulties with the
liver, kidneys, and other organs would be avoided if this amount of
water daily were imbibed. Probably the contention that water should not
be taken at meals is not particularly tenable except as the continual
swallowing of water increases the tendency to swallow food without
chewing, a childish habit sure to lead to distress later. But, to eat
one's dinner or part of one's dinner and then drink a glass of water
cannot reasonably be assumed to interfere with any digestive process. It
is quite likely, in fact, that the greater dilution of the mass in the
stomach will tend to easier absorption later on.

_Condiments and drinks._

There are certain kinds of foods which, though not strictly included in
the four elements of food already named, yet are so common as to deserve
special mention. Chief among these are the condiments and drinks,
particularly coffee and tea. So far as the nutritive value of such
materials as salt and pepper, vinegar or spices, goes, they are
practically negligible, and yet, undoubtedly, these flavors play an
important part in the suggestion of pleasure and therefore in the
excitement leading to the excretion of the digestive juices. If one ate
salt pork and boiled potatoes always, eating would be a tiresome affair,
and it is quite likely that such a sameness of food would fail to
excite subsequent digestion, merely from the monotony of the affair.
Salt, however, has a particular rôle in that the human body craves this
mineral, and, while its exact value in the body is not clearly known, a
certain amount of it must always be provided. The wild tribes of Africa,
for instance, away from deposits of salt consider it their most valuable
possession and will go to great lengths to procure it. Animals, in the
same way, go great distances for a supply of salt.

Coffee and tea are generally consumed merely for the pleasure which the
warm drink gives. Both, however, have a certain stimulating effect on
the nervous system, and when a tired woman refuses food but drinks cup
after cup of strong tea, the exhilarating effect can be produced only at
the expense of nerves and muscular tissue which must be later atoned
for. Similarly, when a man under stress drinks strong black coffee to
keep up, he must pay the penalty for the stimulant. The natural forces
of the human body are able to do normally a certain amount of work,
their ability to perform this work being directly proportioned to the
energy derived from the food-supply taken into the body.

No amount of tea, coffee, or alcohol will add to the living tissue of
the system; it merely goads the nerves and muscles to further action,
however tired and unwilling they may be. When the stimulant is stopped,
or after a time in spite of the stimulant, the exhausted nerves and
muscles refuse to continue, and the depleted body stops work and may
even die. A certain amount of stimulants at infrequent intervals for
particular occasions may do no harm, but the pity of it is that the
habit once started, the ultimate effects are forgotten in the apparent
relief of the moment. In the case of tea, besides the stimulating
effect, a certain substance known as tannin is developed, particularly
when the tea is boiled, and this substance is really harmful on account
of its strong astringent property, which acts injuriously on the
membrane of the stomach. The bitter taste of the tannin is disguised
when milk is used with the tea, and it has been pointed out that tea
used without milk or cream is safer than tea with milk, because without
the milk the bitter taste would prevent the tea being boiled so long.

Alcohol is stimulating in its nature, because of its setting free from
their usual control by the will the unconscious elements of the brain;
while the effect of alcohol on the system as a whole is, as has been
carefully proved by scientific investigation, unfortunate in every
respect. Whether the alcohol be in the form of whisky or brandy or gin
or in such milder forms as wines, beers, and hard cider, the continued
use of even a small quantity acts adversely on the memory, on the will,
on the intellect, on the inventive power, and on all the mental
processes. It has a deteriorating effect on all the muscular tissue
throughout the body, and while this is sufficiently deplorable, its
effect on the mind is by far the more serious. No idea is more false
than that a small amount of alcohol aids in the performance of work of
any sort, and experience in the army, navy, and in exploring expeditions
all go to show that the use of alcohol in any form reduces the capacity,
both for activity and endurance. As a protection against cold, it is
worse than useless, and the feeling of warmth which drinking alcohol in
any form produces, does not manufacture heat in the body, but is rather
a source of danger on account of the reaction of the whole system.

_Tobacco._

The use of tobacco may or may not be injurious to the human system, and
it is said by those accustomed to its use that it is for them a source
of great enjoyment and comfort. The essential poison of tobacco is known
as nicotine, and experiments are very readily made with this substance,
extracted from the plant, to show its deadly character on the heart and
nerve cells of animals. It is easy to demonstrate that the use of
tobacco affects the heart, since the common "out-of-breath feeling"
which comes to users of tobacco when climbing hills or running is well
known. No young man training for an athletic event would think of
smoking, on account of the danger to his wind.

No boy should smoke, because nothing should be allowed to interfere with
the fullest development of the heart and nervous system, and without
question tobacco is a potent factor in influencing both. In many
individual cases it has been shown that the use of tobacco in excess has
a bad effect on digestion, while in other cases the trembling hand and
inattentive mind indicate the result on the nervous system. No general
law or rule can be laid down, and each man must act as his own
individual constitution seems to require.

_The drug habit._

The use of drugs is, in some cases, so persistent and leads to such dire
results that it is well worth while to enter a protest against such
practices. The poor creatures who have become fast victims of the
morphine habit or the opium habit or the cocaine habit, or of any one
of a dozen which might be named, will not be affected by anything that
may be said here. But a word of warning may serve to restrain those who
are only at the beginning of this downward path of which the end is
positive and certain. The use of drugs once begun is sure to increase
until, stupefied by their action, the victim becomes a sot, unfitted for
work and a burden to himself, his relatives, and his friends.

Not less dangerous is the use of so-called patent medicines. In most
cases, patent medicines are swindles, pure and simple, containing no
remedial ingredients and acting only as stimulants. An advertisement
some time since, which claimed to cure not only tuberculosis but also
cancer, falling of the womb, hair, or eyelids, insanity, epilepsy,
drunkenness, disorderly conduct, and pimples was printed in many
newspapers. This remarkable remedy was found by analysis to contain
ninety-nine parts of water to one part of harmless salts. Many of the
vaunted remedies contain morphine or alcohol in such large quantities as
to be dangerous, the more so because their presence is not suspected.
Such remedies as Dr. Bull's Cough Syrup, Boschees German Sirup, Dr.
King's New Discovery for Consumption, Shiloh's Consumptive Cure, Piso's
Consumptive Cure, Peruna, Duffy's Malt Whisky, Warner's Safe Cure, and
Paine's Celery Compound are all by analysis said to contain large
amounts of morphine, chloroform, or alcohol.

Consumptives cannot be cured by any drug now known, and any person who
believes it is mistaken. Cancer still baffles the skill of the most
clever and the best-trained scientists. It is perfect folly to believe
that any drug or man can cure either disease by a few pills or by a few
bottles of medicine. The wise man or woman will avoid patent medicines
unless they carry their formula on their label _and unless they are
prescribed by some reputable physician_.




CHAPTER XIII

_PERSONAL HYGIENE_


Whatever the conditions under which one lives, or whatever his abstract
knowledge of foods and sanitation, the health of the individual resolves
itself at last into a question of his personal habits; and some of these
personal questions must be considered in a book of this character.

_Exercise._

One of the commonly accepted facts of hygiene is that, for the best
development and for the perfect health of the human body, a certain
amount of exercise should be taken by each part of the body. This is
true not only for the larger muscles, such as those of the arms and
legs, but also for the muscles of those internal organs less frequently
considered. Experiments have been made by tying up some part of the
body, such as the forearm, with the result that, in the course of a few
weeks, its functions have been so lessened that its usefulness is
temporarily at an end. But the general effect of exercise on the body,
aside from the beneficial results on the particular muscles engaged, is
to promote the building up of new lung tissue. Oxygen is received from
the lungs through the blood and is carried to the different parts of the
body, where it serves the useful purpose of carrying off the waste
products of the different organs. If the lung action is inadequate, if
deep breathing in fresh air is not practiced, or if, through laziness,
no exercise is taken, then the amount of oxygen supplied will be
deficient and the body will be loaded up with the toxic products
resulting from decomposition. The exact effect of exercise upon the lung
action may be seen from the fact that under ordinary circumstances a man
breathes about 480 cubic inches of air per minute. If he is walking at
the rate of 4 miles an hour, he inhales air at 5 times this rate, and if
he is walking at the rate of 6 miles an hour, inspiration increases to
seven times this rate, or 3360 cubic inches of air passes through his
lungs per minute instead of 480, as when at rest.

Of course, it is assumed that in the country a person has no lack of
exercise, and that of all men the farmer is in least need of exercise.
But, as a matter of fact, the exercise which he gets is irregular and
confined to certain sets of muscles, rather than to the development of
the whole body. Agility, for instance, quickness of action and immediate
control of the muscles, is far less common in the country than is
supposed, although there is probably no lack in the actual power of the
muscles. It is common observation that among farmers an erect carriage
is less frequently seen than an awkward, shuffling gait. The fact is,
that exercise, to be beneficial, should affect not one set of muscles,
but all the muscles of the body, because the continuous exercise of one
set, while leading first to growth, results later in demolition and
waste. When, however all the muscles of the body are exercised, there is
no demolition or waste, but a healthy growth throughout. Regular
exercise is beneficial, not merely to the muscles involved, but also to
the other organs of the body. Exercise sharpens the appetite, makes
digestion more perfect, and increases the absorptive power of the
intestinal membranes; conversely, lack of exercise, which is found in
the country in the winter, lessens both the digestive power and the
appetite.

_Clothing._

Little need be said on this subject, since the amount of clothing needed
varies so greatly with the vitality of the individual. It has already
been pointed out that in rural communities the death-rate from
pneumonia, bronchitis, and similar respiratory troubles is much higher
than in urban communities, and it is quite possible that deficient or
unsuitable clothing is practically responsible for this.

The object of clothing is twofold: to protect the body against the
weather, particularly against changes in the weather, and secondly, to
protect the body against injury. Included in the former are the defenses
against the elements of cold, wet, and heat; while the protection
against injury is chiefly a matter of shoes. As has been pointed out, a
large part of the food consumed by the body is utilized in the
production of heat, whereby the body temperature is maintained at about
98 degrees Fahrenheit. A large part of this heat is continually being
lost from and through the skin by radiation and evaporation, and
evidently some regulating influence must be provided so that the amount
of heat given off may be adjusted to variations of the external
temperature. To be sure, the skin itself acts as a regulator, since a
rise in temperature causes the blood vessels on the surface to distend
so that a larger quantity of blood is distributed over the surface and
thereby more freely evaporated. Fall of temperature, on the contrary,
causes a contraction of the blood vessels and therefore a reduction in
the evaporation. But this is not sufficient where external temperature
undergoes wide variations, as in the northern and central parts of the
United States, and a modification of the clothing is a necessary
supplement. The main object of clothing, then, is not to keep out cold
or heat, but to preserve and make uniform the evaporation from the body.
It is an agent of the same sort as food in so far as the body
temperature is concerned, and without doubt light clothing requires a
greater amount of food; while, on the other hand, warm clothing will
make possible a lighter diet.

The best non-conductor of heat is still air, and if one could always
remain in quiet air, no clothing of any sort would be necessary, even in
the most severe weather, because the air itself would serve as a garment
and would prevent radiation from the body. Therefore, loose, porous
garments containing air in their folds and pores are much warmer than a
single, tightly woven garment, and the same material made up in three or
four thicknesses will give the body far more warmth than an equal weight
of texture made up in a single thickness. Similarly, a tight garment is
much less warm than a loose one. A practical demonstration of this fact
is found in the comparative lack of warmth in an old, much-washed,
quilted, bed blanket which is very heavy but quite lacking in warmth
compared with a light fluffy woolen blanket, newly purchased.

Much has been written on the advantages of woolen underwear, on the
ground that since clothing is intended to retain the body heat and
since wool acts as a more effective non-conductor of heat than either
cotton or linen, therefore the woolen undergarment is of the greatest
value. Another argument urged in favor of woolen undergarments is that
they check the chill resulting from excessive perspiration, since the
non-conducting power of wool prevents any rapid evaporation of
perspiration responsible for the lower temperatures. For this reason,
woolen undergarments are always recommended for those climbing mountains
or in occupations where violent exercise is likely to be followed by
rest or quiet in cold air. The objection to woolen undergarments at all
times is that with sensitive skins irritation may take place, and the
odd saying of Josh Billings becomes pertinent, namely, that "the only
thing that a wool shirt is good for is to make a man scratch and forget
his other troubles." Underwear woolen only in part may take the place of
all-wool garments and have the further advantage of being less
expensive. The amount of clothing worn in winter depends, or should
depend, on the character of the occupation of the wearer.

Formerly, heavy woolen underclothes were almost universally worn
throughout the winter without regard to the employment of the
individual. When an out-of-door occupation was pursued a large part of
the time or when the temperature indoors was hardly above freezing, then
heavy clothing was essential; but now that much time is spent in a
well-heated house or office, heavy clothing is as objectionable as
overheated rooms, and the comfort and health of the body will be much
better preserved by not increasing the weight of clothing except when
exposed to the outer air. It must be remembered, however, that old
persons, whose circulation is impaired and who are forced to lead
sedentary lives, will always have difficulty in maintaining the body
heat unless the outer temperature is high, and for such, woolen
undergarments are very useful. The outer garments in winter, to be
efficient, must have two qualities, namely, an impervious surface so
that winds may not penetrate and a loose open weave in which air may be
held so that warmth may be secured.

Rubber boots, although very common in the country, are not desirable as
a foot covering, because they do not allow the perspiration to
evaporate, but rather hold the foot in a moist condition very
detrimental to it. Rubber-cloth overshoes or arctics are much better
than rubber boots, and felt overshoes are equally satisfactory.
Chilblains are fostered by the use of rubber boots, and cloth shoes are
a great relief when the feet are thus affected.

_Ventilation of bedroom._

Since the agitation for fresh air has become so extensive and the
knowledge of the dangers of tuberculosis so widespread, much more
attention has been given to the ventilation of bedrooms, and whereas
formerly the night air was religiously excluded from a sleeping room, it
is not at all uncommon now for a window to be kept wide open, even
through the coldest nights of winter. From what has already been said on
the subject of ventilation, it is plain that to breathe over and over
one's expired air is not healthy, and while it is possible that a
bedroom may be so large that the concentration of the organic matter in
the air may not affect an individual sleeping in the room, yet in most
cases it must be admitted that the bedroom is so small or the number of
people in the bedroom so large that this possibility does not exist. It
is, again, possible that the structure of the house may be so poor that
it is not necessary to open a window to get plenty of fresh air; the
writer remembers sleeping in rooms where, with the windows shut, paths
of snow across the floor in the morning showed the intimate connection
between the inside and the outside of the room.

But the tendency nowadays is to build better houses, to cover the walls
with paper, to put on double windows, and even to paste up the cracks to
make the room as air-tight as possible. To sleep in such a room without
a window open may not be committing suicide, but it is a deliberate
method of reducing the vitality, of insuring a headache or a numbed and
stupid mental condition, and of loading up the system with poisons which
ought to be eliminated by the oxygen which fresh air supplies. It would
add many years to the lives of the people of this country if, from
childhood up, the habit was formed of sleeping with the window open. Nor
need one fear that a cold would result from such exposure. A cheesecloth
screen in the window prevents any draft and yet allows perfect
ventilation. The face is trained to all kinds of exposure without any
danger of catching cold, and there is no reason why, if the bed clothing
be sufficient, the night air should not be thoroughly enjoyed without
danger. Of course, the bed clothing must be sufficient; two lightly
woven blankets are always better than one heavy one. Wool is better than
cotton; if a cotton quilt is used, it should be loose and not tied
tightly.

_Bathing._

An important function of the skin is to expel objectionable elements
coming from the breaking down of the cells and from digestive processes;
the skin is quite as important a factor in getting rid of this waste
matter as those other processes more commonly considered in this
connection. This action goes on most energetically when the secretion of
perspiration is abundant and when the temperature of the surrounding air
is so high that perspiration does not evaporate as rapidly as
discharged. All these secretions contain more or less solid material
which, unless removed, accumulates on the surface of the skin to clog up
the glands and, in some cases, to putrefy and decay. It is this decay of
organic matter on the surface of the skin which causes the odors plainly
noticeable in a crowd, particularly in the winter time. This
accumulation can be prevented only by frequent bathing and by wearing
clean clothes, and there is no surer indication of a proper self-respect
than the habit of cleanliness, both as to one's person and one's
clothes. There is also the very practical feature that cleanliness is an
effective method of discouraging infection and disease, partly by the
removal of scurf and partly by the greater healthfulness of the skin
thereby induced.

Baths have always served as therapeutic agents, and evidences of their
use may be found in Roman paintings and in Egyptian sculpture to-day.
But from our standpoint it is their hygienic importance that is insisted
upon. Ordinarily, the temperature of the bath should be between 90 and
100 degrees, and enough soap should be used to counteract the oily
nature of the deposits on the skin.

Unfortunately, facilities for bathing, except in summer, have not been
generally supplied to detached houses in the country. Plumbing in most
houses has been lacking, but in these days bath-rooms are being
installed with surprising rapidity, and the conveniences resulting are
enjoyed as soon as they are understood. Only a few days ago, the writer
was told of a small village of perhaps two or three hundred persons
where this last summer one house, the first in the village, was provided
with a bath-room, to the great interest of all the villagers. The
convenience and comfort involved were immediately appreciated, and the
plumber, who came in from a neighboring city twenty miles away, secured
contracts for and installed twelve bath-rooms in twelve houses before he
was allowed to leave the village. This same interest is everywhere
noticeable, and the lack of bathing throughout the winter, formerly,
alas, so common, is now giving way to a greater cleanliness, thereby
improving the health and character of the inhabitants.

A great deal has been written about the value of a cold bath,
particularly in the morning, and many people, from a sense of duty,
suffer what is almost torture taking a shower bath or a cold plunge bath
on rising. When a cold bath (which should not last more than a few
seconds) is followed by a good reaction, that is, when after drying, a
distinct glow is felt, there is no objection to its use, and undoubtedly
it has a tonic effect for those whose vitality is able to endure the
shock. But cold baths for their tonic effect are desirable only when the
individual is assured of their lasting benefits. Nor must one judge of
the effects by the immediate results, inasmuch as the splendid feeling
which follows may be succeeded by a period of depression lasting the
rest of the day; in which case, the total effect of the cold bath is bad
rather than good. Baths for cleanliness are everywhere desirable, and
their frequency should depend upon the individual, his constitution,
habits, and work; upon the season and temperature; and on the
conveniences for bathing in the house. Baths for tonic effect are not
necessary, and if not a pleasure, may very properly be omitted.

One other point to be noted is that no practice is of more value in
reducing the ravages of contagious diseases than a frequent and
conscientious washing of one's hands. For germs are most certainly
transmitted from one person to another, and it is accomplished more
frequently by the hands than by any other part of the body.

The invitation, therefore, to a guest to wash his hands before dinner is
really an invitation for him to disinfect himself or to get rid of the
germs which he is carrying, in order that the host and his family may
not be infected during the meal. The guest owes it to his host always to
accept the invitation, whether he thinks he needs it or not. Doctors
recognize the necessity, and it is surprising to observe how many times
during the day a doctor washes his hands, even though he may not come in
contact with any particularly infectious disease. An ordinary man, on
the other hand, washes his hands only when he thinks they are dirty,
although his daily occupation may expose the skin of his hands to
infection many times worse than that which the doctor experiences.

_Mouth breathing._

Children have sometimes wondered why they were made with both mouths and
noses, since they could breathe equally with either, and many years
have gone by before they realized that breathing through the mouth was
not intended, but that the exclusive province of the nose was to furnish
air to the lungs. The reason for nose breathing rather than mouth
breathing is twofold. In the first place, no provision for removing or
filtering out germs from the air is made in the mouth, whereas in the
nose the crooked passages, the moist surfaces, and the hairlike growths
all tend to strain out any germs normally in the inspired air.

Further, breathing through the mouth has a tendency to induce
inflammation in the tonsils and in the air passage connecting with the
ear. This inflammation develops into those growths known as adenoids,
which, when enlarged sufficiently, close the nostril entirely and
prevent its normal use. A recent examination made by the New York Board
of Health of 150 school children, all in some way abnormal, showed that
137 had either adenoids or enlarged tonsils. Example after example could
be given of school boys and girls whose mental and moral development has
been markedly retarded because of mouth breathing. One need only look at
a child or adult who constantly keeps his or her mouth open to be
impressed by the listless, vacant, inert appearance of the face thus
disfigured. Figure 74 shows a photograph of a schoolgirl just before an
operation and the characteristic expression due to adenoids is plainly
marked. Earache is largely due to adenoids or to inflammation that
rapidly leads to adenoids, and Mr. William H. Allen, Secretary of the
Bureau of the New York Municipal Research, reports that in 415 villages
of New York State, 12 per cent of the children living there were found
to be mouth breathers. Whenever a child is unable to breathe through his
nose, is slow in talking, and then speaks with a stuffy accent, calls
"nose" "dose," has a narrow upper jaw, and is either deaf or has
inflamed eyes, it is practically certain that enlarged tonsils and a
well-developed growth of adenoids are present and should be removed. Not
merely do these growths interfere with the mental and physical
development of the child, but they also make him more susceptible to
contagious diseases, particularly those of the lungs and bronchial
tubes.

[Illustration: FIG. 74.--Schoolgirl with adenoids.]

The removal of adenoids is a simple operation, lasting not over a
minute, and the result of the operation is in some cases almost
miraculous. The medical inspectors of the New York City schools consider
the removal of adenoids as a most important part of their work, and
groups of children are regularly taken from the schools by the principal
to the clinic at the hospital, where one after another tonsils are cut
off or adenoids are removed, all fright and commotion being avoided by
the gift of five cents as a reward.

_Eyes._

Another evidence of advancing knowledge in matters pertaining to
sanitary hygiene is shown in the greater attention given to the eyes,
particularly of children. Such incidental troubles as headache,
sleeplessness, or biliousness are frequently due to weak or strained
eyes, and in the case of school children a great deal of the alleged
insubordination, backwardness, and truancy of the children is caused by
their being unable to see written instructions or explanations.

It is not likely that this increased difficulty with the eyes is a new
thing, but rather that both physicians and laymen are more careful as
well as more expert in diagnosing the trouble. The New York State Board
of Health in the fall of 1907 sent out cards for testing the eyes of
school children to 446 incorporated towns. The results of using these
cards in 415 schools were returned and showed clearly that nearly half
the children of school age in the state had optical defects. A similar
test in Massachusetts recently discovered 22 per cent of the school
children with defective vision, and this knowledge in itself is an
advance inasmuch as it suggests to each individual or to all parents
that deficient vision is common and that good eyesight is not a thing to
be assumed.

In the country it is more difficult, perhaps, to realize these
deficiencies, because the constant outdoor life acts as an offset to
the strain during the time when close work is required, and perhaps the
distance from a competent oculist serves to postpone the time of
consultation, but no greater folly can be indulged in than to suffer
inflamed eyes, persistent headache, and imperfect vision, if it is
possible in any way to secure the services of an oculist.

Never is it worth while to buy from a jeweler, a grocer, or a hardware
store a pair of spectacles, much less to buy them from an itinerant
peddler, since an oculist, with his particular apparatus, can measure
the seeing ability of each eye and fit each eye with the necessary lens
to restore normal vision. It is better to have no glasses than to have
glasses that are wrong.

_Teeth._

A curious result of the recent studies among school children with
defective eyes and ears has been the discovery that bad teeth were quite
as important in their relation to general health as either bad eyes or
ears. One eye specialist went so far as to say that the teeth of school
children should be attended to first, because thus many of the eye
troubles would disappear.

As has already been pointed out, the first, step in digestion is taken
in the mouth, and careful chewing is not less important than the other
parts of the digestive process. If one's teeth are not adapted to
chewing, if they are bunched, crowded, loose, or isolated, the
appearance of the teeth is the least objectionable feature. The real
importance comes from the fact that with such teeth perfect mastication
is impossible. The teeth themselves harbor germs which actually infect
the food and favor its putrefaction. With decayed teeth, infectious
diseases find a ready entrance to the lungs, nostrils, stomach, glands,
ears, nose, and membranes. At every act of swallowing, germs are carried
into the stomach. Mouth breathers cannot get one breath of
uncontaminated air, and dental clinics, organized and conducted in the
interests of the health of school children, have been altogether too
little inaugurated. The use of a toothbrush should be encouraged in
children as soon as they are four years old, and its habitual use twice
a day is most desirable for every one.

Only regular examination by the dentist can keep the teeth in good
condition, and periodic visits at least once a year to a dentist's
office, not to the kind advertised by Indians where they are willing to
extract teeth without pain, free, but where a regularly qualified
dentist practices, should be the habit. Armenian children, who prize and
covet beautiful teeth, are taught to clean their teeth always after
eating, if only an apple or a piece of bread between meals, and while
probably our American customs would hardly make this possible, there is
no question but that a persistent and frequent use of the toothbrush
will help much in reducing dentist bills.

_Sleep._

From many standpoints sleep is the most wonderful attribute of the human
body. Our familiarity, from our earliest years, with sleep, closes our
eyes to its strange, its awful power. We know that every human being,
once in twenty-four hours, will normally close his eyes and for a
certain length of time be as oblivious to things present as if already
in the sleep of death. It is a common belief that sleep is nature's
provision for restoring tired muscles and jaded nerves, and for building
up new tissue in cell and corpuscle. Excessive exertion produces a
numbness and exhaustion so that the body becomes "dead tired," and sleep
brings back life and elasticity. And yet some parts of the body, some
muscles and some organs, do not stop work during sleep, and apparently
feel no bad results for their continuous lifelong exertion. Thus, the
lungs, whose muscular action is estimated at the rate of one thirtieth
of a horse power, have no rest day or night, seemingly without
weariness. Similarly, the heart is continually forcing blood under a
pressure of about three pounds through the arteries without cessation
from birth to death.

Why do the muscles of the arm and leg tire and need sleep as a restorer,
while those of the heart and lungs are independent of sleep? Dr. W. H.
Thomson, in his book on "Brain and Personality," finds an answer to this
question in the fact that the latter do their work independently of the
human consciousness, while the former are stimulated and directed by the
will. He points out that fatigue comes in proportion to the intensity of
the mental effort expended. A baby, to whom everything is strange, whose
consciousness is absolutely zero at birth, however well developed his
body, sleeps five sixths of the time because of the mental efforts
needed in his simplest bodily acts. Brain work, the most absorbing task
of consciousness, is always the most compelling in the matter of sleep.
Not the muscles themselves but the attention, the skill, the mental
effort required to direct those muscles, Dr. Thomson says, constitute
the reason for sleep, a reason which, to those who labor only with their
hands, must seem unutterably sad. He says that while muscle work is the
commonest and the simplest, so it is also the most poorly paid and the
most degrading, and that while brain work is ennobling and the highest
type of labor, it is so difficult of attainment and produced only by
such grievous toil that most of us shirk it, even while reproaching
ourselves at our lack of capacity and purpose. The pathetic burden of
unfulfilled possibilities, he says, is the curse of labor, and only in
sleep does man have temporary oblivion through which, for a time, he
forgets his work and, as it were, uses sleep as an anæsthetic for the
pain of labor, to rise therefrom each morning ready to carry his burdens
for another day.

Lack of sleep, to those whose brains are active, speedily brings nervous
disaster, and the consciousness, from being the active superintendent of
the body, becomes inert, and the body drifts like a boat without a
pilot. Lack of sleep to those whose work is muscular means a numbness in
the nerve cells which guide those muscles, so that they disobey the will
or act unreasonably and without direction. But too much sleep, like
over-indulgence in any anæsthetic, is only shirking that duty and
avoiding that effort to which the higher life calls us, and the sluggard
who sleeps more than the tired nerves need is allowing himself to sink
deeper and deeper into a slough of despond. He forgets his toil in
sleep, but it is only by active, conscious effort when awake that his
work may be lifted to the higher plane where the brain is active, where
work ceases to be mechanical and a burden, and where that greatest
reward of personal satisfaction can be obtained.




CHAPTER XIV

_THEORIES OF DISEASE_


Disease may be defined as an abnormal condition of the human body, and
since there is no one condition of the human body which can be
satisfactorily described as normal, there is, therefore, no exact
definition of disease.

What is disease for one person because of a departure from his normal
health might not be recognized as disease in another person of different
normal vitality. Nor is it possible to assign any particular and special
cause for disease since the condition recognized as disease is the
result, usually, not of one but of a series of causes or circumstances
more or less connected and linked together, and in many cases not
obviously associated with the resulting disease. Thus, in records of
death, it is very common to see reported pneumonia as the cause
underlying and fundamental, when the cause was really typhoid fever, the
patient yielding to the former disease because of the enfeebled
condition due to the latter. Again, many children contract diseases like
measles or whooping cough because of reduced vitality due to
insufficient nourishment, lack of clothing, and neglect, and their
illness is said to be due to measles or whooping cough when under
proper conditions of care and attention they would not have the disease
at all. The causes of disease therefore may be divided into two classes,
direct and indirect. In the latter class are to be included such causes
as environment, heredity, age, and occupation. In the former class are
to be found such causes as the introduction of disease germs into the
system; the action of poisons, whether introduced into the alimentary
canal or into the lungs, and such external conditions as excessive heat
and cold and accident.

_Effects of dirt._

At one time it was thought that diseases could spring up in the midst of
dirt, and one of the strong arguments for keeping houses clean, for
removing manure piles, and cleaning up back yards, was the fear that
without such care diseases might be induced in those living near by.
This is possible in a certain sense, but unless the seed or germ of the
disease is present in a pile of dirt there need be no fear of the
disease being developed. There is, however, a probability that by the
organic decay and the consequent pollution of the atmosphere the
vitality, energy, and resistance of the individual in the vicinity may
be weakened.

It is well known, for instance, that prisoners confined in damp dark
cells lose vitality, and when released, have but little of their former
physical strength. In the chapter on Ventilation, it has been shown that
persons confined in a small room and breathing their own exhaled air may
in time become unconscious and die, and therefore it is reasonable to
believe that persons living in the immediate vicinity of decaying animal
or vegetable matter will suffer a loss of vitality and will have less
resistance to disease.

_Blood resistance._

It is well known that there are present in the body certain agencies
which act as guardians of the body against disease; that there are
certain corpuscles of the blood and certain liquids circulating through
the system which immediately attack and if in sufficient numbers or
strength drive out the advancing enemy, so that "taking a disease" in
most cases means that the activity of these resisting organisms is not
forceful enough to successfully combat the germs of the disease. These
agencies, whether circulating liquids or cells or corpuscles, are most
active in the healthy body, and anything that tends to reduce the
general health, such as exposure, overexertion, imperfect nourishment,
overeating or overdrinking, or lack of sleep, tends to diminish their
activity and so makes the individual more susceptible to disease.

_Cell disintegration._

Although disease is caused by the attacks of germs, another and far more
important cause of disease is the breaking down or overstimulation of
some particular organ. This is very plainly seen in diseases involving
the stomach or intestines, where habitual excesses in eating lead,
sooner or later, to consequent inflammation, disease, and death. This is
also true of the lungs; merely living in an atmosphere full of dust will
irritate the lungs to such a degree as to cause inflammation. Cancer is
presumably the result of local inflammation, although the cause of the
original suppuration is unknown. Similarly, appendicitis starts from
some irritating cause, resulting in inflammation and the formation of
pus. In very many cases the cell-disintegration seems to be a matter of
heredity.

_Heredity._

Heredity, the second of the indirect causes of disease seems to be
assuming less importance as it is more studied. Probably in but few
cases is heredity more than a chance factor in the causation of disease.
Heredity, formerly considered to be the most important cause of
consumption, is now understood to have little to do with this widespread
epidemic, although it is agreed that children brought up in the family
with a consumptive mother and father are more likely to contract the
disease than if they were segregated.

It is a providential arrangement that children inherit the tendencies of
both father and mother, and that the good qualities of one parent are
known to offset the bad qualities of the other; probably for this very
important physiological reason marriage between near relatives, where
both parents would be inclined to the same weaknesses, has always been
proscribed. However, even with the characteristics of the father
offsetting peculiarities of the mother, it is possible for the traits of
a parent to be reproduced in children, and this applies to mental traits
as well as to physical. In some families there exist tendencies toward
nervous diseases, such as epilepsy and insanity, although it is not
accurate to say that either disease is naturally inherited. It has been
observed that a tendency to cancer, to scrofula, and to rheumatism runs
in certain families, but this is hardly more than saying that in certain
families, where the predisposition in this direction by one parent is
not offset by the tendencies of the other parent, the physical condition
of the child is such as to encourage the development of diseases.

_Age and sex._

As indirect causes of disease, age and sex cannot be overlooked. It is
well known, for instance, that certain diseases belong essentially to
childhood, measles and scarlet fever being markedly prevalent among
children under ten years of age. In fact, it has been said by experts
that if measles could be kept from children under five years old, the
disease would be practically stamped out, since beyond that age they are
less susceptible and the course of the disease is much milder. No
greater mistake can be made than in exposing children to so-called
"children's diseases" because of a desire "to have it over with." Not
only is such exposure foolish, since it is quite possible to escape the
disease altogether if in the first few years of life it is avoided, but
also inviting death, since the mortality of the disease becomes markedly
less and less as the age of the patient advances.

Many of the diseases of children are due to imperfect and incomplete
development; either the lungs or the stomach or some other organ is not
equal to its work, and the child remains an invalid or dies. Many
children die from imperfect nutrition, especially in the second summer,
when teething is at its height, on account of the ignorance of the
mother and on account of unsanitary surroundings. No movement is more
promising in the way of prolonging the lives of children than that
recently inaugurated in New York which undertakes to teach mothers, of
foreign nationality in particular, how to dress, bathe, feed, and bring
up their children.

Another reason why disease occurs more frequently among children is, as
will be seen later, that one attack of a disease frequently confers
immunity upon the patient, so that, for example, a child having scarlet
fever is not likely to have the disease later on in life; but this is no
argument for exposing one's self to contagion, since it is quite
possible that even the first attack may be avoided. Tuberculosis or
consumption is preëminently a disease of youth, as is also typhoid
fever. It is very rare for the latter disease to appear in children or
in adults over forty-five, and for the former to develop until maturity.

In old age, diseases occur due to the gradual failure of the different
organs to perform their normal functions. Some of these diseases are
connected with the heart and the circulation, others with the liver or
with the mucous membranes, so that among those advanced in life,
rheumatism, gout, cancer, and diseases of the kidneys are very apt to
occur.

One of the objects of sanitation is to eliminate disease due to bacteria
and to prolong the normal life, so far as is possible, past the early
period when diseases are easily contracted. It is not hoped that death
can in any case be prevented, but hygiene will have done its utmost when
death occurs only among the aged and when the diseases then causing
death are only those which are consequent upon the wearing out of the
body.

So far as sex is concerned, the ordinary rules of hygiene or the
violation of those rules seem to have but little concern. It is
generally understood that males are on the average shorter-lived, by a
few months, than females, and all statistics support this position. Some
diseases, like typhoid fever, attack males more than females in the
ratio of three to two, while cancer attacks females to a greater extent
than males at about the same ratio reversed. Generally speaking,
however, excepting in so far as their occupations and manners of living
make different their vital resistance, the principles of hygiene are not
affected by the incident of sex.

_Occupation._

Inasmuch as this discussion is a part of rural hygiene and is assumed to
apply to only one occupation, namely, that of cultivating the soil, or
of raising stock, it may not be considered pertinent to discuss the
effect of occupation on disease. It is worth while pointing out,
however, that occupation is a very important factor as an indirect cause
of disease, and that one's chances of life are vastly greater in the
open country surrounded by hygienic conditions than in a city in crowded
quarters, confined for long hours each day at some unhealthy occupation.

As a general warning, it may be stated that a factory containing a
dust-laden atmosphere is most undesirable, and this is particularly so
when the dust is mineral dust. In the country, the only comparison of
conditions possible is between that of the outdoor worker and that of
the indoor worker; enough has already been said upon the value of fresh
air and its improving effect on the vital resistance to make further
repetition unnecessary. Unfortunately, in the past the occupation known
under the general term of farming has not made itself conspicuous in
statistics for healthfulness; but this has been undoubtedly due not to
the lack of the value of the outdoor part of the farmer's life, but to
the monotony of the work and to the very bad conditions found indoors,
particularly in the winter. When this indoor life has been modified so
that plenty of fresh air is supplied day and night, and when reasonable
attention is paid to the demands of the body in the matter of food and
drink, then the duration of life of farmers will rank high in comparison
with other occupations.

_Direct causes of disease._

The direct causes of disease may be due to the introduction into the
human body of a specific microörganism which, if not met by the
antagonistic agencies, finally pervades the whole system with its
progeny or its virus. The microörganisms thus responsible for disease
are commonly divided into two classes, namely, parasites and bacteria.
In the first group are included those parasites that cause tapeworm,
malaria, trichinosis, and hookworm; in the second group those bacteria
that cause typhoid fever, cholera, erysipelas, diphtheria, and probably
smallpox, measles, scarlet fever, chicken pox, and a number of others
presumably similar.

_Parasites as causes of disease._

The introduction of worms into the body must come either from impure
drinking water, from impure food, or from the bites or stings of
insects. When introduced into the body, those parasites that are
inimical to man and produce abnormal conditions interfering with usual
physiological functions may or may not develop further. In some cases,
as in malaria, the very act of hatching the malarial brood is sufficient
to throw the host on whom the brood will feed into a violent chill.

In other cases, as with the hookworm, while eggs are produced in the
human body, they have no directly detrimental effect, the objectionable
feature of their residence being due to the fact that the continual
draught which they make upon the blood vessels of the intestine reduces
the vitality, causing anæmia.

In other cases, as with the guinea worm, found in Africa and South
America, the worm wanders from the stomach, which it enters toward the
surface of the body, and finally breaks through, causing ulcers or
abscesses.

In still other cases, as with that form of filaria which causes
elephantiasis, the adult worm or the embryos are present in the
lymphatics in such numbers as to interfere with circulation, causing the
fearful swellings characteristic of the disease named.

Finally, in such cases as trichinosis and tapeworm, there is usually but
little inconvenience to the human being harboring them, except when
their number becomes very large. Then there may be diarrhoea, loss of
appetite, and other digestive disturbances. The different tapeworms are
generally responsible for nothing more than indigestion and nervousness.
These latter parasites are, however, formidable in so far as their size
is concerned. The mature pork tapeworm is about ten feet long, although
the eggs, seen in the pork flesh, giving it its name of "measly," are
only about a thousandth of an inch in diameter. The fish tapeworm, when
mature, measures about twenty-five feet in length, while the beef
tapeworm is about the same length. These worms can develop only in the
bodies of the animals named, and find their way into the human body only
through the medium of imperfectly cooked meat.

If proper precautions be taken in these directions, if only water is
used for drinking which is known to be free from such parasites and
their eggs, and if insects like mosquitoes and fleas are kept away by
screening windows and doors, and if meat be always thoroughly cooked,
the dangers of diseases from parasites will be reduced to a minimum.

_Bacterial agencies._

By far the most important of the living agencies concerned with the
direct production of disease are those small vegetable organisms known
as bacteria. Not all bacteria, by any means, produce disease; in fact,
it is not too much to say that the majority of bacteria are benefactors
to the human race. Their chief agency is not to cause disease, but to
prevent it, and they do this because they are able to transform the
waste products of animal life, which would normally be dangerous to
health, into harmless mineral residue. They are really the scavengers of
the earth's surface, not actually carrying off garbage, but rather
transforming it, and, in the process, not merely destroying it, but
changing it so as to make it available for plant-food. It is through the
agency of bacteria that the air, which is being continually overloaded
with carbonic acid from the lungs of animals, is reduced and taken up by
plants so that an equilibrium is maintained. Otherwise, the atmosphere
would be more and more vitiated with carbonic acid and organic vapors,
and every one would die as if shut up in an air-tight room. But, because
of bacteria, neither is the surface of the earth overloaded with waste
organic matter nor do streams, however much polluted, continue to flow
without some improvement being traced in their quality.

In some of the ordinary manufacturing processes, bacteria are
all-important, as in making vinegar, wines, cheese; in fact, in any of
the fermented food products. In agriculture, they are entirely
responsible for supplying an adequate amount of food material to growing
plants. Fresh manure is not suitable for plant-food and would be of no
value on the fields or in the garden except as improved and modified by
bacterial action. One of the greatest discoveries of their importance
recently made has to do with the way in which peas and beans are able to
absorb nitrogen from the air through the agency of bacteria. One knows
that plowing under a crop of peas or clover enriches the soil, and that
peas or clover make the best growth for this purpose. The reason is that
these plants, through the activity of bacteria, are able to absorb
nitrogen from the air and afterwards to convert it into food material.

But with all these good qualities a few bacteria, gone bad, perhaps, are
associated with diseases, and by a series of experiments, chiefly those
of a Frenchman named Pasteur and of a German named Koch, and of their
followers, it has been ascertained that certain bacteria, and those
only, will cause certain diseases. These diseases, that is, these caused
by bacteria, are generally spoken of as epidemic or contagious, of which
typhoid fever and cholera are examples.

All contagious diseases cannot at present be definitely associated with
bacteria, probably for the reason that the methods employed to find the
bacteria have not been adequate. For instance, the bacteria of smallpox
has never been found, although the disease is so characteristically one
of bacterial origin that no one can doubt the cause. Similarly, the
bacteria responsible for measles, scarletina, and whooping cough have
never been discovered, although the cause of each is also presumably
bacterial. More definite information on the subject of the individual
and responsible bacteria will be given in the subsequent chapters
dealing with specific diseases. Inquiries into the method of growth and
into the life history of specific bacteria serve our present purpose
only as they teach methods for the prevention of the disease. For
example; when it was found that the parasite of yellow fever, in the
course of its life, spent fourteen days in the mosquito's body in such a
condition that the mosquito during that time was harmless, it made
possible exposure to mosquitoes laden with yellow fever for a period of
thirteen days from the time of the preceding case.

_Antitoxins._

But the methods of combating the different diseases when once contracted
in the human body, based on the knowledge obtained of the life history
of these germs, have been the most important result of their biological
study. A large part of this knowledge has been acquired by the study of
animals which have been found susceptible and so available for
experimental investigation, and it may be that the impossibility of
studying measles, for instance, in animals, may be one reason why the
germ has never been discovered.

There is no evidence that animals suffer spontaneously from such
diseases as typhoid fever, Asiatic cholera, leprosy, yellow fever,
smallpox, measles, and so on; but it seems that in animals, as in man,
the disease is the direct result of the life and growth in the animal of
the characteristic disease-producing germ. The fact that diphtheria or
tuberculosis can be experimentally given to rabbits or guinea pigs is
without doubt the chief source of our knowledge of those diseases,
although, in general, it is impossible to produce diseases in any animal
which will be, clinically, precisely like the disease as it appears in
man. The converse of this is also true, namely, that when it has been
found impossible to experimentally inoculate an animal with a disease
supposed to be bacterial in nature, then but very little of that disease
is known.

The most important result of bacterial studies has been the production
of what are known as antitoxins, and no more wonderful discovery has
ever been made. To understand as best we may the principle involved, it
is necessary to explain the process of bacterial attack. When bacteria
capable of producing disease are introduced into the system, either
through the mouth or into the lungs or into the blood through some skin
abrasion, the bacteria, finding there a congenial habitat, thrive, grow,
and multiply. In some cases, this bacterial growth results only in
breaking down the cell tissues at the point or in the vicinity of the
place where growth occurs; for instance, if a cut is made with a dirty
knife, that is, one carrying bacteria on the blade, and is not
immediately washed out with an antiseptic solution, bacteria will grow
and pus will form in the cut. Similarly, a splinter, if not removed and
cleansed, will produce a pus-forming wound. But unless a very extensive
suppuration starts, the difficulty is all local. So it is with
consumption, when the bacteria are localized in the lungs and by their
growth destroy the lung tissue without, at least for many weeks,
affecting the general health.

There are germs, however, like typhoid fever and diphtheria, which do
not produce any particular local disturbance with the growth of
bacteria, but the whole body becomes sick, the circulation of the blood
is affected, and a general disturbance ensues. This is due to the action
of a poison, called a toxin, which is set free as a result of the growth
of the bacteria in some one part of the body, which poison is then
carried by the blood throughout the entire system, inducing fever and a
general debility.

Just how these toxins are formed is not certain. They are not the
bacteria themselves. This we know because the disease-producing bacteria
can be grown in broth and the mixture can be strained through fine
porcelain, fine enough to strain out the bacteria. Yet it has been found
that the clear liquid passing the porcelain filter is capable of
producing disease and is a deadly poison without the presence of any
bacteria at all. During the incubation period of a disease, as, for
example, in the three-week period when typhoid fever is developing,
these poisons are being formed and are being scattered through the body,
and it is during this time that the fight takes place between these
poisonous forces and the defending forces always present in the human
system. As already pointed out, these defensive forces are powerful or
not, according as the general health of the individual is good or bad,
and we see the familiar sight of persons said to be run down taking a
disease, while those not so depleted of vitality are able to resist or
remain immune.

So certain are scientific men of this power and of the fact that the
power resides generally in the white corpuscles of the blood that, in
the presence of a dangerous infection, a person's blood may be examined,
and, if the white corpuscles are not present in sufficient quantity,
proper means must be taken for developing this element in the blood, or
else the person must take himself away from the infection, if the
infection is to be avoided.

As a result of the conflict between the toxins and the defensive forces
of the body, certain vital processes are set free in the blood and in
the cells which seem to possess a highly specialized power of defense
against any subsequent attack. Pasteur, in his researches on the subject
of rabies, developed this power of resistance by inoculating into
rabbits the rabies infection of a monkey. Monkey rabies is not a severe
form and is scarcely felt by the ordinary rabbit, but if the infective
material (usually part of the spinal cord) of the monkey-infected rabbit
is transferred to a second rabbit, the disease becomes more severe; and
if the disease is passed from animal to animal, it may be built up into
as severe a form as desired, up to the maximum. Pasteur found that by
inoculating an individual with a one-day rabbit, that is, with the
weakest brand of infection killing a rabbit in one day, and the next day
with a two-day rabbit, that the person could receive this two-day
inoculation without discomfort or danger because of the greater
antagonism acquired by the preceding inoculation. Continuing the
inoculations for fourteen days and making the strength of the infection
stronger each day, at the end of the period it was found that the
fourteenth inoculation, strong enough to produce the disease and kill a
fresh subject, had, on account of the preceding inoculations, produced
ability to withstand or counteract the actual disease developing perhaps
at the same time. Fortunately, in the case of this disease, the shortest
period for its development is fifteen days, and often it is a month or
more after the bite of the dog before the disease develops. By
successive inoculation of increasing strength for fourteen days, the
system will have acquired a habitude to the disease which prevents the
normal effects.

Diphtheria is prevented in much the same way, except that in this case
horses are used, their blood being strengthened to resist the disease by
successive inoculations of the diphtheria poison. It is probable that
all the bacterial diseases which exert their influence through the
transmission of toxins in the blood may be counteracted by the
production of an antitoxin when once the method of building up this
antitoxin has been learned. At present, rabies, tetanus, diphtheria, and
cerebrospinal meningitis are the four diseases for which antitoxin is
made commercially and generally used. For a great many years, scientists
have labored without success to find an antitoxin for consumption, and
within the last year extensive experiments have been made in the
American army on the use of antitoxin for typhoid fever.

_Natural immunity._

It may be worth noting that not all resistance to specific diseases
needs to be acquired in the roundabout way just described. The state of
being free from disease is known as immunity, and the way of securing
immunity just described is known as artificial immunity. This artificial
immunity may also be obtained in the course of events by having the
disease as a child, thereby generating the antitoxin in one's own body
instead of in the body of some cow or horse or rabbit.

There is, however, a natural immunity which is due to long-continued
environment or to protracted heredity. The negroes in the South have,
by a lifelong proximity and struggle with the disease, acquired a
practical freedom from typhoid fever, although it remains with the negro
sufficiently to form a focus for the spread of the disease among others
not equally immune. Creoles in yellow-fever districts have a natural
immunity from the hookworm disease, although probably the class are
responsible for its generous transmission to the poor whites with whom
they associate. Racial immunity from certain diseases may be shown by
statistical studies.

_Chemical poisons._

Instead of the introduction of toxins into the body by the agency of
bacteria, it is quite possible for chemical poisons, not formed
originally by bacteria, to be set free in the body. Sulphate of copper,
for instance, is essentially a mineral poison which acts on the human
system in such a way as to produce death, and certain other mineral
substances may be mentioned, such as phosphorus, arsenic, and mercury,
which are well-known poisons. There are also many vegetable products,
not bacterial, which are poisonous in their nature, that is,
distributing to the blood and lymphatics certain substances in solution
which act on the cells of the various organs of the body in such a way
that the activity of those organs is stopped. Opium, cocaine, alcohol,
and some of the coal-tar products used for headaches, as phenacetin, are
deadly poisons when a limited dose is exceeded.

There are also certain poisons engendered in the body itself whose
action is similar to that of chemical bodies and which can hardly be
called bacterial. These poisons represent generally stages in the
process of nutrition where for some reason the normal process is
arrested and chemical bi-products are set free. Also, tissue which has
been thrown off, in or by any organ, begins to decompose, thereby
sending throughout the system the poisons of decomposition. Inflammation
too generally results in the breaking down of the cells and the
distribution of the resulting poisons. Of late years, much has been said
of the poisonous property of the body waste not disposed of by
excretion, and the theory of auto-intoxication, so-called, has received
many adherents. The great scientist, Metchnikoff, has even gravely
contended that it would be well for children to have their larger
intestine removed entirely, because in that organ putrefaction occurs,
the cause of the auto-intoxication he would try to prevent.

_External causes._

The external causes responsible for disease are due to conditions of
weather so severe as to be outside the possibility of self-protection.
Excessive heat is responsible each year for deaths from sunstroke, and
other conditions of weather are often the direct causes of disease, if
not of death.

Accidents are the indirect cause of death, and there will always be a
small proportion of the deaths occurring each year due to violence or
accident. But, inasmuch as these deaths are clearly preventable, it is
the duty of those interested in rural hygiene to study the reasons for
accidental death, and, if the number of such accidents can be reduced,
to strive for that reduction. As an example, it may be mentioned that
each year a number of deaths in New York State, and probably in other
states, occur from accidents at culverts and bridges, due to
insufficient protection in the way of railings and fences. A method of
reducing the deaths from accidents, therefore, would include a proper
survey of all the roads of a vicinity to make sure that no danger exists
in this regard. Other precautions against preventable accidents will
readily suggest themselves.




CHAPTER XV

_DISINFECTION_


Inasmuch as more than 10 per cent of all deaths are due to bacterial or
to various infectious diseases, it is of considerable interest to study
the various means by which these germ diseases may be prevented. In this
chapter it is proposed to discuss the different ways in which the active
agents concerned in the spread of disease may be captured and put to
death. It has already been pointed out that infectious diseases can be
acquired only by the introduction of the specific germs into the human
body, either through the mouth or lungs or through some skin abrasion.
Further than this, it is quite as definitely known that the vitality of
the germ after leaving a diseased person depends primarily upon its
condition at the time of leaving the body and afterwards upon the
environment which that germ finds outside of the affected person, while
waiting for a chance to make its next human resting place.

It is evident, therefore, that if during the interval which elapses
between the time when the germs leave a sick person and the time when
they enter another person some method could be found by which these
germs could be killed, the progress of the disease would be effectually
stopped.

This, in the most general sense, is what is meant by disinfection. It
is a determined effort to destroy the carriers of disease while
temporarily absent from the human body which is their natural home. This
process of killing bacteria, however, is not so simple a matter as it
might at first seem. They are, unfortunately, such minute beings that
they cannot be seen, so that the warfare is waged against an invisible
enemy, not, however, to be despised on that account. The methods of
warfare must be uncertain, since the exact location of the enemy cannot
be known, and it is manifestly impossible to disinfect the universe.
What is done is to fix upon the location or surroundings where the
original patient was confined, and, assuming that the germs, if any,
which have escaped ready for further infection are somewhere near, to
poison the air and the wall and floor of the room in question so that
happily the germs may be killed.

_Disinfecting agents._

The various agents used to destroy those germs which are carriers of
disease may be divided into two groups, namely, heat in its various
forms, and chemicals. Literally, the word "disinfection" means "doing
away with infection," so that to disinfect a room is to do away with the
infection present in the room. It has, however, come to have a more
general meaning than this and is commonly used instead of the word
"destroy," so that a disinfecting solution is the same thing as a
destroying solution, applied, of course, to bacteria.

It has already been explained that by far the majority of bacteria are
useful if not essential to human life, and one of the difficulties in
employing disinfecting or destroying solutions is that they put an end
at the same time to both useless and useful bacteria. As an example,
the fermentation processes in the human intestines are accompanied if
not produced by certain kinds of bacteria, although on occasion these
harmless or useful bacteria may develop into most obnoxious germs,
producing unpleasant fermentation. It might be easy enough for a doctor
to make a patient swallow some antiseptic solution, like carbolic acid
or corrosive sublimate or nitrate of silver, for the purpose of getting
rid of certain undesirable bacteria in the intestines, but it does not
need a doctor to know that for a patient to swallow such active poisons
as these would not merely kill the harmful bacteria and the good ones as
well, but probably the patient himself.

_Antiseptics._

There is another word often used in connection with bacteria, namely,
"antiseptic," and the common significance of this word applies to a
substance which interferes with or retards the growth of bacteria
without actually destroying them. Doctors, for instance, use antiseptic
instead of disinfecting solutions on wounds, not because they do not
wish to kill the pus-forming bacteria, but because the antiseptic
solution will prevent their growth and not be, as a disinfecting
solution, harmful to the cells which he is trying to repair. It would be
folly, for example, to inject a strong 50 per cent solution of carbolic
acid into a wound on the arm produced by a saw, because all the energy
of the vital forces at the seat of the wound are needed for repairs, and
there is none to spare for so active a detergent as carbolic acid. An
antiseptic, on the other hand, is mild enough so that it does not act on
the tissue at all, but merely prevents any undesirable growth of
bacteria.

_Deodorizers._

There are substances used, perhaps not so much around country houses as
around city houses and in water-closets, which are neither disinfectants
nor antiseptic, but act as deodorizers only. Such a substance, for
example, may be thrown into the kitchen sink, not at all for the purpose
of killing bacteria, but for disguising the smell from the cesspool into
which the sink-wastes discharge. It has no disinfecting properties and
is good for nothing unless the material is so scented as to be agreeable
on that score. One of the frauds perpetrated on the public is the
preparation and sale of the various appliances designed and regulated to
produce a perpetual smell and claimed on that account to be either
disinfecting or antiseptic agents. The smell is worth nothing.

_Patented disinfectants._

The poison of the disinfectant or antiseptic, whether it be in liquid or
in gas form, is the essence of the material, and since the value of
disinfectants is based on the crude raw materials which any one can buy,
it is clearly unnecessary to buy expensive patented solutions for
disinfectants when ordinary lime or carbolic acid are equally as good
and can be had at much lower prices.

A disinfecting solution, to be successful in its action, must be
reasonably proportioned in volume to the amount of material to be
disinfected, whether this be a liquid or clothing or the air of a room.
It is the height of absurdity, for instance, to pretend to disinfect the
air of a large room by burning a tablespoonful of sulfur on a shovel in
the center of a room without even taking the trouble to close the door.
It is absurd to attempt to disinfect the bed linen in a single pailful
of hot water, since even if the water was hot at the beginning, it would
be so reduced in temperature by the first piece that went in that its
efficacy would be lost for everything else. It is equally absurd that a
liquid from a bottle, no matter how much advertised, can effectually
disinfect a room, either by a gentle sprinkling of the liquid on the
walls and floor or by a more thorough spraying of the air with an
atomizer containing the liquid.

_Disinfecting gases._

Two gases are available for use in disinfection, and these are valuable
particularly in killing germs left in a room after a patient suffering
from an infectious disease has been removed. The diseases referred to in
the following chapters are all of this nature, and one of these two
gases ought to be used in every case; otherwise the room may continue to
harbor germs of the disease for months or years with the possibility of
infecting a future tenant at a time when his vitality was such as to
make him an easy prey. Nor must the contents of the room be overlooked.

The writer was recently told of a large family where one child had
scarlet fever, recovering in September. The sick room was thoroughly
disinfected, but the careful housewife, fearing damage to her blankets,
had taken them to the attic before disinfection began. In the cold
weather of February these blankets were brought down, and in six days
the two children sleeping under them had contracted the disease.

_Sulfur as a disinfectant._

When sulfur is burned, a gas is formed known as sulfurous acid, and
until the last few years, it was the most common of all disinfecting
agencies. The writer well remembers that when about to visit a city in
South America infested with yellow fever, he was seriously advised to
fill the inside of his shoes with sulfur as a precaution against the
disease. He might as well have worn a red ribbon on his hat so far as
any protection went, but it illustrates the confidence formerly shown in
sulfur as a disinfectant.

It is now known that in the dry, powdered state, sulfur is of no value
unless, perhaps, the germs be smothered with the sulfur flour. When
burned, however, the gas given off has a certain disinfecting property,
although this is limited. It has almost no power of penetrating into
curtains, blankets, and upholstered furniture, although the penetration
is decidedly increased if these objects are moistened either by steam or
by water vapor. The proper amount of sulfur to be burned for any room is
at the rate of 3 pounds per 1000 cubic feet of air space in the room.
Thus, if a room be 12 feet by 15 feet and 8 feet high, containing 1440
cubic feet, it would be necessary to burn 144/100 of 3 pounds, or 4-1/3
pounds.

Before undertaking to disinfect a room with sulfur, it should be made
thoroughly air-tight, and this must be done carefully, not merely by
closing the larger and obvious openings, like doors and windows, but by
pasting strips of paper over every crack which might allow air to
escape. Thus the four edges of the window sash must be pasted up, and a
strip must close the crack between the two sashes. All the doors but the
one reserved for exit should be pasted up from the inside, and finally
this last door pasted up on the outside. If the floor has settled away
from the base-board, the cracks thus made must be pasted up. In short,
the room must be made absolutely air-tight. The room should be left thus
closed for at least twenty-four hours, and since there is some danger
from fire, a proper provision should be made for the burning sulfur.
This can be done by placing an old milk pan (a most convenient object in
which to burn the sulfur) on a couple of bricks, which may be set inside
a wash tub with perhaps three or four inches of water in the tub. The
most convenient way of ignition is to moisten the sulfur with a little
alcohol which can be readily set on fire.

Since clothes of every sort are more effectually acted upon when moist,
they should be sprinkled with a hand atomizer just as the sulfur is
lighted, and this should always be done in the case of any stuffed
furniture or hangings. Anything that can be removed should be taken out
and sterilized by steam, since live steam is the only disinfecting agent
which will penetrate such things as mattresses, pillows, and rolled-up
bundles of every sort, and with these last even steam is not certain. It
is far safer to send a mattress to the cleaner to be steamed than to try
to sterilize such bulky objects at home. It requires about twenty-four
hours with the room tightly closed to generate enough gas so that the
bacteria which may have found their way onto the walls or floor or
ceiling or into the air of a room will be surely killed. After that time
the room can be opened and then the usual household cleansing processes
carried out as an additional safeguard. It is a wise measure in the case
of infectious diseases, even after a room has been fumigated with
sulfurous gas, to wipe off the woodwork and the walls, if their
construction allows it, with a solution of carbolic acid, since in this
way the germs which have accumulated on the woodwork will certainly be
killed.

_Formaldehyde disinfectant._

Formaldehyde is the other gas which is commonly used for disinfecting
the air of a room. It is most readily produced by buying solidified
formaldehyde and then decomposing it by the action of heat. Formaldehyde
candles, as they are called, may be purchased at almost any drug store,
and while special forms of generating stoves may be found in the open
market, an ordinary heating apparatus of almost any sort will answer the
purpose of decomposing the solid formaldehyde. About 20 ounces of the
formalin should be used for each 1000 cubic feet of space. With this
agent, however, as with sulfur, the penetrating power of the gas is not
very great, and such things as mattresses and clothing should be sent to
a steam sterilizer rather than be trusted solely to the power of the
formaldehyde.

In using this gas, the same care about pasting up cracks and crevices in
the room should be followed as already prescribed for the use of sulfur,
and, as with sulfur, a reasonable precaution against fire should be
taken by placing the apparatus in a tub of water or in a large pan of
sand where accidents cannot happen. The room should be kept closed for
at least twelve hours, and then should be thoroughly aired, and if the
room is to be used again soon, the disagreeable odor may be removed by
the free use of ammonia, either sprinkling it around in the room or by
placing about saucers of ammonia.

_Liquid disinfectants._

More common than gases and most readily suggested as disinfectants are
certain liquids which have been proved both by laboratory
experimentation and by actual experience to have the power of killing
bacteria when brought into contact with them. Those liquids which have
commended themselves particularly have additional advantages in not
destroying fabrics, metals, or tissue with which they are brought in
contact and in being purchasable at moderate prices.

There is little choice between a number of such liquids, and the number
of modifications or combinations which are made and bottled and sold
under some fancy name is legion. But the label, the name, and the
additional price add nothing to the value of the basic chemical from
which they are all compounded, and except for their convenience, they
have little to recommend them.

_Carbolic acid as disinfectant._

Carbolic acid is one of the most useful of these liquids, and in its
various forms appears in almost all disinfectants. It may be obtained
from the drug store in two forms, either as a crystal or as a
concentrated solution.

A 2 per cent solution, that is, one pint of carbolic acid to six gallons
of water, is the proper strength for all such uses as wiping off wooden
surfaces, furniture, floors, etc. A stronger (5 per cent) solution is
used when it is intended to destroy organic matter containing large
quantities of germs. This is practically a saturated solution, so that
if a bottle be partly filled with the crystals of carbolic acid and then
completely filled with water, the water will absorb enough of the
carbolic acid to make a 5 per cent solution, and the water may be poured
on and off as long as the crystals remain. This 5 per cent solution is
the proper strength to receive sputum from tuberculous patients,
material ejected from the stomach in diphtheria, and fecal matter from
typhoid and cholera patients. This strong solution should not be used
on the living human body, since it is powerful enough to eat directly
into the flesh, and being a violent poison, it should be kept out of the
way of the household and carefully labeled to avoid accidents.

Carbolic acid has no value at all in the way of disinfecting the air,
although fifty years ago surgeons were accustomed to use a spray of
carbolic acid around the operating table before an operation in order to
destroy any germs of the air lingering in the vicinity. It is equally
futile to pour carbolic acid into sewers or to stand it around on the
mantelpiece for the purpose of disinfecting a room. Nor are sheets wet
in carbolic acid and hung over doorways and at the end of passages
anything more than a remnant of medievalism.

_Coal-tar products._

There are certain preparations made from coal-tar which, either alone or
combined with carbolic acid, have very strong disinfecting properties
and which are the bases of most of the patented disinfecting solutions
now sold. They are commonly called cresols or creosols and a 4 per cent
solution of any of the three ordinary forms will destroy bacteria in a
few hours. They are commonly used for receiving organic excretions of
sick persons in the same way as carbolic acid is used, and have about
three times the power of carbolic acid to destroy bacteria.

They have one great advantage besides the strength mentioned, in that
they are not materially affected or interfered with by the presence of
albuminous material. Carbolic acid in the presence of albuminous
material, like sputum, for instance, has the strength of the
disinfectant partly used up in combining with this albuminous material
so that the strength remaining for disinfection is weakened, and the
result is not as satisfactory as it would otherwise be. The coal-tar
products, on the other hand, are not so interfered with, and the
solution acts in full strength upon the bacteria.

_Mercury for disinfectant._

Corrosive sublimate, or bichloride of mercury, is one of the most active
poisons known and is as effective in dealing with the microscopic
organisms known as bacteria as it is in dealing with the larger animals
for which it has been used for years past,--the destruction of bed-bugs.

For general cleaning purposes, such as scrubbing woodwork, floors, and
walls, it should be used in strength of about 1 part to 3000 parts of
water. This means that for 1 ounce of corrosive sublimate 3000 ounces of
water or 25 gallons must be taken. This solution is very active in its
effect on all metal, so that it must be kept in brassware or
earthenware, and when mixed with the material which it is intended to
disinfect, it must be kept from tin or iron. This solution is also
affected by albuminous material, although this may be counteracted by
the addition of salt. It is a good plan, therefore, to add to the
solution salt at the rate of about 4 teaspoonfuls to each gallon of
solution. On account of the very poisonous action of this solution great
care must be taken to keep it away from children, and it has been
suggested that it is desirable to add some coloring matter to the
liquid, since without this it may be mistaken for clear water.

_Lime for disinfecting._

Chloride of lime is one of the most useful as well as one of the
cheapest disinfectants available. It costs about $25 a ton, although by
the pound this wholesale price would not be obtained. It is effective in
a 1 per cent solution, that is, 1 pound of chloride of lime to 100
pounds or 12 gallons of water. To be effective, the solution must be
well stirred into the organic matter to be disinfected, since it is the
chloride rather than the lime which is the disinfecting agent. Saucers
or soup plates of chloride of lime standing around the room have no
effect upon the germs in the air and on the floor and are of no more
value than sulfur, or roses for that matter. Chloride of lime is
commonly known as bleaching powder, and its effects on clothes or on any
substance which can be eroded is well known. It is, therefore, not a
suitable material for disinfecting towels, because the action is on the
towel as well as on the bacteria, differing in this respect from
mercury, which does not hurt the fiber of clothes.

Milk of lime is produced by slaking ordinary building lime until a fine
white powder is obtained, about an equal quantity of water to the amount
of lime to be slaked being necessary. When the powder has formed and
steam has ceased to be given off, then about four gallons of water
should be added to each gallon of the powder and the mixture well
stirred. This will probably always leave some lime in the bottom of the
vessel, since limewater is a saturated solution, and these proportions
furnish more lime than is necessary. If not too thin, it is a good
whitewash and is a most important agent when used as a whitewash in
disinfecting walls and ceilings of such rooms as hospitals and cellars
and other places where have been contagious diseases. Milk of lime is an
admirable disinfectant in the sick room and generally in houses where
infectious diseases have been. It may be poured down drains, into
water-closets and privies, and used liberally in all places where
bacteria may be supposed to thrive. It must come into intimate contact,
however, with the bacteria, and merely sprinkling a little lime dry
around the borders of a gutter or drain is of no value. The writer saw,
not long ago, a chicken yard where the inspector of a health department
had undertaken to secure disinfection by a generous sprinkling of white
lime powder around the yard. Such a procedure, however, is not
effective, but in a drain the dry powder might be of value because it
would later become effective when washed in solution into the drain.
Ordinarily, the dry powder is to be avoided.

_Soap as an antiseptic._

No better antiseptic exists than ordinary soap, not altogether because
of the properties of the soap, but because of the action of the soap
combined with hot water. Washing soda, dissolved in water and used for
boiling clothes which have become polluted, adds to the disinfecting
power of the hot water the disinfecting properties of the soap, and the
result is most effective. Ammonia has not the same value as the soda or
potash soap, although it has the power of destroying bacteria in the
course of a few hours.

It may not be out of place to emphasize the value of soap, not
particularly in times of epidemic or contagious disease, but as a
continual safeguard against infection. A large proportion of the
contagious diseases are probably the result of infected fingers or hands
coming in contact with the mouth and leaving there the germs of
infection. One of the first things a surgeon learns, in order to avoid
any possible infection of wounds or of openings which he makes for an
operation, is to thoroughly wash his hands in order to remove therefrom
all possible germs. He scrubs his hands, particularly his finger nails,
with soap and water and then bathes them in a solution of bichloride of
mercury before touching the patient in any place where infection might
occur. The difficulty, even with this great care, of freeing their hands
from bacteria has been found to be so great that, in late years,
surgeons have preferred to use, during operations, thin rubber gloves
which can be boiled before using and can be soaked in a stronger
antiseptic than the hands could bear.

It is extraordinary, from the standpoint of self-infection, to see how
men can be so careless as to sit down to dinner, after having worked in
places where their hands have come in contact with all sorts of organic
filth, without stopping to wash those hands even in cold water. It is
certainly providential that disease germs are as uncommon as they are,
for with the careless habits of most people in putting their hands to
their mouths, the death-rate from infectious diseases would be much
higher than it is except for the fact that most of the germs thus
introduced into the mouth are not disease-producing.

_Disinfecting by heat._

Better than any chemical agent known to be a destroyer of bacteria is
heat in one form or another. This may be steam or hot water or dry heat.
If a high enough temperature is maintained for a sufficient length of
time, the action is absolutely destructive to all germs. Fire does, of
course, destroy bacteria along with whatever material the bacteria are
concealed in, but such a disinfectant is of little value for ordinary
purposes, since the object of disinfection is to destroy bacteria
without destroying the surface on which they are lodged. In some old
buildings, where consumption or smallpox, for example, has become
permanent, it may be that the surest way of killing all the bacteria is
to burn up the house.

_Dry heat._

Unfortunately, even a moderate heat cannot always be applied. One's
hands, for example, can neither be heated in an oven to the necessary
temperature for destroying bacteria in their pores, nor can they be
immersed in boiling water or steam for a sufficient time to secure
thorough disinfection. Therefore, with the body, chemical means for
disinfection must be employed. Also when it is desired to disinfect a
liquid, such as beef broth, in which the experimenter desires to grow
some particular species to the exclusion of all others, dry heat is
inapplicable because it would evaporate the liquid, nor is chemical
disinfection possible because of its antiseptic effect on the bacteria
to be cultivated. Moist heat, therefore, must be used. When dry heat is
used, it is usually for the disinfection of glassware or earthenware or
metallic objects, the quality of which will not be affected by the
necessary temperature, namely, 150 degrees Centigrade, or about 300
degrees Fahrenheit. This temperature must be maintained for at least an
hour, and it is not certain even then to penetrate in full power to the
middle of blankets or comfortables. Except for glassware to be used in a
laboratory, dry heat, such as would be obtained by a kitchen oven, is
not to be recommended.

_Boiling water._

Boiling water, on the other hand, is the most effective and penetrating
disinfecting agent available. One has only to expose an object to
boiling water for five minutes to absolutely kill all disease-bearing
bacteria contained, and since bed linen, clothes, blankets, and such
articles as are naturally used in a sick room have to be washed after a
patient's recovery, it requires but very little additional trouble to
subject the soiled articles to that temperature of the water which will
secure disinfection at the same time. But the water must be boiling. The
mere fact that it was once boiling water gives it, half an hour later,
no disinfecting properties, and complete disinfection can be secured
only by actually boiling the garments or articles for at least five
minutes. The apparatus necessary therefore--and no better piece of
disinfecting apparatus can be secured anywhere--is a good old-fashioned
wash boiler. The action is more certain, that is, more penetrating, if a
little washing soda is added to the water at the rate of a tablespoonful
of soda to a gallon of water. This solution is admirable for washing
dishes, spoons, knives, forks, and other eating utensils used by sick
persons. It is always a mistake to wash dishes from the sick room in the
same vessel with other dishes. They should not only be washed
separately, but they should be washed in boiling water, and preferably
in a soap solution as just described.

_Steam._

For some purposes, steam is better even than hot water; its effect on
cotton and woolen garments is not so disastrous. A comfortable or
blanket, for instance, may be subjected to steam without losing its
elastic quality, and for small garments, an ordinary steamer, such as
is used for puddings, answers admirably. Cities use steam sterilizers
because of the greater convenience in furnishing steam to a large tank
as compared with filling and emptying a tank with water and then
providing sufficient heat to boil that water. The exposure to steam
should last from half an hour to an hour, depending on whether the
objects to be disinfected are small, open, and loose, or large, compact,
and dense. Some articles, like bales of rugs, rolls of wool, and large
bundles of cloth, cannot be sterilized at the center by ordinary steam,
and while it is not likely that infection at the centers of such tightly
rolled bundles has occurred if exposure took place while rolled up, yet
it is certain that the disinfection does not reach these centers. In the
case of such bundles as rugs from infected countries, where any single
rug may become the medium of infection, it is requisite to thoroughly
sterilize all parts of the bundle. For this purpose, it is necessary not
merely to expose the articles to live steam, but to have the live steam
under pressure so that it is forced into the inside of the packages by
an excess of external pressure. This is probably not available in an
ordinary house, where boiling must continue to be the method of
disinfection.

_Drying, light, and soil._

Before leaving this chapter, three agencies for disinfection may be
pointed out, not perhaps to be depended on, but in order that the kindly
provisions of nature may be appreciated. All germs removed from the
body, which is their natural home, and exposed to the air are subject to
drying and thus are killed. Unfortunately, this does not become true
except after long periods of time, nor is it equally true with all
germs, but it is certainly one of the methods by which the evil effects
of disease germs may be lessened. The germ of consumption lasts as long
as any germ, and yet this, when dried in the street, loses its vitality
after about a week. Similarly, the typhoid fever germs, unless kept in a
moist condition, dry up and die in a few days. With the drying, however,
comes the danger that in the process they may be lifted by the wind and
carried in the air to the mouths or nostrils of well persons, so that it
is not wise to depend solely on this method of disinfection.

Sunlight is more positive than the wind, and the exposure to direct
sunlight of a bottle filled with disease germs will kill them all in two
or three hours. The surface layers of a pond never have as many bacteria
in them as the lower layers, partly on account of the sedimentation, but
largely because they are killed by the direct action of sunlight. The
bacillus of consumption and bacillus of diphtheria are both killed in an
hour or so by direct sunlight. This is one reason why living rooms
should have sunny exposure and why, on the other hand, disease thrives
in dark tenements.

The soil is the third natural method of disinfection, not because the
soil itself destroys bacteria, but because in the soil are to be found
millions of non-harmful germs and these germs are hostile to the
disease-producing germs, so that they destroy their virulence. It is on
this principle that the wastes from typhoid fever patients are buried in
the garden, the presumption being that the bacteria there present will
destroy the typhoid fever germs before they can escape and do any harm.
While this action undoubtedly exists, it is not positive enough to
depend upon, and disinfection by the use of chemicals should always be
practiced.




CHAPTER XVI

_TUBERCULOSIS AND PNEUMONIA_


These two common widespread diseases affecting the lungs may be
discussed together, although they are not closely related in origin or
effects.

_Tuberculosis._

That form of tuberculosis known as consumption is at present the most
prevalent and the most dreaded of all infectious diseases. In 1908, in
the Registration Area of the United States (about one half of the whole
country), it caused 67,376 deaths. Deaths from other infectious diseases
are shown in the following table, together with the population:--

TABLE XVIII. SHOWING DEATHS FROM VARIOUS INFECTIOUS DISEASES IN THE
UNITED STATES, 1908

Population of Registration Area             45,028,767
Deaths in Registration Area                    691,574
Deaths from tuberculosis                        67,376
Deaths from pneumonia                           61,259
Deaths from diarrhoea (chiefly of babies)     52,213
Deaths from cancer                              33,465
Deaths from typhoid fever                       11,375
Deaths from diphtheria and croup                10,052
Deaths from scarlet fever                        5,577
Deaths from whooping cough                       4,969
Deaths from measles                              4,611
Deaths from smallpox                                92
Deaths from hydrophobia                             82
Deaths from leprosy                                 11
Deaths from bubonic plague                           5
Deaths from yellow fever                             2

Pneumonia is second in fatality, the two diseases of pneumonia and
tuberculosis carrying off 128,635 persons, or about one fifth of all
persons dying in the year. While these have both been great plagues to
humanity from the very earliest days, it is only within the last ten
years that their ravages have been appreciated and, especially with
tuberculosis, their causes actively combated. There are two phases to be
considered in discussing tuberculosis or consumption, namely, first, the
method of prevention and second, the method of cure. It follows also
that, since the cure of advanced cases is impossible and since every
case which exists is a menace to the health of the community on account
of the danger of the spread of the disease, the prevention is far more
important than the cure.

Until the discovery by Robert Koch, in 1882, of the germ causing
consumption, little could be done in the way of prevention, but since
that time, only one quarter of a century ago, we have learned and
applied the knowledge that, in the vast majority of cases, the disease
is spread by the sputum of consumptive patients, which becomes dry,
forms dust, and so is carried into the air to be breathed by persons not
otherwise affected. It seems so simple a method, then, to prevent the
spread of consumption. All that need be done is to take care of the
expectorations of persons suffering with the disease. It is thoroughly
believed by experts that if this were done carefully and faithfully, the
disease would be stamped out within a few years, and the slogan of a
certain sanitary organization is "Complete Control of Tuberculosis in
1915." Too much emphasis cannot be placed on the direct and simple
method of infection, and while other factors enter, as will be shown
later, a thorough recognition and control of tuberculosis sputum would
practically stamp out the disease.

The following circular, issued by the Committee on the Prevention of
Tuberculosis of the Charity Organization Society of New York City,
indicates the procedures advised by them to prevent the spread of the
disease and, as will be seen, the essence of the axioms there expressed
are summed in the words "Don't spit!":--

     DON'T GIVE CONSUMPTION TO OTHERS.

     DON'T LET OTHERS GIVE IT TO YOU.

     _How to prevent Consumption._

     The spit and the small particles coughed up and sneezed out by
     consumptives, and by many who do not know that they have
     consumption, are full of living germs too small to be seen.
     THESE GERMS ARE THE CAUSE OF CONSUMPTION.

     DON'T SPIT on the sidewalks; it spreads disease, and it is
     against the law.

     DON'T SPIT on the floors of your rooms or hallways.

     DON'T SPIT on the floors of your shop.

     WHEN YOU SPIT, spit in the gutters or into a spittoon.

     Have your own spittoons half full of water, and clean them out
     at least once a day with hot water.

     DON'T cough without holding your handkerchief or your hand over
     your mouth.

     DON'T live in rooms where there is no fresh air.

     DON'T work in rooms where there is no fresh air.

     DON'T sleep in rooms where there is no fresh air.

     Keep at least one window open in your bedroom day and night.

     Fresh air helps to kill the consumption germ.

     Fresh air helps to keep you strong and healthy.

     DON'T eat with soiled hands; wash them first.

     DON'T NEGLECT A COLD or a cough.

To be sure, the precept of "Don't spit," as applied in cities, has other
reasons for enactment than to prevent tuberculosis. Spitting is a filthy
habit, and its practice should be decried on the score of cleanliness
whether on the streets or in any public place, so that the signs now
seen in street cars and railroad trains, in halls and office buildings,
are intended not altogether for consumptive patients, but also for those
who need laws to force them to observe ordinary rules of cleanliness and
decency. It is, however, the main step towards doing away with
consumption, and the faithful observance of the injunction ought to be
insisted upon quite as much in the individual home as in a city street
or public building. Case after case has been cited of instances where
one consumptive patient in a family has spread the disease through the
household, and, at intervals of a year or so, one after another of the
family has succumbed to the attacks of the consumptive germ, when by
proper precautions and suitable care of the sputum of the first sick
person, the other deaths might have been prevented.

_Individual resistance to tuberculosis._

There is a remarkable difference in the ability of individuals to
withstand the attacks of this disease, and it will be found always that
the first to succumb are those whose vitality has been in some way
depleted. The women of the family, who are generally confined to the
house, who do not have their lungs reënforced by a continual influx of
fresh air, who are tired and worn out with their household duties, give
themselves an easy prey to the attacks of the bacteria, while the men
and boys, who are more outdoors, who are vigorous and strong, throw off
the attack and are not affected.

It is a significant fact that by examination, dead bodies, so far as was
known, not afflicted with tuberculosis in life, have, to the extent of
60 per cent, been found to have evidences of consumption in their lungs;
that is, the edges of the lungs have been found affected, although the
vitality of the individual was such that the action of the germ had been
stayed before any serious injury was done. Most of us, at one time or
another, have had, unknowingly, mild cases of consumption. It would be
strange, indeed, if we did not, in view of all the tuberculous infection
flying around in the air. But most of us are able to successfully combat
the disease, so that the germs are destroyed before they are able to
affect the entire body.

The other part of prevention consists in building up and holding up the
vitality of the individual to a point where the vital forces can
successfully oppose the attacks of the germs. Probably the decrease in
the number of cases of consumption in the last quarter of a century has
been due quite as much to the improved sanitary conditions of living,
whereby the germs have been unable to secure a foothold in the
individual, as to any precautionary measures taken against the germ
itself.

_Precautions by the consumptive._

But the chief factor in the future restriction of the disease, as in the
past, must be the disinfection of the germs immediately after they are
thrown off from the consumptive patient, and it is well worth while to
emphasize just what the consumptive should do or have done for him in
order that he may not be responsible for the further spread of the
disease. In the first place, when he spits, he must appreciate and act
on the fact that the sputum is alive with consumptive germs, each one of
which may possibly transmit the disease to whoever may come in contact
with it. The patient must keep in mind continually that this sputum is
poison, a deadly poison, and that it is his duty to see that every
particle of it is disinfected or destroyed by one of the methods already
indicated. He may expectorate into a vessel filled with a carbolic acid
solution or he may expectorate into a vessel filled with water which may
afterwards be boiled. He may use a cloth or paper, like a Japanese
napkin, which may later be burned in the fire. But, above all things, he
must not expectorate anywhere and everywhere, regardless of the
consequences.

The consumptive patient must not cough without holding a handkerchief
over his mouth, since small particles of sputum may become dislodged and
distributed in this way.

The eating utensils used by a consumptive patient must not in any way be
allowed to infect other people. The consumptive must have his own dishes
reserved exclusively for him, and they must be, after each meal,
carefully disinfected. With these precautions and with avoidance of such
practices as kissing or otherwise directly infecting others, there is no
reason why a consumptive patient should be in any way an object of
dread or why he should not live with his family in as much comfort as he
can obtain, in perfect safety to himself and to them.

_Cure of consumption._

The chief factor in the cure of consumption is the time at which the
attempt at cure is started. Consumption is not an incurable disease, as
was once thought, and there is no reason for so considering it. There is
no such thing as galloping or quick consumption as distinguished from
slow or lingering consumption, since the consumptive germ is the same in
all people. The same germ may act differently in different people, and
if one's power of resistance, as happens with those accustomed to
drinking liquor, is low, the action of the germ is rapid, although the
disease is identical with the form in which death comes only after years
and years. If taken in time, that is, before the germ has so infected
the body as to be beyond all possible restraint, as large a proportion
of consumptive patients may recover as of patients from typhoid fever or
diphtheria or any other infectious disease, but the cure must be started
early. For instance, at one of the sanitariums in the Adirondacks, out
of 267 patients admitted, who had the disease in an incipient stage,
complete recovery was had in 219 cases, the disease was arrested in the
case of 42 others, and in only 6 was the treatment not effective. Where
the disease had become advanced, however, it was found that out of 192
cases, only 32 apparently recovered and 140 were improved to some
extent. These are the significant facts in an institution for incipient
cases only, where advanced cases, such as are met with by the practicing
physician, are not received.

Unfortunately, the ordinary physician does not always recognize the
disease in its first stages, and a person may suffer for months with
consumption, and even pass the time when the cure of the disease would
be possible, without its being recognized. Such sick persons are treated
for catarrh, for an obstinate cold and bronchitis, for grippe or
malaria, whereas a proper diagnosis of the disease would be a
recognition of the early stages of consumption and thus would prompt the
patient to start at once on the necessary methods for cure. Nor is it
possible to recognize the disease by any one definite indication. The
cough which was once thought to be the deciding symptom is very often
absent until the last stages of the disease. Expectoration of blood is
similarly one of the last symptoms, exhibited only when too late for
remedial measures. The presence of the tuberculosis bacillus or "T. B."
in the sputum is also not generally found until the tissue of the lungs
has become well advanced towards destruction, too late for remedy.

Experts in diagnosis attach great importance to family history, and have
learned to expect the disease in persons when exposure to contagion is
inevitable. They will recognize the disease from evidence not
discernible to regular practitioners. For instance, if one member of a
family is known to be affected, any chronic indisposition in another
member, involving, perhaps, a daily rise in the temperature of the body,
not sufficient to arouse alarm, but apparent in the listless behavior of
the person, may be enough to suggest the beginning of the disease. An
expert may detect the clogging up of the lung tissue by an examination
of the lungs themselves, and probably this direct examination, with a
record of the daily rise and fall of temperature, particularly if the
suspected patient has a listless feeling and a gradual loss of weight,
would be sufficient to suggest the ordinary remedies.

The three remedies, which are nature's own methods, are good food, fresh
air, and rest. It is difficult to say which of these three items is the
most important. Certainly no hope of building up the resistance of the
patient against the inroads of the disease can be expected unless the
patient is thoroughly nourished. One of the sad facts in connection with
those unfortunates whose fight against tuberculosis is nearly over and
who in desperation have fled to Arizona, hoping that the dry air might
afford relief, is that the lack of nourishing food, inevitable in those
deserts, hastens on the disease, so that the expected benefits from the
dry air are entirely offset. Likewise, in tenement-house districts in
cities, the fight against consumption is practically useless because of
the impossibility of securing for those starved or underfed helpless
ones the nourishing food necessary. In the country, this part of the
treatment ought to be the simplest, and yet one fears that the habit of
eating through nine months of the year only salted and dried foods has
not furnished patients in the country with the kind of nourishment
necessary. Experience indicates that eggs and milk should be the bulwark
on which the patient must depend for food, and in the sanitariums of New
York State it is not uncommon for patients to be stuffed with two dozen
raw eggs every day in addition to other food.

The next important factor is rest, since the effect of tuberculosis is
to break down lung tissue, and for the prevention of this it is
necessary to give the forces of the body every aid in preventing this
destruction. All exercise taken by a tuberculous patient means the
withdrawing of that much blood from the lungs, where is the strategic
point of the disease, to the part of the body being exercised, and one
of the most striking features of sanitarium treatment is the absolute
rest enjoined on the patients. Flat on their backs, day and night for
months, without so much exercise as walking across the room, is the
ordinary treatment, and the effect of disobedience is plainly seen in
the rise in temperature or increase in fever which follows a violation
of these rules. Even when the patients are allowed to sit up, they do
not sit straight, but rest on couches or reclining chairs, so that their
heads are down and their feet up, making the passage of the blood to the
lungs easier. Even where the patient, determined to recover, is not able
to place himself in the hands of a hospital physician, he can adopt this
important method of arresting the disease by strictly avoiding exercise
and exertion of every sort. The Massachusetts General Hospital in Boston
has tuberculosis clinics, where patients who are not far enough advanced
in the disease to require absolute rest are inspected daily, their
condition noted, and advice given for the following twenty-four hours.
One of the most common violations of the prescriptions given is
overexertion, and yet the rest condition is essential for building up
the diseased lung.

The third method of treatment involves fresh air, in order to improve
the oxygenating character of the blood. If one remembers that the oxygen
in the blood is the chief scavenger of the body and that the vitality of
the red corpuscles and their abundance is an essential factor in curing
the disease, it will be seen why fresh air is so important. The tendency
to-day is to insist on fresh air and to lay less stress on the climate
than was formerly done.

It was not uncommon a few years ago for a physician, recognizing
consumption, to send his patient away, partly because he honestly
believed the climate of Arizona or Colorado or the Sandwich Islands was
better than that where the patient lived, and partly, without doubt,
because he was glad to get rid of a disease which he knew it was not in
his power to cure. To-day, unless the patient can go to a properly
equipped and maintained sanitarium, physicians recognize that conditions
may be as beneficial at home as elsewhere and, provided the three
factors mentioned--good food, rest, and fresh air--can be obtained, the
chances for recovery are better because of better care at home than
elsewhere.

But fresh air is essential, and this means that the patient must spend
twenty-four hours a day in the open. He must eat and sleep out of doors.
He must not go into the house when it rains, nor when it snows, and even
with the thermometer at zero he must still stay out, wrapping himself
up, to be sure, so that his body is not cold, but breathing into his
lungs the life-giving, vitalizing, oxygen-bearing air. The side porch of
a house may be very easily transformed into a room with a cot bed and an
easy chair, where the consumptive may stay continually, and while it is
convenient to have a window or a door opening from the porch into a room
where the patient may be dressed and bathed, this is not essential,
although customary in sanitariums. If no side porch exists, it is
possible to build such a porch, and the picture shows how such a
construction may be added to even a small house in the city (Fig. 75).
If this is out of the question, the windows of a room may be left open
all the time, or the patient may lie on a bed, the head of which either
extends through the window or is arranged to admit fresh air by a
specially devised window tent.

Educational campaigns have been vigorously prosecuted for the past ten
years, and gradually through the world is spreading a growing
appreciation of the dangers of this disease. The effect of this
increasing knowledge is reflected by a continually decreasing number of
deaths in proportion to the population. The following diagram (Fig. 76)
shows how this law is obeyed in New York State, the downward tendency of
the line since 1890 being very plainly marked.

[Illustration: FIG. 75.--Outdoor sleeping porch for tuberculosis
patients.]

The results being so manifest, the prophecy of Dr. Biggs of New York,
written in 1907, is certainly justified:--

"In no other direction can such large results be achieved so certainly
and at such relatively small cost. The time is not far distant when
those states and municipalities which have not adopted a comprehensive
plan for dealing with tuberculosis will be regarded as almost criminally
negligent in their administration of sanitary affairs and inexcusably
blind to their own best economic interests."

[Illustration: FIG. 76.--Mortality from pulmonary tuberculosis. Deaths
per 100,000 population.]

_Pneumonia.--The germ._

In New York State in the year 1908, the largest number of deaths from
any specific disease was due to consumption, the number of deaths in the
rural population alone being 2906. The next largest number of deaths in
the rural communities, and always a close second to consumption, was
from pneumonia, the number being 2191; so that pneumonia justly ranks as
highly important in the list of diseases which are at present most
deadly in their effect on the human race and against which a vigorous
fight should be made.

While pneumonia, like tuberculosis, is due to the action of a specific
organism, the germ itself is not so generally infectious; that is, the
germ has not the power of remaining vigorous when out of the human body
in the same way as has the germ of consumption. Like tuberculosis, the
germ is expectorated and remains virulent when dried into dust, but the
germ is much more sensitive to temperature changes and does not live
longer than two or three hours when dried and exposed to the sun. It is,
very curiously, a normal resident in the mouths of at least one third of
all healthy persons, and it is only necessary for the body of these
persons to become weakened for the germ to be able to secure a foothold
and produce the disease. Unlike tuberculosis, which attacks chiefly
those in the vigor of life, from fifteen to forty-five years of age,
pneumonia attacks generally the very young and the very old; those under
five and those over forty-five, the time of life when the vital
resistance is the least.

_Weather not the cause of pneumonia._

One of the sources formerly believed to be largely responsible for
pneumonia, that is, exposure to severe weather, is curiously negatived
by the fact that children and old people are not those generally exposed
to weather. Perhaps no fallacy in any disease has been more prevalent
than that pneumonia is usually contracted by exposure to wet or to cold.
It has, indeed, been noticed that the disease has been practically
non-existent under conditions where it would be prevalent if exposure
alone were the cause. For instance, in the Arctic zone, where the
temperatures are very low and where no adequate provision against the
rigors of a severe climate are possible, pneumonia is practically
unknown. During Napoleon's retreat from Moscow, when thousands of
soldiers died from physical exposure, from frost bite and starvation,
where if exposure were the predisposing cause of pneumonia, it would
have raged as an epidemic, it seldom appeared, proving this opinion.

Perhaps one reason why the disease has been supposed to result from
exposure is the undoubted fact that it is chiefly prevalent in the
winter and spring rather than in the summer. This argument is, however,
modified by the fact that the majority of cases do not occur in January
or February when the temperature is lowest, but in March, when the
opening of spring is in sight. The reason for this is evident when we
remember that the cause of the disease is a germ, generally present in
the body and needing only a reduced vitality for its successful inroad
on the human system. When, therefore, a person shuts himself up in an
overheated house, without ventilation, takes insufficient exercise, and
lives with an apparently determined effort to do everything possible to
reduce his bodily vigor, then it is no wonder that the germ, almost in
exultation, finds an opportunity for successful development.

_Preventives in pneumonia._

Much as in tuberculosis, then, the best remedy and the best prevention
for pneumonia is a careful attention to the needs of the body in order
that it may preserve its normal vigor. Regular hours, sufficient sleep,
and good food will, in most cases, keep the body in such a condition
that pneumonia need not be dreaded, no matter what the exposure or what
the temperature. Further than this, if the disease does once start and
gain a foothold in the lungs, the best cure is, as with tuberculosis, a
plentiful supply of oxygen or fresh air in order to remove the toxins
formed by the disease and give the lung tissue an opportunity to
recover.

Formerly medical men treated pneumonia by confining the patient in an
overheated room in which steam was generated, with the idea that the
lungs would be most helped by an atmosphere of moist heat. Now, a
pneumonia patient is supplied with all the fresh air possible, the
windows of the sick room, even in winter, being kept continually open,
and every effort being made to give the patient fresh air even when
every breath means a shooting pain, and apparently untold suffering. In
some of the New York City hospitals, the ward for pneumonia patients is
on the roof, and children and babies suffering with pneumonia are at
once taken there, even with snow piled all around the tent in which they
are kept. The nurses and physicians are obliged to don fur coats, and
heavy blankets must be provided to keep the patients from freezing to
death; but the pneumonia germ, under these conditions, is worsted almost
as if by magic, and within a few hours after leaving the warm wards of
the hospital the patients start on the road to recovery.

The remedy, then, for the 2000 cases of pneumonia which occur in New
York State each year, is an improved regulation of the health conditions
of the separate families throughout the state--a better hygienic
regulation of the everyday life. Care must be taken to provide better
ventilation in the houses, more fresh air in the sitting room and in the
sleeping rooms, more outdoor life in the winter time, and more exercise
by which the blood circulation will be kept active. Then more varied and
more suitable food must be consumed, food which will be capable of
absorption by the tissues and not clog the intestines and poison the
system. More bathing, by which the pores of the skin can be relieved of
the organic matter which otherwise clogs them and prevents their
effective action in the removal of waste products, must be indulged in.
With these three factors properly evaluated, with more fresh air, with
better food, with ample bathing, pneumonia need not be dreaded, since
then it would attack only those few whose constitutional vigor was
impaired, and in the course of a generation or two the number of these
would be so decidedly diminished that pneumonia would find no one
susceptible.

_Infection of pneumonia._

It must not be forgotten that a pneumonia patient is a source of
infection quite as much as is a tuberculous patient, and the same
precautions against infection should be followed. The nurse should be
particularly careful not to infect herself. She should be careful to
exercise enough self-control always to get daily exercise and fresh air
and must, as a matter of self-protection, avoid overfatigue. The eating
utensils, food refuse, and soiled clothing may all be infectious and
must be sterilized by boiling as soon as removed from the sick room. The
severe epidemics which have occurred from pneumonia have occurred in
camps where sanitary conditions are grossly violated. Under such
conditions pneumonia has become a most alarming epidemic, sometimes
called the black death. In a single house, however, disinfection of the
wastes of the patient and a proper care of the personal hygiene of the
rest of the family will avoid the spread of the disease, and if the
patient has sufficient vitality, sustained by good food and fresh air,
he will recover without serious after affects.




CHAPTER XVII

_TYPHOID FEVER_


The two diseases already described, tuberculosis and pneumonia, are by
far the most serious of all the infectious diseases, being responsible
in New York State alone, in 1908, as already stated, for 5727 deaths. No
other infectious disease even approximates the virulence and deadliness
of these two, and while some of the constitutional disorders, such as
Bright's disease, diarrhoea, and irregularity of the circulation, each
result in from 2000 to 3000 deaths, the cause and prevention of these
are so little understood as to baffle the hygienist. There are a number
of contagious diseases which, while comparatively unimportant in the
number of deaths, yet are of concern because the cause of the disease is
so well known that the means of prevention is quite within our power. Of
these, typhoid fever, in New York State in 1908, among the rural
population alone resulted in 437 deaths, a rate of 18.7 per 100,000
population. The facts substantiate the assumption that for every person
dying with typhoid fever there are ten cases of it, so it is a fair
statement that in the rural part of New York State, in 1908, there were
not far from 5000 persons afflicted with this disease.

Perhaps one of the reasons why so determined a fight against this
particular disease, involving only 5000 cases of illness during the
year, has been made, is on account of the length of the illness in each
case and on account of the fact that the disease usually attacks those
in the very prime of life, from 15 to 40 years. It is also to be
economically considered by reason of the loss of time involved in an
illness of nearly two months and the loss of money implied in the
nursing, doctors, and medicine. The movement against the disease is most
encouraging because the line of attack is well known, and there is,
humanly speaking, no reason at all why the disease should not be stamped
out.

_Cause of the disease._

Typhoid fever is a modern disease, and only for the last fifty years has
it been recognized in medicine. It is caused by bacteria, and its
manifestations are the results of bacterial growth in the body, chiefly
in the smaller intestine. Here the toxin produces a violent poison which
results in an attack of fever, lasting about six weeks. Owing to the
bacterial growth, serious failings, commonly known as perforations, may
develop after a severe attack, in the membranes and linings of the
intestine, and the resulting inflammation is not infrequently the
immediate cause of death. It is a thoroughly established fact that the
disease is caused by a special type of bacteria and that if the bacteria
could be killed outside the body, no transmission of the disease could
occur. It is also true that if the disease germs could be destroyed
within the body the patient would recover immediately, provided the
toxins had not been already distributed through the system.

There are, therefore, two possible methods of doing away with typhoid
fever, one by eliminating all possibility of transmission outside of the
body of the patient and the other by killing the germs while in the body
of the patient. The latter plan is not feasible, since no antiseptic has
been found which will kill the germs without killing the patient. It has
been discovered that a drug called utropin will act on the germs when
located in certain parts of the body, as in the kidneys; but this drug,
although very effective in destroying germs in those organs, has no
effect elsewhere. In general, we must eliminate the disease by
preventing its transmission from the sick to the well.

_The bacillus of typhoid._

Unfortunately, the typhoid fever germ is comparatively hardy and is not
so easily killed by unfavorable environment as is the germ of pneumonia,
for instance. It lives in water and in the soil, although probably it
does not increase in numbers in either place. Nor will it live in the
soil or in water indefinitely, and a great deal of study has been
expended in trying to determine just how long typhoid fever germs will
live under different conditions. It has been found, for example, that
drying kills the typhoid bacillus in a few hours, although a few may
survive for days. Experiments have also shown that it cannot leave a
moist surface. It cannot, for instance, jump out of cesspools and drains
and take to flight through the air, conveying the disease.

There is no possibility of contracting typhoid fever because a drain
near the house is being cleaned out, since, so far as is known, the
typhoid fever germ does not get into the air. The direct rays of the sun
will kill typhoid fever germs within a few hours, although the value of
this sort of disinfection is limited, because where typhoid fever germs
are apt to accumulate, the turbidity of the water prevents the
penetration of the sun's rays for more than a few inches.

It has been found that a high temperature kills typhoid fever germs, and
even so moderate a temperature as 160 degrees Fahrenheit is sufficient
to destroy them. This is the principle employed in pasteurizing milk,
since it is assumed, justly, that by raising the temperature of the milk
to 160 degrees Fahrenheit, for ten minutes, it will be possible to kill
any typhoid fever germs present. Boiling, of course, since this involves
a temperature of 212 degrees, will kill the germs, and it is for this
reason that wherever a water is suspected of typhoid pollution, it
should be boiled before being used for drinking. It has been found that
in distilled water, that is, in water where no available food is to be
had, the germs will live about a month, and that in water with organic
matter present, but without other bacteria, this period may be extended
two or three times. In water rich in organic matter, but where other
antagonistic bacteria are also present, the typhoid germs are usually
driven out or killed at the end of three or four days.

It is not unreasonable to expect that at least half of the germs
discharged into a stream will live a week, and if the stream has a
uniform current, so that the germs are continuously carried downstream,
they will be found below the point of infection, a distance equal to
that which the stream will flow in a week. This is important because it
shows how unlikely it is that the germs once placed in water will die
out or disappear without infecting those who subsequently drink the
water. There is evidence that the typhoid germs, like all other germs
for that matter, are likely to settle to the bottom of a lake or pond,
and so a stream passing through a pond will lose a large part of the
bacterial pollution with which it entered. This is not positive enough,
however, to insure a good water-supply, since in the spring the heavy
flow of the stream will wash this deposited material out through the
pond, carrying the infectious matter downstream. In addition, the
upheaval of the settled material from the bottom of the lake, which
occurs twice a year on account of the variation in temperature at
different depths, will bring the settled germs to the top.

It has been found also that just as a high temperature destroys the
germs, so a low temperature has the same effect. Typhoid fever germs in
ice are practically harmless after two weeks, and since in natural ice
the impurities of the water are largely eliminated mechanically, so that
frozen water is purer than the water itself, there is very little
chance, even when ice is cut from a polluted pond, for typhoid germs to
be found alive after being in an ice house for three or four months. In
the ground, the life of the bacteria is longer, and while experiments do
not agree very well as to the exact length of time that the germ may
live there, there seems to be evidence that they may live several
months, if not a year or more. Cases have come under the observation of
the writer which seemed to show that certain well waters were polluted
by germs which could only have been deposited in the near-by soil nearly
a year before the time of the consequent outbreak.

Entirely to deprive the germs of life, therefore, it is necessary,
inasmuch as they are so widely distributed, to act promptly and at once
disinfect the fecal discharges from the patient rather than to wait
until those discharges have been thrown into a stream or onto the ground
and then attempt disinfection. There is probably no more important thing
in stopping the spread of typhoid fever than to practice carefully
disinfection in the sick room, using bichloride of mercury and chloride
of lime, as already described in Chapter XV. Since, however, such
disinfection is not always practiced and since care must be taken to
avoid the introduction of the germs into the system, it is well to know
how, assuming that they have not been killed in the sick room, they make
their way from that place to a healthy individual.

_Methods of transmission of typhoid._

There are three main avenues used by the germ, namely, water, milk, and
flies, and of these three, the first is by far the most important and
includes probably 80 per cent of all the cases. The reason for this is
twofold. First, that water is so universally used, and second, that it
is so easily and generally polluted. There are many historic examples
which show definitely that water once polluted by typhoid germs is able
to spread the disease far and wide.

The epidemic in Ithaca, New York, is a good example and ranks as one of
the most serious that this country has ever known. The water-supply of
the city is taken from a small stream, Six Mile Creek, which is a
surface water with a drainage area of about 46 square miles. The stream
is polluted to a large extent. About 2000 persons live on the watershed,
and there are many houses practically on the bank of the stream which
runs for a large part of its course at the bottom of a valley with steep
side slopes. At the time of the epidemic, 1903, a dam was being built
on the stream about half a mile above the waterworks intake, and while
no proof of the fact could be found, it was generally supposed that some
of the Italians working on the dam were affected with typhoid fever and
had polluted the water. However, there were on the banks of the stream,
farther up, no less than seventeen privies, and it was known that there
were at least six cases of typhoid fever during the season just previous
to the epidemic. During the month of December, 1902, a heavy rain
occurred, so that any pollution on the banks would naturally have been
washed down into the stream. On the 11th of January, the epidemic broke
out through the town and by the middle of February there were some 600
cases reported in a population of 15,000. The number of deaths from this
epidemic was 114, and there is reason to suppose that the number of
cases was double the number reported by the physicians. After the water
from the creek was shut off and after the citizens had been persuaded to
boil all water used, the epidemic stopped and the installation of a
filtration plant has prevented any recurrence of the epidemic.

In 1880, a severe epidemic occurred in Lowell, Massachusetts, and was
traced to an infection of the river from which the city's water-supply
was taken. This was definitely shown to have come from a small tributary
of the Merrimac River, and the particular infection responsible for the
epidemic was traced to a small suburb named North Chelmsford, where one
case of typhoid fever occurred in a factory, the privy of which was
located directly on the bank of the small tributary.

In 1900, an epidemic of typhoid occurred at Newport, Rhode Island,
through the pollution of a well, and about 80 persons were affected,
most of whom lived within a radius of 300 feet of the well and all of
whom used the well water. The well was a shallow one with dry stone
sides and a plank cover, and surrounding the well were about 20 privies,
the nearest one only 25 feet away. The water in the well was 2 feet
below the surface of the ground. It was found that a month before the
epidemic broke out, there had been cases of typhoid fever in houses
adjacent to the well, and that discharges from the typhoid patients
found access to the privy vault which was only 25 feet from the well. It
was practically certain that the well was infected by the leechings of
these privies, particularly from the one only 25 feet away.

[Illustration: FIG. 77.--Spring infected by polluted ditch.]

Another example of the way in which underground waters, such as springs,
may become contaminated is described by Whipple as occurring at Mount
Savage, Maryland, in 1904. Through this village ran a small stream
known as Jennings Run, which was grossly contaminated with fecal matter.
In July, 1904, a woman who had nursed a typhoid patient in another town
came home to Mount Savage, ill with the disease. She lived in a cottage
on the hillside above the stream, and the drainage of the cottage was
conveyed through an iron pipe onto the ground just above the stream.
Figure 77 (after Whipple) shows the relative positions of the cottage
and stream. Heavy rains occurred during the first week in July which
probably washed the infectious matter from the ground into the ditch and
then through the ground into a spring just below down the slope. A week
afterwards twenty workmen who had been drinking water from the spring
came down with the fever and new cases occurred daily for a week or two.

An interesting epidemic occurred in Massachusetts, caused by a farmer's
boots carrying infectious matter from recently manured fields onto the
well cover, whence it was washed into the well by repeated pumping.

The moral of these incidents is very plain, namely, that where any
possibility of the infection of drinking water occurs, that water ought
either to be avoided or else to be thoroughly sterilized before using.
This applies particularly to the old-fashioned well,--the kind with
loose board covers and chain pumps.

_Construction of wells in reference to typhoid._

Two points already mentioned are essential if well water is to be kept
pure. One is to line the well with a water-tight masonry lining, and the
other point is to have the cover of the well made with a thoroughly
water-tight coating. This does not always give full protection, since
in some cases polluting matter may pass through even ten feet of soil.
This would be particularly true if the well was in a fissured or seamed
rock, and very recently the writer found a well dug in a laminated
granite, where a near-by sewer, leaking at the joints, contaminated the
water of the well, although the well was cased with an iron casing
twenty-five feet deep. The sewage escaped into a crack in the rock and
followed the crack down vertically and horizontally into the well.
Limestone is even more dangerous if any pollution exists in the
vicinity. In cases where a well goes down to a horizontal layer of
limestone and where a privy vault is dug to the same rock, it is found
that pollution will follow the surface of the rock horizontally a long
distance, and this condition of things always makes a well water
suspicious. In sand or fine gravel, on the other hand, the danger of
contamination is almost negligible; on Long Island, for example, the
cesspools and well are both dug ten or fifteen feet deep and only fifty
feet apart without any trace of contamination being detected.

_Milk infection by typhoid._

Milk is responsible for perhaps 5 per cent of the cases of infection.
Although the infection is always foreign to the milk itself,--that is,
enters the milk only after the milk is drawn from the cow,--milk
frequently becomes infected because infected water has been added to it
or because the cans have been washed in infected water, or because some
persons in contact with a typhoid patient have had their hands infected
and then handled the milk or the milk utensils. There are a number of
epidemics which have been clearly traced to milk polluted in one of
these ways. In Somerville, Massachusetts, for example, in 1892, 32 cases
occurred, 30 of which were on the route of a single milkman. It was
found that the milkman had two sons, one of whom had typhoid fever just
before the outbreak. This son washed the milk cans and mixed the milk in
a milk house in the city, and the inference was that in some way this
man infected the milk, probably in one of the mixing cans.

In Stamford, Connecticut, in 1895, an epidemic occurred which caused 386
cases and 22 deaths. Ninety-five per cent of all the cases occurred
among those who took milk from one dealer, and it was probable that in
this case the infection came from using a badly polluted water to wash
the cans. In Montclair, in 1902, a small epidemic involving 28 cases
occurred, where the health officers decided, after having found out that
the cases were all among those customers taking milk in pint bottles,
that the infection came from a house on the route, where typhoid fever
had occurred. It appeared that this family infected the bottles left at
their house, and since the milkman failed to sterilize the bottles
before re-filling them, the infection was passed on to others also
taking milk in pint bottles.

_Infection by flies._

Flies also transmit typhoid fever chiefly because they are essentially
such unclean insects. They are born in filth and they delight in living
in filth, and if privies and cesspools and manure piles and garbage
piles could be shut out from flies, the fly pestilence would be at an
end. The feet of the flies are suction tubes, and when a fly lights on
any object, it causes more or less of that material to stick to his
feet, and then when he flies elsewhere, he may leave the particles on
the object on which he alights. This has been proved by allowing a fly,
caught in the house of a typhoid fever patient, to walk over a gelatine
plate, leaving on the plate not merely his tracks, but the germs which
his feet had carried. When the plate was exposed in an incubator, it was
found that, within two or three days, millions of bacteria had grown
from the number deposited by the one fly.

It is believed that the number of cases of typhoid which occurred in our
Spanish-American War, at the military camps, and which were so
disastrous, were due largely to flies. Among the 107,973 soldiers
quartered in military camps at that time, there were 20,738 cases of
typhoid fever, and the number of those which were fatal constituted 86
per cent of all the deaths from disease during this campaign. It was
shown by the commission appointed to investigate the matter that the
spread of the disease was not due to water or to food, but in most cases
to the direct transmission of the germs through the agency of flies. In
the Japanese and Russian war, where in the Japanese army of over a
million men only 299 deaths from typhoid occurred, strict measures were
taken to do away with all the breeding places of flies, and Major
Seaman, who writes most interestingly on the success of the Japanese in
avoiding typhoid, describes the ways in which the Japanese soldiers made
flycatchers of themselves and waged war against flies quite as actively
as against the Russians.

_Other sources of typhoid fever._

There are other sources of the disease; for instance, there have been a
number of small epidemics undoubtedly caused by infected oysters. One
of the unpleasant habits of the oystermen is to bring in oysters from
the ocean and leave them for a few days in shallow water where they may
plump up or fatten, and they have found by experience that this
fattening occurs more rapidly in dirty water. If the oysters are
fattened in sewage-polluted water, the typhoid germs get inside the
shell in the oyster liquor and are thus transmitted to those persons who
eat the oysters raw.

Some kinds of food may transmit the disease: lettuce and celery, for
instance, if washed in contaminated water or handled by persons with
unclean hands or perhaps fertilized with manure containing typhoid
germs. Finally, it is possible to acquire the disease by direct
contact--not that the germs of typhoid are in the air in the room where
a typhoid fever patient is lying, but rather that the nurse in some way
soils her hands and then infects herself by putting her fingers in her
mouth, or handles dishes or food afterwards used by other people, and so
infects those others. It is not uncommon, for example, to see food
partly consumed by a sick person given to children, or it may be that a
child in the sick room is fed dainties prepared for the use of the
patient. The result of such division of food is very apt to be a
division of the sickness to the injury of the child.

_Treatment of typhoid fever._

So far as present knowledge extends, the disease is one best treated by
being let alone, with some moderate modification. When germs have been
swallowed and when the vitality of the individual is such that the
disease is contracted (happily, as has already been said, only about 10
per cent of those into whom the germ effects an entrance are
inoculated), the first stage in the disease is a multiplication of the
germs. This constitutes what is known as the incubation period, and
lasts about ten days. During this time, the individual feels uneasy, has
more or less headache and backache, and loses mental energy. The typhoid
bacillus during this time spreads into almost every organ and tissue of
the body, and towards the end of the period, when the resisting forces
of the body have been proved unable to counteract the attack and the
fever is well developed, the condition of the patient is deplorable. The
bacteria are everywhere throughout the system, although they are
especially active in the small intestines. This inflammation may produce
ulceration and the blood vessels may be attacked, so that hemorrhages or
even peritonitis may occur. A slight rash appears on the body, and a
peculiar appearance of the tongue is to be found in severe cases. In
from two to four weeks, the battle has been decided, and if the
resisting forces prevail, the fever stops, and the patient begins to get
well. This means probably, not that the bacilli are all dead, but that
the patient has developed in his blood a sufficient antidote to the
poison, so that the effects of the latter are no longer noticeable. The
period of recovery, if the patient does recover, is most tedious, since
the condition of the alimentary canal is such that great care must be
exercised lest serious disorders there occur, and, although the patient
is excessively hungry and really in great need of nourishing food, no
greater folly can be committed than in allowing his desire for food to
lead to indiscretion.

Injudicious exposure or fatigue will also cause a relapse, and while
recovery is usually a simple matter, it is only so when under the eye of
a judicious and careful nurse. The only treatment required is plenty of
water for drinking, to make up for the enormous loss by perspiration
from the skin, which helps to wash out the poisons from the body. Then
baths, where such methods of treatment can be used, as in hospitals, are
also used both to lower the skin temperature and to add water to the
surface. Sponge baths in water or alcohol are valuable and in some cases
tub baths with the temperature as low as 40 degrees are used. Then a
proper diet to keep up the strength of the patient, liquids always, and
usually milk, forms the only other treatment possible. No drug is of any
avail, and uninterrupted watchful care is the only way of combating the
disease.

In concluding this chapter, it may be mentioned that certain army
officers interested in medical work have discovered what they believe to
be an antitoxin for typhoid fever, and they have inoculated hundreds of
soldiers as a preventative. The results are not yet conclusive, but
there seems to be great promise. It is hoped that the time may come soon
when people will be so educated that there will be no opportunity of the
germs escaping from the sick room, and that food and drink will be so
cared for that there will be no possibility of infection. The writer
feels that it is in these last two methods of prevention rather than in
the use of antitoxin that the hope of the future lies.




CHAPTER XVIII

_CHILDREN'S DISEASES_


There are four diseases, scarlet fever, measles, whooping cough, and
chicken pox, which are recognized as belonging preëminently to the
period of childhood and which are supposed to be the result of bacterial
contagion, although, curiously, the specific bacteria concerned in any
one of these four diseases has not been detected. They may be rationally
grouped together for two reasons. First, because of their attacking, in
the majority of cases, children under the age of fifteen years, and
second, because the first stages of these diseases are very similar, so
that the recognition of them is not easy except for the practiced
physician. It must not be thought, however, that because these are
diseases of childhood and because a majority of children have them at
one time or another, without great suffering and without serious after
effects, they are on that account to be despised. Scarlet fever, for
instance, is to-day probably the most dreaded of children's diseases,
not because so many children die of it,--although the death-rate is
large, about 20 per cent of the cases finally succumbing,--but because
of the large number of complications and consequences which are directly
due to this disease. Measles, also, though not to the same extent, is
frequently followed by serious after results. In the United States,
about 13,000 children die every year of measles and about half as many
die of scarlet fever. It is a significant fact that the death-rate is
much higher among younger children, so that if, by carefully keeping
children from the possibility of infection, the disease can be postponed
until they are well along in years, the danger of fatal termination is
much reduced.

The following table, for instance, shows the number of deaths from
measles and scarlet fever at different ages, and it is very evident from
this table that if the former disease is contracted by a child under
five years old, the danger of death is four times as great as if it were
postponed until the child were ten years old:--

TABLE XIX. TABLE SHOWING DEATHS AND PERCENTAGES FROM MEASLES AND SCARLET
FEVER FOR DIFFERENT AGES IN UNITED STATES REGISTRATION AREA FOR 1907

====================================+=====================================
               MEASLES     |        SCARLET FEVER
------------+----------+------------+-------------+----------+------------
            |          | Per cent of|             |          | Per cent of
Age Period  | Number of|    Total   | Age Period  | Number of|   Total
            |  Deaths  |    Deaths  |             |  Deaths  |   Deaths
------------+----------+------------+-------------+----------+------------
All ages    |   4302   |     100    | All ages    |   4309   |     100
Under 1 yr. |   1058   |      24    | Under 1 yr. |    175   |       4
1-2 yr.     |   1315   |      31    | 1-2 yr.     |    474   |      11
2-3 yr.     |    626   |      14    | 2-3 yr.     |    639   |      15
3-4 yr.     |    343   |       8    | 3-4 yr.     |    640   |      15
4-5 yr.     |    189   |       4    | 4-5 yr.     |    511   |      12
5-9 yr.     |    350   |       8    | 5-9 yr.     |   1213   |      30
10-14 yr    |     89   |       2    | 10-14 yr.   |    315   |       8
Under 5 yr. |   3531   |      82    | Under 5 yr. |   2439   |      58
Under 15 yr.|   3970   |      92    | Under 15 yr.|   3967   |      92
Over 5 yr.  |    771   |      18    | Over 5 yr.  |   1870   |      42
Over 15 yr. |    332   |       8    | Over 15 yr. |    342   |       8
============+==========+============+=============+==========+============

The table shows also that the dangerous age period for scarlet fever is
later than for measles. It indicates that while 82 per cent of all
deaths from measles are of children under five years of age, only 58 per
cent of the deaths from scarlet fever are in that period; but that the
number of deaths of the latter between five and nine years is so great
that the percentage of deaths under fifteen is the same in both cases.
The moral is plain, namely, that a child should be carefully protected
from infection by measles until he is five years old and from scarlet
fever until fifteen, if the danger to the child's life is to be reduced
to a minimum.

_After effects of scarlet fever and measles._

In themselves, these diseases may not be severe, children often having
mild attacks of scarlet fever, called scarletina, and apparently
suffering only from a cold, but exposure, by which a cold is developed
either during or after the disease, may lead to serious troubles.
Inflammation of the kidneys often occurs, which may develop into chronic
Bright's disease and ultimately cause death. Inflammation of the ear is
another incident of scarlet fever, in which abscesses are formed,
resulting not infrequently in permanent deafness.

The consequences of measles are not so serious usually, and a more
common after effect is trouble with the lungs or bronchial tubes.
Pneumonia, croup, and bronchitis very often follow measles, due, as
already indicated, to exposure before the body has regained its normal
condition. In both scarlet fever and measles the eyes are apt to be
affected, and it is very important in both diseases to keep the patient
in a darkened room and to forbid use of the eyes in reading or other
close work. On account of the complications following scarlet fever and
measles, as well as for their greater death-rate, these diseases are
more serious than the other two included in this discussion,--whooping
cough and chicken pox.

_Preliminary symptoms._

The beginning of each of these four diseases is much the same, and the
symptoms are likely to be mistaken for those of an ordinary cold. In all
of them, the first indication of illness is redness and itching on the
inside of the nose and throat with snuffling and discharging from both
eyes and nose. Sometimes the throat is affected, and the patient
complains of sore throat. Then the cheeks become flushed, headache may
follow, and fever begins, so that the patient is in a sort of stupor,
unwilling to do anything and glad to lie in bed. In severe cases
vomiting may accompany or precede the outbreak of fever.

At the outset, the probable reason for the similarity of these four
diseases as well as their likeness to a common cold is that the germs
responsible for all of them enter the body through the nose and throat
and begin their attack upon the membranes there. The action of the germ
is followed by the formation of poisons or toxins which are distributed
by the blood through the body, causing the fever and what are known as
"general symptoms." At the beginning it is not possible to determine to
which particular germ the distress of the patient is due, and probably
the continued prevalence of these diseases is chiefly owing to the fact
that in the early stages and in mild cases throughout, the sufferer is
allowed to be at large with every opportunity for spreading the disease.

_Contagiousness._

If, whenever a child has a cold accompanied by a fever, the mother
would promptly put him in bed in a room by himself, keeping the other
children of the family away from the sick room and the invalid under
restraint until all possibility of transmitting the disease is over, the
number of cases would be greatly diminished. Unfortunately, there seems
to be a general impression that such precautions are useless, and that
sooner or later every child must have these children's diseases. This is
a mistaken notion, and the table already referred to is sufficient
evidence to prove the error of this way of thinking.

All these diseases are affections of the whole body, caused by poisons
generated by germs, for which so far scientists have found no antidote.
The reason is plain. The germ itself is not known, and no animal has
been discovered on which scientists can experiment. If we could only
produce measles in a rabbit, for instance, we could very soon detect the
germ and would no doubt be able to procure an antidote to the measles
poison. But this has not been done, and therefore in measles and in the
other diseases mentioned we can only hope that the sick person will be
able to generate in his own body sufficient antidote to secure his own
recovery. Physicians therefore are almost helpless in treating these
diseases. They keep the patient in bed in order that all his strength
may be kept for fighting the disease. They insist on ventilation in
abundance, so that oxygen may be applied to the lungs in large
quantities in order to neutralize the poison. They advise sponge baths
in cold water and alcohol to allay the fever, and they prescribe
nourishing, easily digested food, such as milk, eggs, fruit, and plenty
of water to drink. In the hope of diminishing the chances of infection,
particularly in measles and scarlet fever, they recommend antiseptic
sprays for the nose and throat and antiseptic ointments, such as
carbolized vaseline for the skin when peeling or desquamation is going
on.

_Quarantine for scarlet fever._

Scarlet fever, while the most violent, is also the shortest lived, in
the majority of cases not more than three or four days, although the
full period of recovery is much longer. The peculiarity of this disease
lies in the abundant peeling which takes place usually from the entire
body and particularly from the hands and feet; in fact, in a number of
cases where the disease is light, the peeling from the hands and feet is
the only positive proof that the malady has been scarlet fever. During
this process of peeling contagion seems most active; therefore, although
recovery seems entire so far as the fever is concerned, the patient
should remain strictly isolated during this time. It is a slow process,
lasting from two to five weeks, and is very tiresome for the child who
feels perfectly well; yet, in the interests of other children, the child
must be kept strictly at home until at least a week after the last sign
has disappeared. It is also for the child's own sake very desirable to
observe this quarantine, since it is during this period of recovery that
most of the complications of scarlet fever occur, and if the patient is
kept under observation, either in his sick room or on some porch where
atmospheric exposure is not too great and where the child is certain to
eat nothing harmful, the chances for avoiding lung troubles and
digestive disturbances are minimized.

There is such a striking difference in the severity of cases of scarlet
fever that the name "scarletina" was for a long time applied to mild
cases with the feeling that possibly it represented an altogether
different disease. At the present time the disease is more intelligently
diagnosed, and while there is vast difference in the severity of the
sickness, it is all the same thing. Of the ordinary cases, about 5 per
cent terminate fatally; that is, in a village or a community where a
hundred cases occur, there would be five deaths. If the epidemic,
however, is of the severe form, a larger percentage of deaths occur,
often reaching 20 per cent of those affected. It has been noted that as
an epidemic progresses, the disease becomes more serious, and a
death-rate of only 5 per cent may, in the course of an epidemic lasting
several months, gradually increase to one of 20 or 25 per cent. For this
reason strong efforts ought to be made to stamp out an epidemic while it
is in the first stages.

Besides the possibility of contagion from the skin as it comes off, to
prevent which the antiseptic ointment is used, contagion also occurs
through clothing used in the sick room. In fact, the contagiousness of
scarlet fever is probably as malignant as any other infectious disease.
It has been observed that a year after a case of scarlet fever in a
house, the unpacking of a trunk or the unrolling of a bundle would set
free the contagion and would result in new cases of the disease. The
writer learned recently of a family in which a child had died of scarlet
fever and some of its clothing had been packed away in the attic. A
younger sister grew up, married, moved away, and some twenty years after
the death of the child, came back to her former home on a visit with her
own little girl. The grandmother, visiting the attic, found the clothing
packed away so long before, gave it to her grand-daughter to wear, and
in ten days the child was dead with the same disease.

There are a number of cases where scarlet fever seems to have been
carried by infected milk, and great care must be taken on dairy farms to
avoid any possibility of this kind of infection. To prevent the disease
being transmitted after apparent recovery, thorough disinfection should
be practiced. The patient's body should be very carefully and completely
and continuously covered with antiseptic ointment which prevents the
distribution of the contagion in small particles of skin. The sick room,
after the patient's recovery, should be thoroughly disinfected, and all
bedding steamed or boiled. All the surfaces in the room should be washed
with a solution of carbolic acid, 1 in 50, or corrosive sublimate, 1 in
1000.

_Measles._

If the disease is measles, one may expect a general epidemic, since its
power of direct contagion is nearly equal to scarlet fever, although the
fatality is much less. It is unfortunate that so little pains are taken
to prevent the spread of this disease and fortunate that, except in the
case of very young children, the effect of the illness is only a
temporary inconvenience. Curiously, however, if measles attacks savage
tribes where it has been before unknown, the severity of the disease is
very great. Cases are on record where measles have broken out on the
frontier and whole villages were wiped out; where the insignificant
measles, so innocuous in civilized communities, became a plague similar
to a scourge of the Middle Ages. It apparently has been modified by its
passage through generations of individuals, just as any bacterial
disease germ is modified by successive transmission through the bodies
of different animals. When, however, the disease breaks out in a
community which has not suffered from the disease for many years, it is,
on that account, likely to appear in a far more virulent form.

_Characteristic eruptions of measles._

Measles, like scarlet fever and chicken pox, is an eruptive disease;
that is, is accompanied with a rash, differing slightly in the three
diseases of which the presence of the rash and its progress over the
body is one of the distinguishing features. In scarlet fever, for
instance, the rash appears first on the neck and chest or back and
spreads outward to the extremities. In measles, the rash appears on the
extremities, beginning on the face usually, and spreads to the chest and
trunk. In scarlet fever, this rash appears as fine scarlet pin points
scattered around on the reddened skin, and on the second or third day
the entire body may look like a boiled lobster. In measles, the rash
appears as blotches, while the skin is not flushed but retains its
natural color. In chicken pox, the rash appears generally on the body
first and consists of small red pimples which develop into whitish
blisters about as large as a pea and well separated. They are much more
distinct and separated than the rash of scarlet fever and measles, and
are much more likely to be mistaken for smallpox pustules than for an
ordinary eruptive rash.

One of the old-time fancies connected with these eruptive diseases is
the belief that an abundant eruption is a sort of guarantee against the
severity of the disease. The old nurse was careful to keep the child in
bed, well covered, steamed in fact, until the eruption appeared, and it
was commonly thought that nothing should be done to check the rash or
to prevent its coming out. This is not sustained by later science, and
the appearance of the rash, whether it strikes in or strikes out, has
nothing to do with either the disease or with its severity. No possible
connection can be traced between the dissemination of the poison through
the system by the action of the bacteria and the appearance of the skin,
which is a minor factor in the disease. It may be worth while to repeat
that the greatest danger from measles consists in the possibility of
lung complications, and infinite care should be taken to keep the
patient shielded from drafts and free from overexertion until recovery
is complete. Like scarlet fever, the skin peels off, although not to the
same extent, and the small particles are capable of transmitting the
disease. Probably, also, the secretion from the nose and throat will
transmit the disease, so that it is the height of folly to allow a sick
person to use a handkerchief, for example, and then to use the same
handkerchief to wipe the baby's nose when he comes into the sick room.
All dishes and clothing of every sort should be boiled or steamed, and
to be rendered harmless they should be soaked in a disinfecting solution
before being taken from the sick room. The room itself, after being
vacated, should be disinfected and the walls washed, as already
prescribed.

_Whooping cough._

Whooping cough is unlike the other three diseases in that it is a
nervous trouble, and probably the germ or the poison formed by the germ
attacks the nervous system, and particularly one great nerve connecting
the lungs and stomach. This is why the spasm of coughing is frequently
followed by vomiting, and the only remedy which is of value in whooping
cough is a nerve depressant which will diminish the activity of the
nervous system without at the same time interfering with the strength or
vigor of the patient. On account of this connection between the lungs,
whose spasmodic ejection of air seems to threaten the entire collapse of
the little patient, and the stomach, so alarming do the repeated fits of
vomiting appear that often this feature of the disease is even more
serious than the coughing, pathetic as it is with younger children. In
some cases the stomach cannot retain nourishment long enough to feed the
body, and the child literally wastes away unless the period of the
disease runs out before the child starves to death.

It is often weeks instead of days before the disease can be recognized.
Then, if it develops in its usual form, begins the coughing so
characteristic of the malady and the hard straining whoop so painful to
listen to. Occasionally this coughing may be severe enough to cause a
rupture of a blood vessel; but ordinarily, unless the stomach is
affected by sympathy, no great danger need be feared. Fresh air,
moderate exercise, good food, and some mild nerve depressant is all that
can be done. The disease is very contagious and is usually transmitted
directly from the sick person to the well person. It may, however, be
carried in clothing, particularly in handkerchiefs and towels. Like
measles, if it gains a foothold in an uncivilized community, it attains
the size of an epidemic or plague with very fatal results. It seems to
have a great power over girls and children, particularly those whose
vitality is below the normal. Like measles, one does not generally have
two attacks of this disease. In the winter, and this is the time when
the whooping cough is most common, it is often followed by lung
troubles, such as bronchitis and pneumonia. The death-rate from whooping
cough is as large as from scarlet fever and measles combined, but
chiefly because the disease is common among the smallest children. It is
not unusual for babies under a year old to have whooping cough, and when
their vitality is low, they scarcely ever recover.

_Precautions against spread of whooping cough._

Probably the disease does not become contagious until the cough starts,
and there is no reason why the disease should not be arrested in the
first victim, provided proper isolation is practiced. The idea of a
child with whooping cough, even when he whoops only once or twice a day,
being allowed to attend school and mingle with the other scholars and to
distribute the disease among them seems in these days of sanitary
knowledge almost criminal. As soon as the first whoop occurs the child
should be put in a room by himself and kept there until the last whoop
has been whooped, and no other child should be allowed to go into the
room, and the nurse or mother who is in charge should be careful about
contact with other children after coming from the sick room until she
has changed her outer garment. A big apron with long sleeves, fitted
closely around the neck, which may be slipped on and off easily, is an
admirable protection. The same precautions about disinfecting dishes,
napkins, towels, handkerchiefs, and bedding should be observed here as
already referred to.

_Chicken pox._

Chicken pox is the mildest of eruptive diseases. It has no relation to
smallpox, so that the theory sometimes held, that an attack of chicken
pox prevents any attack of smallpox later, is a mistake. Instances are
on record where a person has had both diseases almost at the same time.
The appearance of the eruption is the characteristic feature of this
disease, and it is so well distinguished that there is no danger of
failing to recognize it. It is not common in grown people, and while it
should not arouse suspicion in children, it is so uncommon in adults
that a suspected case is probably a mild case of smallpox, and should
always be quarantined as such.

With children, the accompanying cold and fever is often very mild, so
that the appearance of the rash is the first and only symptom of the
disease. The eruption is a progressive thing, each day's crop coming to
full bloom and dying out as the next day's crop develops. This is, by
the way, a distinguishing characteristic of this disease,
differentiating it from smallpox where the pustules are more persistent
and where the breaking out is more general. The pustules are sometimes
extremely irritating, and it is very hard to keep children from
scratching, the results of which may leave deep scars and so should be
avoided. An antiseptic ointment should be used as with scarlet fever and
measles, carbolized vaseline being suitable, although sometimes a strong
solution of soda is substituted. It is not common to disinfect in
chicken pox to the same extent as in the other diseases, the contagion
being apparently in the air rather than in clothing and short lived. In
New York State, in 1908, no deaths are recorded from chicken pox, and it
is because of this lack of fatal results that the disease is regarded so
indifferently and no particular pains taken to prevent its spread.




CHAPTER XIX

_PARASITICAL DISEASES (MALARIA, YELLOW FEVER, HOOKWORM, BUBONIC PLAGUE,
AND PELLAGRA)_


_Malaria._

From time immemorial, malaria (or fever-and-ague) has been one of the
great plagues of humanity. No advance outpost of civilization but has
suffered, more or less severely, from this disease. Dickens, in one of
his novels, describes graphically the disease as it existed in the early
American settlements, and vividly portrays its ravages, both mental and
physical, among the pioneer settlers. Certain sections of the world have
been especially noted for the prevalence of this disease, making
extensive regions practically uninhabitable. The vicinity of Rome, with
its swampy marshes and low-lying areas, has been one of these plague
spots. The jungles and swamps of the equator and the coastline of Africa
and South America and the valley lands of the Mississippi River have all
been noted as most dangerous districts for human beings to live in. Even
in civilized communities the ravages of the disease have, under
conditions most conducive to malaria, been fearful, so that only most
urgent requirements of mining, manufacturing, or similar material
processes have prevented the obliteration of entire communities.

The cause of the heavy death roll resulting from a bold defiance of the
reputation of these localities--a defiance bravely adopted by hardy
pioneers, by agents of trading companies, and by representatives of
governments--has been, up to the last ten years, assigned to the
water-laden condition of low-lying ground. Swamps and stagnant pools,
moisture-laden air, and a hot climate have been universally considered
to be the cause of the fever, and the transmission of the disease has
been supposed to be due to the passage through the moist air of the
germs of the disease, although the exact form and behavior of these
germs was unknown. Certain specifics have been proved by experience to
have some value. For instance, it has been found that planting a row of
trees between the house and a pool from which malaria might come has
been of aid in warding off the disease. In a number of cases a thick row
of eucalyptus trees, so associated in the popular mind with this purpose
that they are known as the malaria tree, have been planted as a tight
hedge with apparently very useful results. Drainage or filling up the
low lands has always been found to reduce the prevalence of the disease.

Many years ago the use of quinine in large doses was found to be a
specific, and the writer well remembers, on the occasion of his visit to
a malarial region, buying quinine at the grocery store by the ounce in
the same way that one would buy spices or tea, the dose being a
teaspoonful. Why quinine should prevent the daily or periodical chills
characteristic of the disease was not known, or why a row of eucalyptus
trees interfered with the development of the disease was not known, and
people generally were content to rest with the knowledge of these facts
only.

_Mosquitoes and malaria._

[Illustration: FIG. 78.--Resting positions for ordinary mosquito (left)
and malarial mosquito (right).]

In the year 1900, however, English scientists, working in the Roman
Campagna, demonstrated conclusively that which had been vaguely
suggested before, namely, that the cause of malaria is a parasite
composed of little more than an unformed mass of protoplasm, not
floating in the air at all, but transmitted only by the bite of a
mosquito. By a series of most interesting experiments, conducted by them
and by other scientists in other parts of the world, it has been
definitely proved that when a mosquito bites an individual suffering
from malaria, the mosquito draws up into his body, along with the blood
of the bitten person, some of the malarial parasites. In the body of the
mosquito, the parasite develops, requiring for a full-grown specimen
about seven days; then, if the mosquito bites another person, the
parasite is injected into the skin of the victim, and in the course of
about a week a good case of malaria ensues.

Fortunately, only a small proportion of the number of mosquitoes in the
world are capable of nourishing the malaria parasite. Under ordinary
conditions about 5 per cent of all mosquitoes found are malarial, and a
particular name has been given to those capable of transmitting the
disease. The ordinary mosquito is known as the "culex," while the
malarial kind is known as "anopheles." Figure 78 shows the
characteristic attitude of the two kinds by which the one can be
distinguished from the other when resting on a wall or ceiling. As will
be noticed in the drawing, the culex carries his body parallel to the
wall with his hind legs crossed over his back. The harmful mosquito, the
female anopheles, always hangs on by her front legs and has her body at
an angle of about forty-five degrees to the surface to which she clings,
her hind legs hanging down. The wings of the harmless mosquito are
usually mottled, while the wings of the malarial mosquito are of an even
color. The details of the behavior of the parasite on its long journey
from the original malarial patient through the body of the mosquito and
into the body of the person bitten is full of interest to the scientist,
who must, however, be provided with a good microscope to follow such
minute bodies; but the methods of avoiding the disease are more
pertinent to our present purpose.

While quinine is still recognized as the particular antidote for the
malarial poison, efficient as we know now because it is poisonous to the
parasite and not because it has any particular effect on the person, of
late years more and more stress is being laid on the elimination of the
mosquito. Naturally, if the mosquito can be destroyed and the
transmission of the disease thus prevented, there will be no further
need of quinine. The general impression that swampy land is favorable
to the development of malaria is correct, but not because the damp air
is itself pernicious. The significance of the damp ground lies solely in
the fact that mosquitoes in one stage of their existence require water
for their development. They breed only in water and always deposit their
eggs in water, on the surface of which the eggs float in very small
layers. The eggs hatch into larvæ or wrigglers, which also must remain
in water for development, and it is not until the third stage, that of
the full-grown mosquito, that the animal leaves the water which was his
birthplace. Obviously, therefore, if there is no water there can be no
mosquitoes.

_Elimination of mosquitoes._

Another pertinent fact discovered by scientific research is that the
development of the malarial mosquito is confined to the vicinity of
stagnant pools, because in fresh water, where fish are to be found, the
eggs and larvæ of the mosquito are a most acceptable fish food. One of
the most practical ways, therefore, of getting rid of possible
mosquitoes is to make sure that the pond always contains a number of
fish. Woods Hutchinson gives the following interesting description of
the way this fact was discovered:--

"It was early noted that mosquitoes would not breed freely in open
rivers or in large ponds or lakes, but why this should be the case was a
puzzle. One day an enthusiastic mosquito student brought home a number
of eggs of different species, which he had collected from the
neighboring marshes, and put them into his laboratory aquarium for the
sake of watching them develop and identifying their species. The next
morning, when he went to look at them, they had totally disappeared.
Thinking that perhaps the laboratory cat had taken them, and
overlooking a most contented twinkle in the corner of the eyes of the
minnows that inhabited the aquarium, he went out and collected another
series. This time the minnows were ready for him, and before his
astonished eyes promptly pounced on the raft of eggs and swallowed them
whole. Here was the answer at once: mosquitoes would not develop freely
where fish had free access; and this fact is an important weapon in the
crusade for their extermination. If the pond be large enough, all that
is necessary is simply to stock it with any of the local fish,--minnows,
killies, perch, dace, bass,--and presto! the mosquitoes practically
disappear."

[Illustration: FIG. 79.--Top view is of larva of Anopheles. Bottom view
is of larva of Culex.]

Another factor in the development of the mosquito from the egg to
full-grown mosquitohood is that in the larvæ stage air must be supplied,
curiously enough, through the tail which projects slightly above the
surface of the water as the larvæ hang head downwards (see Fig. 79). If
the surface of the water is covered with some impervious material, the
mosquito larvæ will be suffocated, and it has been found that oil lends
itself most readily to this desirable purpose, applied at the rate of
one ounce per fifteen square feet of water surface. The oil spreads out
over the surface in a very thin film, but persistent enough to keep off
the air supply from the mosquito larvæ. This method, about which much
has been written and said, is perhaps the one most commonly employed,
and its results have been most satisfactory. In the vicinity of the city
of Newark, New Jersey, for instance, is an area of about 3500 acres, 8
miles long and about 3 miles wide, practically all marshland. In 1903
ditches were dug throughout this marsh in such a way that the surface
water was drained off, drying the ground so that hay can now be cut
where formerly rubber boots were necessary to get onto the ground at
all. The consequence has been that the mosquitoes have practically
disappeared from this region, formerly frightfully infested, and the
cost of the 70 miles of small ditches dug has been amply repaid by the
freedom from malaria as well as from the nuisance of the ordinary
mosquito.

Other campaigns have been waged, using kerosene or crude petroleum for
the coating of ponds or pools. Wherever clear water exists the kerosene
treatment is probably best. Where marshland is found, through which the
kerosene penetrates with difficulty, drainage is a more useful method.

The size of the pools required for the development of the mosquito is
very small. Thousands of mosquitoes may be formed in the amount of water
contained in an old tomato can, and barrels half full of rain water or
pools of water in the vicinity of an old pump or in the barnyard will
afford golden opportunities for mosquitoes looking for a place to lay
their eggs. While the ordinary culex requires from one to two weeks only
for the complete transition from egg to mosquito, so that a pool filled
with rain water and not dried up within that period will be sufficient
to develop a brood, the malarial mosquito requires much longer--two or
three months--for the full completion of her development. It is,
therefore, a simple problem for an individual householder to search out
the pools which remain filled with water for a period of two months, and
either stock them with fish, drain them entirely, or coat them with
kerosene. No hesitation need be felt about the result of this treatment.
It will positively eliminate all malaria in the vicinity if the work is
thoroughly done.

_Limitation of mosquito infection._

The distance that the malarial mosquito can fly is of interest as
indicating the distance which one must go from a house, hunting for
available pools. All mosquitoes are unable to fly against the wind, so
that, as already noted, one side of a swamp may be comparatively free
from malaria, while the other side may be overrun with it, merely on
account of the direction of the prevailing winds. Some mosquitoes that
breed in salt marshes may be carried for miles, so that a land breeze
will bring millions of the pests to seashore cottages which, with a sea
breeze, are quite free from them. The anopheles has a habit of clinging
to weeds, shrubs, and bushes when the wind blows, so that it is seldom
carried more than about two hundred yards from the place where it is
hatched. If all pools of water, therefore, within this radius are
disposed of, the elimination of malaria will logically follow.

If one is obliged to be in a region where malaria is common, the disease
can be avoided absolutely by protecting one's self from mosquitoes, and
since the anopheles prefer the early morning and evening hours, it is at
those times of the day particularly when precautions must be taken. It
was once thought that the night air caused malaria, and this had some
foundation in fact, because it is in the early evening that the
anopheles is on the wing. By staying in the house after sundown and by
carefully screening the doors and windows, one may live in a malarial
country with perfect immunity. Volunteers have lived for months in the
worst malarial regions in the world without a trace of the disease, the
only precaution being to keep the doors and windows screened and to
prevent mosquitoes from biting.

An interesting experiment was made some years ago by sending a malarial
mosquito by mail from Italy to England, where an enthusiast allowed
himself to be bitten by the insect. He had had no trace of malaria
before, but a week after the mosquito's bite he came down with the
disease. It has also been noted that in such parts of the country as
Greenland and Alaska, where mosquitoes are as thick as in the far-famed
New Jersey marshes, malaria does not result from the mosquito bites
unless a malaria patient from other countries starts the infection.

The disease itself may be mild or severe. It takes about a week after
the mosquito bites before the symptoms appear, and sometimes the attack
is postponed for weeks or months. Chills are the usual accompaniment of
the disease; in children under six, convulsions are more common. The
chill lasts from a few minutes to an hour, and directly after the chill
comes the fever, which lasts three or four hours. The attacks usually
occur every other day and sometimes every two days, generally at the
same time of day. When persons have lived for a long time in malarial
regions, the intermittency of the chill and fever is less noticeable and
the continuous character of the fever often leads the disease to be
mistaken for typhoid. The intermittent regularity of the fever, however,
although between attacks the temperature never falls to normal,
distinguishes this type of malarial fever from true typhoid. The
positive determination of the disease is possible by an examination of
the patient's blood, in which the malarial parasite can readily be
found. Quinine is the remedy and the only remedy, and, fortunately, it
does no harm, even before the character of the disease is positively
known. The chill seems to be due to the development of a new brood of
parasites in the blood of the malarial patient, and in order that the
quinine shall have its effect on the blood, it must be swallowed three
or four hours before the time of the expected chill, and then it will
probably prevent, not the next chill but the one after. If the quinine
cannot be taken directly with reference to an expected chill, then it
must be taken regularly, sometimes for months before the chills cease.

_Yellow fever._

Yellow fever, although not common in this country, is interesting as
being almost exactly similar in its mode of infection to malaria. It is
transmitted through a parasite, as is malaria, and can only be passed
along through the agency of another kind of mosquito, known as
stegomyia. In 1899 there was a serious outbreak of this pestilence in
the cities of our southern coast, and the terrors of the plague of the
Middle Ages were revived for a number of months. Trains going out of the
infected regions were stopped by crowds armed with guns and the
passengers prevented from proceeding, lest the disease might spread. No
goods or freight were allowed to pass out from the infected area, and
the prejudice against intercourse with the outside world went so far
that guards even forbade the carrying of disinfectants to the victims.

Like malaria, the disease is one requiring a hot climate, generally
because it is favorable to mosquito growth. It is most common in the
seacoast cities of the South, and is probably transmitted often by
mosquitoes brought on board ship. Since Havana has been cleaned up by
Americans, the danger formerly existing from intercourse with that city
has ceased, although only three years ago the writer stopped in a hotel
at Havana, where two persons had died of yellow fever a week before. The
smell of disinfectants in the hotel was so great that not a fly or
insect of any sort was visible, and no other hotel in the city could
have been safer or more comfortable. It has been proved positively that
yellow fever cannot be transmitted by direct contact, since, in the
interests of science, volunteers have slept in beds from which the dead
from yellow fever had just been removed without contracting the disease.
That the infection is due only to mosquitoes is proved by the fact that
later, when bitten by mosquitoes, they succumbed to the disease. It
requires about two weeks for the disease to pass through its regular
stages in the body of the mosquito, so that there is no possibility of
its transmission for that time after the mosquito has come in contact
with a yellow fever patient.

The symptoms of yellow fever are characteristic and very severe. The
eyes first become bloodshot and, in the course of two days, yellow,
whence the name of the disease. Severe vomiting is also characteristic,
the discharge being sometimes discolored like coffee or even tar and
known as black vomit. The skin appears yellow, a condition which lasts
for some time and is particularly noticeable if by the pressure of the
finger on the skin the blood is made to recede. Among persons previously
in good health, the death-rate is about that of typhoid fever, but among
those in unfavorable surroundings and among those given to the use of
alcohol, the rate will be much higher. Practically, it may be expected
that this disease, like malaria, will disappear from the face of the
earth. When the only requirement is the destruction of the mosquitoes
and when mosquitoes can be so easily killed as already explained, it is
only a question of time before mosquitoes and the diseases they cause
will be stamped out. In Havana, before 1901, the number of the deaths
yearly was about 750. In the year after the American intervention, when
Colonel Gorgas, by military command, insisted on the thorough cleaning
of the houses and the general use of kerosene in all drains and
cesspools, there was not one single death.

_Hookworm disease._

The third parasitical disease common in some parts of the United States
has received much attention during this last year and is known as the
hookworm disease. It is a new discovery in medical science, and whereas
the physical condition of the victim is usually a clear indication of
the disease, a positive diagnosis is always obtained by the use of the
microscope. Several years ago it was announced in the United States that
the laziness and shiftlessness of the poor whites living in the sand
lands and pine barrens of the South was due, not to any inherent
cussedness but to the presence of a parasite in the intestine, known in
Italy and Germany as the hookworm, the disease being called
Uncinariasis.

The development of the disease is interesting. The worm, which is about
an inch long and looks not unlike a bit of thread, lays eggs by the
thousand in the intestinal tract of a human victim. Afterwards they pass
out in the excreta and, favored by heat and moisture, develop in the
soil in about three days into minute larvæ. These larvæ have a most
extraordinary power of attaching themselves to and penetrating into the
human skin and body. They may also enter the human body in a drink of
water or on unwashed vegetables. In infected regions the soil becomes
fairly alive with these larvæ, and it is hardly possible for a child to
walk barefoot outdoors without becoming infected. When the larvæ have
penetrated the hand or foot, they begin a long and circuitous journey
through the body, moving from the extremities through the veins to the
heart and thence to the lungs. From here they are carried through air
cells into the bronchial tubes, thence along the mucous membrane up the
windpipe and down into the stomach and finally, from the stomach, they
pass out into the intestines, the goal of their long journey.

This all takes time, and probably from the time they enter the skin to
the time they begin their murderous work on the lining of the intestines
requires about two months. In the intestine the larvæ develop into
adults; but before this final stage an intermediate existence is
reached, at which time they attach themselves to the mucous lining and
bore into it, presumably for the purpose of making a nest in which
later to lay their eggs. The burrowing parasite causes a great loss of
blood, and it is on account of the resulting anæmia that the poor whites
show always such incapacity, indifference, and apparent laziness. That
this disease is of importance in considering the hygienic condition of
the country is apparent when it is pointed out that in the southern part
of the United States, chiefly in the rural districts, there are at least
two million persons at present infected with the disease, and that
should these hookworms be blotted out of existence, two million
incapables would be changed into two million active Americans, ready to
raise the southern districts to a commercial elevation which their
natural resources seem to justify.

The treatment of the hookworm disease is simple, and the donation by Mr.
Rockefeller of $2,000,000 is intended to be sufficient to furnish the
opportunity at least for a complete cure of all the cases. It has been
found that a small dose of a preparation of thyme known as thymol
stupefies the parasites with which it comes in contact, so that they
unloose their claws and are set free in the intestine after its use. A
dose of epsom salts shortly after clears them out, and except for the
loss of blood, the disease is finished. Sometimes, however, in
long-continued cases the worms have penetrated so far into the membrane
that the use of thymol cannot withdraw them. In fact, in autopsies, it
has been found necessary to take tweezers and to use considerable force
in order to pull them out.

The prevention of the disease is really the cure of the disease, an
apparently simple matter, as already described. An improvement of
sanitary conditions so as to make impossible further pollution of the
soil should be also undertaken. Wherever the disease has prevailed in
this country or in Europe, it has been because of an utter neglect and
disregard of what are now known as ordinary sanitary conveniences, and
the report of the Country Life Commission, although many charges were
made against the conditions of living in different parts of the country,
was far from telling the whole story in the matter of the shortcomings
in parts of the southern states. There is, therefore, every reason why
the farmer and others living in the country should be urged to make
themselves comfortable with all known modern sanitary appliances. This
is desirable, first, for the sake of others on whom their sins of
unhygienic living might be visited, and then for their own sake, because
there such sins would also have an effect to a degree tenfold more
severe.

_Pellagra._

Another disease peculiar to country life, and which has only within the
last few years been recognized, is known as pellagra. Not yet is it even
known through what agency the disease is transmitted, but it has been
beyond question established that in some way corn is responsible for its
spread. Apparently, spoiled corn is necessary, and while presumably the
corn itself is not the agent, the parasite or organism that is
responsible lives only on corn which has been spoiled. Scientists have
long worked on the disease, and it would be a merely speculative
pursuit, one of interest to scientists and medical men only, except for
the fact that within the last few years it has broken out in this
country and is increasing to a most alarming degree. The disease itself
is almost hopeless when once established, physicians being yet utterly
unable to grapple with it; and while in Italy, Spain, and Egypt it has
been known for a century, there is still a death-rate of over 60 per
cent, and these deaths occur after most horrible suffering and agony.

As in rabies, the parasite, if it is a parasite, acts through a poison
which penetrates to the nervous centers, producing mental disturbances
culminating in an active insanity. At the same time, the agent attacks
the skin, whence its name "pell'agra," which means "rough skin," so that
the body appears as if it were affected with a severe attack of eczema,
large patches of skin peeling off and leaving the raw surface. In fact,
in one of the Illinois hospitals, only a few years ago, some insane
persons, infected with this disease, died, and because the effect of the
disease on the skin was not known, the nurse in charge was accused of
scalding the patients with boiling water, the appearance of the skin
being the only proof. The nurse was discharged, although, without doubt,
she was innocent, and the appearance of the skin was due solely to the
disease. It has been estimated that there are at present in the United
States five thousand victims of pellagra, with the number constantly
increasing, although physicians of standing make estimates largely in
excess of this.

Apparently preventive measures must consist in eliminating the
possibility of the use of spoiled corn. Indications are that the disease
appears only when such corn has been used, and in parts of Mexico where
corn is always roasted before being used, pellagra is never known. It
has been described as a disease of the poor, because the disease has
flourished chiefly in districts where poverty is so extreme that corn,
and spoiled corn at that, is the only food within reach. Usually, where
a mixed diet with meat is possible, pellagra never appears. In other
places, as in Italy, where the peasants live on a porridge of corn meal
cooked in great potfuls, a week's supply at a time, and during the week
exposed to dirt and flies and often spoiled before eating, pellagra is
most common. Experiments have shown that in these districts, by
excluding corn from the diet and furnishing a substantial fare, the
disease has been banished. Unfortunately, the taint of the disease
passes from parent to child and even to the third and fourth generation,
and the physical deformities commonly seen in pellagrous districts are
due to this hereditary taint. Dr. Babcock, Superintendent of the City
Hospital at Columbia, South Carolina, after discussing the disease, sums
up by saying, "Pellagra is a fact, and the United States is facing one
of the great sanitary problems of modern times."

_Bubonic plague._

The bubonic plague, or "The plague," as the importance of the disease
has caused it to be called, is one of the oldest of known epidemics. In
the third century it spread through the Roman Empire, destroying in many
portions of the country nearly one-half of the people. Its immediate
origin is a bacillus causing symptoms similar to blood poisoning,
although in some cases, where the lungs are attacked, the disease has
some of the characteristics of pneumonia.

A description of this disease is included here because, while bacterial
in its nature, it is transmitted largely, if not entirely, by fleas and
by a particular species of flea known as the rat flea. These fleas
harbor the plague bacilli in their stomachs and inject them into the
bodies of those they bite, in the same way that the anopheles or
stegomyia mosquito transmits malaria or yellow fever. Elaborate
experiments made in India in 1906 show conclusively that close contact
of plague-infected animals with healthy animals does not give rise to
any epidemic, so long as the passage of fleas from infected to healthy
animals is prevented. When opportunity, however, was given for fleas to
pass from one animal to another, the bacillus and the disease was
generally carried over. It has also been found that while this species
of fleas have their normal residence on the body of rats, they will also
desert a rat for man, if the infected rat is dying and no healthy rat is
in the vicinity to receive them. It is, then, obvious that to eliminate
the disease, the most direct and positive course is to destroy the rats
which are the home of the disease.

In India, where the plague appeared in 1896, causing about 300 deaths,
it rapidly increased in virulence until in 1907 it caused 1,200,000
deaths. The ports of the Pacific coast became much alarmed, and when
cases of the disease were actually found in San Francisco in 1906, the
matter was so terrifying that the United States Marine Hospital Service
was at once instructed to stamp out the disease if possible. This
procedure was directed almost entirely against rats. Deposits of garbage
on which rats might feed were removed, rat runs and burrows were
destroyed and filled in, and stables, granaries, markets, and cellars
where rats might abound were made ratproof by means of concrete. Rats
were trapped and poisoned by the thousand, nearly a million being thus
disposed of. As a result of such thorough work, the plague was stayed,
and in 1909 not a single case of the disease among human beings was
found, and although 93,558 rats captured were examined, only four cases
of rat plague were found.

In southern California, however, the fleas deserted the rats for ground
squirrels, and one county in particular, Contra Costa County, had an
epidemic which caused the squirrels to die by the thousands. The
attention of the scientists was thus turned to the squirrel as a host of
the flea, and a warfare similar to that against the rat has been for a
year past carried on against the infected squirrels. Between September
24, 1908, and April 12, 1909, 4722 ground squirrels were killed and
examined for plague infection, and from June 4 to August 13, 1909, the
work being continued, 178 squirrels were found to have the plague.

Now that the relation between fleas and their hosts and the transmission
of the disease is known, there need be but little fear in the future of
this old enemy of man again getting control and spreading without
hindrance throughout a whole country.




CHAPTER XX

_DISEASES CONTROLLED BY ANTITOXINS (SMALLPOX, RABIES, TETANUS)_


_Smallpox._

A hundred years ago, the most dreaded disease in this country or in
Europe was smallpox; and even yet writers of fiction, when they desire
to expose their hero to the most harrowing conditions possible, leave
him in a deserted hut with a man dying of smallpox. But to the educated
person of to-day smallpox is encountered absolutely without dread, since
it has been robbed of its terrors by the introduction of vaccination. As
far back as 1717, Lady Mary Montague, writing home to England, described
the eastern method of taking smallpox deliberately, under comparatively
agreeable conditions, in order that severe cases of the disease might be
prevented.

Why one attack of the disease should prevent a subsequent case was not
known, nor why inoculation with other virus than that of the disease
itself should be efficient was not known. But the fact was thoroughly
established then that in some way, in the process of the disease and
recovery, there was left in the body some substance or agency which was
sufficiently powerful to ward off subsequent attacks.

In 1796, Dr. Jenner discovered that a disease very similar to smallpox
existed in the cow, and that if the scab from a pustule on the cow was
used for inoculation instead of similar material from a smallpox
patient, the resulting disease would be less severe and the protection
against subsequent attacks equally efficient. Since that time,
therefore, cowpox matter or vaccine has been used to develop a mild form
of disease for the express purpose of preventing subsequent attacks.

This is the fundamental principle involved in all antitoxin treatment,
and the only difference between vaccination and the injection of
diphtheria antitoxin is that with vaccination the disease and the
consequent protection is developed in the individual during the course
of the disease, while with diphtheria the first attack of the disease
and the resulting protective agencies are developed first in the horse
and then the essential elements of the blood are introduced into the
patient, thereby increasing his resistance to the disease. Smallpox, of
all diseases, formerly claimed the largest number of deaths. A hundred
years ago, persons marked with smallpox were a common sight. Among the
Indians, whole tribes were wiped out with it. It is computed that in
Europe, during the eighteenth century, 50,000,000 people died of
smallpox. In England, the death-rate was 300 per 100,000. As late as
1800, Boston was visited by severe epidemics of smallpox.

_Value of vaccination._

Owing to vaccination, the extent and intensity of the disease has
continually grown less until to-day attacks of smallpox are not serious
and the results are seldom fatal. For this reason and because of the
chronic objection of uneducated persons to submit to governmental or
outside restrictions, there has been, in recent years, a serious outcry
against vaccination, with the result that in New York State, during the
year 1908, there were in certain parts of the state epidemics of
smallpox with, however, but two deaths. The disease may, however, at any
time become serious, and, because of its virulent contagiousness, no
objection ought to be made to reasonable requirements in the matter of
vaccination.

Vaccination is usually not the cause of any serious inconvenience or
illness, and, while some slight swelling of the arm may result, the
protection afforded is so great in comparison with the temporary
inconvenience that the latter ought not to be even considered. The
protection afforded by a successful vaccination lasts usually from two
to seven years, and it is understood that after ten years the protection
is certainly lost, and in the presence of a smallpox epidemic one ought
to be re-vaccinated after the minimum time named. Whether every person
always ought to be vaccinated at intervals of five years or so is open
to discussion. If one were on a desert island in a large or small
community without intercourse with the outside world, vaccination would
be of no value since smallpox would be impossible. There are communities
where smallpox has been for years unknown, and consequently where the
need for vaccination is not apparent. On the other hand, where smallpox
is prevalent in the vicinity, and the disease is continually recurring,
it is of the greatest importance, in order that it may be promptly
suppressed, that every individual lend himself readily to vaccination.

Whatever harmful results formerly came from vaccination were due to a
lack of cleanliness on the part of the person vaccinated or in the
vaccination material itself. More care is now used in disinfecting the
surface of the arm and in protecting the exposed skin after the
inoculation. If the vaccination "takes," a certain amount of
inflammation follows, the spot on the arm suppurates, the suppuration,
however, disappearing at the end of about three weeks. If this does not
occur, that is, if the vaccination does not take, it may be either
because the vaccine was not good or because of the unsusceptibility of
the person. In the largest proportion of cases, however, the difficulty
is with the vaccine or with the doctor who does the inoculating, and
when smallpox is prevalent in the vicinity a person should be
re-vaccinated until the vaccination does take. The disease itself, while
disagreeable, is not as hopeless as was formerly thought. There is no
particular heroism in being physician or nurse to a smallpox patient
now, inasmuch as vaccination absolutely prevents contraction of the
disease, and the isolation practiced is the most serious objection from
the standpoint of the attendants.

_Characteristics of smallpox._

The disease first shows itself as does measles and scarlet fever, with
the appearance of a severe cold accompanied with a high fever. On the
second day a rash resembling that of measles and scarlet fever breaks
out on the body; this preliminary rash almost immediately disappears and
is followed by the real characteristic smallpox eruption, usually about
the fourth day. This eruption appears first on the forehead or face and
then on the other extremities, the hands and feet.

In mild cases, it is very difficult to distinguish between smallpox and
chicken pox, and the only safe measure is to consider all cases of
chicken pox in adults to be smallpox, as they probably are, since the
former disease almost never attacks grown-up people. The pustules which
form in smallpox are first hard and red, and then two or three days
later they are tipped with little blisters which later fill with pus and
appear yellow. About the tenth day of the eruption this yellowish matter
exudes, forming the scar or scab which later dries up and falls off.
Often this eruption is accompanied by excessive swelling of the face, so
that the eyes become closed, it is impossible for the patient to eat,
high delirium prevails, and the task of the nurse in such cases is an
unenviable one. Although usually the pustules are separate and distinct,
sometimes in severe cases they run together, so that the hands and face
present one distorted mass of suppuration and crust.

The disease is particularly prevalent among negroes, perhaps because
they are seldom vaccinated, and in recent epidemics in New York State it
has been chiefly through negroes that the disease has been kept alive.
The method of prevention for this disease is almost entirely
vaccination. Just how the disease spreads is not clearly understood,
although it is supposed that it is transmitted chiefly by clothing,
dishes, and other articles in contact with the infection. These should,
therefore, be thoroughly disinfected. The hope of eliminating the
disease, however, comes rather in the use of vaccination. In New York
State, in 1908, only two deaths from smallpox occurred, although twenty
years before, with the smaller population, the number of deaths ran up
into the hundreds.

_Treatment of smallpox._

The actual treatment of a case of smallpox consists in little more than
providing suitable food, in sponging the body to reduce the fever, and
in anointing the skin to allay the irritation of the pustules. As in
measles, the eyes are badly affected, and a darkened room is essential
for the comfort of the patient as well as for the avoidance of permanent
injury to the eyes. Carbolic acid solutions or ointments are to be used
continually on the surface of the body, relieving the irritation and to
some extent preventing pitting, which is a lasting mark of the disease.

_Diphtheria._

Diphtheria was also formerly a much-dreaded disease, physicians standing
helpless before severe attacks and in all cases unable to do more than
suggest ameliorating remedies.

The disease usually begins with a cold, sore throat, and local
inflammation, which develops sometimes with alarming rapidity. In the
days of our grandmothers, the first thing that the anxious mother did
when a child complained of sore throat was to get a spoon and look for
white patches in the back of the throat. With severe cases of diphtheria
which these white patches foretold, the growths of membrane would be so
rapid as to obstruct the breathing, and the child--for the disease is
preëminently one of childhood would be in danger of dying of
strangulation. The doctor's remedy for this condition was to make an
incision in the throat below this accumulation and insert a tube through
which the breathing might continue. The writer will never forget having
lived through a sickness and death of this sort in his family, seeing as
a boy a bottleful of the membrane which the doctor was taking away after
the death of the victim, and, while doubtless the size of the bottle and
the amount of the membrane has been magnified by the lapse of years, it
still remains to him as a terrible visitation and an inevitable cause of
death.

_Cause of the disease._

The immediate cause of diphtheria has been known only within recent
years. Sewer air was for a long time thought to be responsible, and
overcrowding or congestion in tenements was believed to be a fruitful
source of the disease. Some years ago, when diphtheria had been epidemic
in one of the state institutions and when experts had been called in to
suppress the disease, the elaborate reports which they made dwelt on the
quality of the drinking water and on the method of disposal of the
sewage as if those factors would account for the disease. About
twenty-five years ago, it was shown definitely that the disease was due
to certain bacteria, and that while the membrane in the throat was the
result of the rapid development of these bacteria, yet the mortality
from the disease was not due to the suppression of the act of breathing,
but to the development of a poison by the bacteria which went into the
circulation of the body and produced death, just as any poison, as
strychnine, for example, would do.

When once this fact was accepted, namely, that the disease was dangerous
because of the poisons involved, scientists undertook to find a way to
neutralize these poisons, and it was soon discovered that such
neutralizing substances could be grown in the blood of guinea pigs. It
was found that if a small dose of diphtherial toxin was injected into a
guinea pig,--a dose small enough so that the guinea pig would
recover,--it could then be given a larger dose from which it would also
recover. This process might be repeated, until at the end of several
weeks it could be given a dose the size of which would have been
sufficient to have killed it almost instantly at the beginning, and
which it could take and enjoy at the end of the series. The point was
that evidently, as with smallpox, successive inoculations resulted in
the formation in the body of some substance or agent capable of
neutralizing the poisons of the disease, subsequently formed. The guinea
pig is so small that the amount of restraining substance available made
it desirable to find a larger animal, and the horse, equally susceptible
to the disease with the guinea pig, was selected as the animal best
suited for producing what is now known as diphtheria antitoxin.

_Production of diphtheria antitoxin._

In laboratories, to-day, sound horses incapable of ordinary labor are
devoted to this life-saving task, and, without serious injury or
inconvenience to themselves, they develop artificially in their blood
this agent which neutralizes the effect of the diphtheria germ. The
blood of the horse, when removed, precipitated, and strained, contains
this property which is used almost exactly as vaccine in the case of
smallpox, except that in the case of diphtheria the development of the
disease is so slow that it is not necessary to use this treatment until
the disease has appeared. In smallpox, on the other hand, the disease is
so rapid that when contracted it is too late for vaccination to be of
much value. In New York State, the Department of Health furnishes this
horse antitoxin free of expense to health officers to use with persons
or families unable to purchase the preventative, so that no longer does
any need exist for the continuance of diphtheria as a cause of
mortality.

If the disease is early recognized and a proper amount of antitoxin
injected, that is, forced in under the skin so that it may be absorbed
by the blood, the probability is that in all cases the patient will
recover. It is equally useful with vaccine as a preventative of disease,
and in a school, for instance, where diphtheria has broken out, it is
only a reasonable precaution to use antitoxin freely to prevent
infection of those exposed to the disease.

To make use of the antitoxin at the proper stage of the disease, early
recognition is important, and fortunately science here can be of great
service. By wiping out the throat with a sterilized swab of cotton, the
bacteria present in the throat, if any, will adhere and may be wiped off
onto a gelatine substance in which the germs can grow. In twelve hours,
they will have developed, if present, so that with a microscope they can
be positively recognized. In Massachusetts, and particularly in the city
of Boston, the Board of Health maintains a laboratory with a medical
expert in charge, to whom physicians may refer these smears for
diagnosis. No excuse exists, therefore, in such a city for failure to
recognize and prevent the further development of diphtheria, since every
wise physician would take a sample of mucus from a throat in case of any
irritation there, the Board of Health would furnish accurate diagnosis,
and the use of antitoxin will prevent the disease.

_Symptoms of diphtheria._

The disease itself acts on the human body through the formation of
poisons which the bacteria generate by their growth. If the germs have
secured a foothold in the upper throat, then the well-known membrane is
formed and the toxins produced spread through the blood and cause
headache and fever, even before any experience of sore throat is felt.
The temperature rises very high, the child begins to vomit, and the
pulse becomes weak, and after about seven days a large percentage of
these throat cases begin to improve. The membrane breaks off, the fever
declines, and the child begins to recover. If the localized attack is in
the larynx, a harsh cough is one of the symptoms, and this is soon
followed by a serious difficulty in breathing.

The poisons are formed, as before, in the blood, and, while a surgical
operation has been performed often in the past to afford relief from the
tendency to strangulation, the bacterial poisons are not affected
thereby, and, while the operation might be successful, the child was
quite apt to die as the result of the poisons. Now, in either case,
antitoxin is administered at the very outset of the attack, with the
result that the poisons are counteracted, the temperature drops rapidly,
the membrane is apparently at once affected and lessened, and the child
recovers at once. No greater boon to the human race in the matter of
disease has ever been discovered, and it is certainly most absurd for
parents to refuse the use of this wonderful antidote. Not long since,
the writer found a family of four children in a home where diphtheria
was rampant. The mother and two children were sick with diphtheria in
its worst form, and the father refused to allow the doctor to administer
the antitoxin even to those sick, much less to those who had been, up to
that time, only exposed. Apparently there was no direct law requiring
the administration of the antitoxin, and the physician in attendance and
the health officer were obliged to stand by and wait for the death of
the children, which actually happened, knowing that a dose of the
antitoxin ready at hand could have been administered and the children's
lives, in all probability, saved.

The diphtheria poison is so virulent that in many cases it acts on the
different organs of the body, particularly on the kidneys and the heart,
and the recovery from this poison may take weeks. It is very necessary,
therefore, for the patient to be kept quiet, and this can best be done
in bed, for at least three weeks after the crisis has passed. The
nervous system is often affected, so that the child may squint or
stutter or perhaps not be able to see, but these effects are usually
temporary and pass away as the effect of the poison disappears.

_Rabies._

Rabies is the third assumed bacterial disease which is reacted upon by
the administration of an antitoxin. When it occurs in man, it is
generally known as hydrophobia, although it is the same disease as that
known as rabies in dogs, skunks, wolves, and other animals. The virus of
the disease is in the saliva of the animal, so that when a dog bites
another animal or human beings, the poison is injected into the wound
made with the teeth.

The actual germ has not been found, and while there is no doubt that it
originates with some specific bacterium, it is probable that the
transmitted disease is due rather to the toxin of the germ than to the
germ itself. The greatest number of cases, by far, are caused by the
bites of dogs, and the most obvious and plainest method of preventing
the disease is to prevent dogs from biting. That this is efficient in
stamping out the disease has been proved by the records of cases in
England and Germany. There, a quarantine on all the dogs in the country,
that is, the strict enforcement of laws requiring muzzling, has
eliminated the disease except on the borders of other countries where
such quarantine is not enforced.

In New York State, the number of cases of rabies is increasing at an
alarming rate, as determined by the examinations made on dogs' heads at
the New York State Veterinary College in Ithaca. Whereas a few years ago
one suspected case a month was the average number sent in, during this
last year, 1909, there have been sent to the laboratory, at times, as
many as five or six a day, the number being larger in the warm weather.
When the disease appears in the dog, one manifestation of it is that the
animal runs over large areas of country, perhaps within a radius of
twenty-five or thirty miles, and in this mad race the dog may infect
other dogs throughout the entire distance. It is, therefore, of small
value to muzzle dogs only in a particular village, since the dogs while
muzzled may be bitten by an outsider. There is no reason why the disease
could not be stamped out of a state in six months by muzzling all the
dogs. But muzzling the dogs in a village here or in a town there is
really only temporizing with the trouble.

Hydrophobia in man requires usually from two to six weeks to develop, so
that there is a long period in which to utilize preventive measures, and
it is on this account that children may be sent, as happens frequently,
to New York City or to Paris to be treated by what is known as "Pasteur
treatment." This treatment involves the inoculation of the rabies virus
which has first been passed through a series of rabbits, in the course
of which the virus has become exceedingly strong. The treatment of the
human being consists in successive inoculations with virus of various
strengths, beginning with the weakest and ending with the most powerful
rabbit virus. After this has been done, the effect of the bite of the
mad dog has been neutralized, so that in most cases the disease has been
robbed of its power. Of the cases treated at the Pasteur Institute in
1897, numbering 1521, there were six deaths, and these six were among
those whose arrival at the Institute was so late that the treatment
could not be begun in time.

_Tetanus._

The fourth disease for which an antidote in the form of antitoxin has
been developed is tetanus, commonly known as lockjaw. This is a
bacterial disease caused by a specific germ, the peculiarity of which,
in its progress, is a long-continued spasm of certain muscles of the
body. The germs are commonly found in dirt, garden soil being always
full of them, and whenever the skin is broken by any object, such as a
rusty nail or a knife not clean, lockjaw may be the result. Rather
curiously, it is particularly likely to develop after gunpowder wounds,
and the number of cases of tetanus after the Fourth of July is notable.
This special prevalence of the disease is so well recognized that health
officers usually lay in a large stock of antitoxin about the first of
July, awaiting the inevitable demand for it.

The disease is most commonly contracted from wounds which occur in the
hands or the feet, although it may be the result of wounds in other
parts of the body. Very often the wound may be so insignificant as to
escape the attention, as a pin prick, and yet be followed by an attack
of tetanus. Formerly, the universal treatment for injuries from which
tetanus was feared was to firmly cut out all portions of the flesh and
skin which might have been infected. Sometimes cauterization was
employed, as was done also with cases of rabies, and, if it were
possible to reach the virus in the wounds before it escaped into the
blood, such a method of treatment would be quite reasonable, but it is
quite beyond hope to prevent infection in a jagged wound by cutting out
adjacent flesh, with no regard to the dissolved poison. The more
reasonable treatment is to inject the antitoxin, which neutralizes the
poison and prevents, or at least minimizes, the disease.




CHAPTER XXI

_HYGIENE AND LAW_


One of the fundamental principles of society is that each individual
must, in his methods of living, conduct himself with a due regard for
the rights, comfort, and health of others in the same society. A single
man or a single family living alone on a desert island requires no
restrictions of conduct, since there are no fellow-beings on whom his
violations of good conduct might react. The inhabitants of small
villages with small families on large lots are but little concerned with
laws governing social intercourse, since, at best, the amount of that
intercourse is inconsiderable. But, as population becomes greater, as
congestion increases, and as civilization and its requirements develop,
the need for law governing the interrelations of individuals becomes
imperative. Such laws deal with the moral life under many phases, and
the courts exist for the enforcement of such laws as the people
themselves, through their legislatures, demand for their own
self-protection.

One of the primitive laws found necessary, even among uncivilized
people, is that against theft, and, whether committed in the barbarous
tribes of Africa or on the frontier plains of the West, the act is
recognized as being contrary to the greatest good of the community, and,
if detected, is severely punished. As civilization advances, the code
of laws found necessary becomes more and more complex, and, although
use has made obedience to such laws almost second nature, it is hardly
possible to-day to escape the immediate restraint of such laws for more
than a moment at a time throughout any period of twenty-four hours.

_Principle of laws of hygiene._

It is particularly the laws which pertain to health and hygiene which we
shall consider in this chapter. The principle on which laws relating to
hygiene are passed is that while nominally a person is always free to do
with his own whatever he may choose, yet as a member of a community he
must choose to do only that which shall not injure or affect the health
or comfort of his neighbors. This principle was not at first invoked to
prevent violations of laws of health, but rather to prevent the
inconvenience which might come to a neighbor or to the public at large
by some unreasonable though apparently legitimate use of individual
property. As an example we may mention the law of New York State
requiring each owner of property in the country to cut grass, weeds, and
brush along the highway twice each year. Although this interferes with
the right of the owner to have the land which belongs to him left as he
chooses, it is legal because of the greater convenience and comfort it
contributes to the larger number of persons traveling along the highway.

The state does not assume the right to interfere with the acts of
individuals so long as such acts affect only their own individual
well-being, but when those actions affect others, then the police power
of the state may be invoked. It is on this principle that the law
prohibits suicide, assuming that no man can live or die without
affecting the interests of other people. This is plainly so in the case
of the head of a family or in the case of a man upon whom others are
dependent and whose death removes their support and causes those
supported to become dependent upon the state or county. This principle
has been extended so as to include the cases where a method of living, a
lack of care, or even a mere appearance in public may adversely affect
the health of others in the same community. If, for example, a member of
a family has diphtheria or smallpox, and such a child is isolated so
that no danger of the spread of the disease exists, the state would not,
in general, insist upon the use of any preventive or curative
inoculation; but if a child with incipient diphtheria or whooping cough
goes to school where other children may be infected and the disease
spread, the state, acting through its Board of Education, would have a
perfect right to send the child home and prevent its enjoying school
privileges until recovery from the disease.

It is on this principle that the state says that no child in New York
State may attend school unless vaccinated, the law reading, "No child,
not vaccinated, shall be admitted into any of the public schools of the
state, and the trustees of the schools shall cause this provision of law
to be enforced." This law has been questioned and brought before the
Supreme Court for review, and it was held by the judges that the
protection to the community implied is of sufficient importance to
justify its enactment.

For like reason, other restrictions governing the control of contagious
diseases is a function of the police power of the state in which the
rights of the individual must yield to the greater good of the
community. The writer remembers a particularly malignant case of
smallpox where the efforts of the local Board of Health had been
concentrated on the enforcement of quarantine, and where by the aid of
policemen, day and night, it was hoped that the disease was being
confined in the one house; yet, after the death of the patient, and when
apparently efforts for protection might be relaxed, a wake was held in
the house, in the very room of the patient, which might have resulted in
the spread of the disease through the entire town. Regulations,
therefore, covering the conduct of funerals and of burials should be
agreed to, since they are intended to prevent the spread of disease.

_Self-interest the real basis of law._

Many practices which are required by law in cities where the population
is crowded are not required or are not enforced in country districts,
since there the failure to carry out protective measures reacts only on
those immediately concerned. Disinfection of rooms in which contagious
diseases have occurred is one such provision. It rarely happens that a
health officer of a country community concerns himself with seeing that
a case of scarlet fever, for example, is prevented from spreading by a
thorough disinfection of the rooms. That seems to be left to the good
sense of the individual. It is hardly conceivable that a mother with
three or four children (when one child has been sick with a contagious
disease) will neglect ordinary and reasonable precautions to prevent the
spread of that disease to the rest of the family.

It is inconceivable, when the small amount of trouble and expense is
considered, that the parents of a family, after a case of diphtheria,
will neglect to fumigate and disinfect the clothing and bedding which
may be thus infected, particularly if such clothing or bedding is to be
used by other members of the family; and yet instances are recorded
where a child has died of scarlet fever and a year later another child,
perhaps wearing some of the clothes of the previous victim, has been
seized with the disease and has followed its brother or sister to the
grave. Cases of tuberculosis have been known to follow each other almost
year after year, as one member of a family after another occupied a room
where the infection persisted, either in the carpet or furniture, which
was never properly disinfected. Such cases must be left to the good
sense, intelligence, and understanding of the persons concerned. The
police power can never in this age take the place of an enlightened
sense in the community, nor are laws, as a matter of fact, of any use
except as they are sustained and enforced by public sentiment.


QUALITY OF WATER

There is another way in which the police power of the state exercises
control over rural communities, and that is in the matter of food which
the country generally supplies to the city. Perhaps the pollution of
water, which is, after all, one kind of food, is as important as any
matter covered by health laws.

In most cities to-day the pollution of streams is prohibited on two
grounds, first, that the streams are public property, even though for a
part of their course they may be owned individually. The sum of the
parts making up the whole stream involves so many individuals as to
imply public ownership, and inasmuch as one individual is limited in
his uses of the stream by the principle already referred to, he cannot,
even on his own land, do what he pleases with a stream or with its
waters. When streams are navigable, according to the law of this
country, no private ownership can exist, for the waters are controlled
and owned by the federal government. This latter body, in general, does
not undertake to control the quality of such waters, but there are many
laws covering the quantity of water in such streams, limiting the
amounts that can be withdrawn, restricting the filling up or silting of
such streams, and qualifying the bridging or damming of such waterways.
In small streams, such as are generally found in rural communities, the
vital principle of ownership is always limited by the requirement that
no owner shall so interfere with the normal quantity or quality of water
in the stream as to prevent their full enjoyment by the next man
downstream whose rights are equal with his own. This means, in the
matter of quantity, that while one individual may water stock in a
stream or may pump water from a stream for household use, he may not
withdraw from the stream the entire volume to use for irrigation, nor
may he, as a riparian owner, sell the water to some city near by which
might take out all the water of the stream.

The quality of a stream, likewise, may only to a certain extent be
interfered with. If a stream flows through a meadow, cows pastured in
the meadow have a natural right to wade in the brook, and if, in so
doing, a certain amount of pollution is added to the waters of the
brook, no one downstream can justly complain.

If, however, a sewer is carried from barns or houses into a brook which
is later used for drinking purposes, the quality of the water is
affected, and such a discharge is so revolting to the senses that
complaint to the courts would result in an order to find some other
method of disposing of such wastes.

In New York State, the legislature has delegated to the Department of
Health certain rights in the matter of the protection from pollution of
the waters of the state, particularly when those waters are used for
drinking purposes. Upon application from the water company, this
department, having carefully inspected the watershed, will prepare a
complete and elaborate series of rules, giving in detail just what an
individual may or may not do on the watershed, and, when enacted, these
rules have all the force of law. They are, however, like all laws,
subject to the constitutional limitations, and particularly to the
clause of the constitution which provides that "no state shall make or
enforce any law which shall deprive any person of property without due
process of law." This means that if any law prevents an individual
enjoying reasonable use of his own property, or if the deprivation of
such use is for the special benefit of some special community or
company, then that special body must be prepared to make compensation
for that deprivation, although if it were for the general good of the
community of which the individual was a member, no compensation might be
required.


REGULATIONS GOVERNING FOODS

Laws covering the sale of adulterated foods are of two kinds, namely,
those enacted by the national government at Washington, and those
enacted by the local authorities, either state or municipal. The laws
enacted by the national government, which are comprehended in the
recently enacted National Pure Food Law, deal particularly with the
adulteration and misbranding, not only of foods, but of all sorts of
medicines and liquor. Their effect, however, is limited entirely to such
articles as make up interstate commerce. If an article is made and sold
within the boundaries of any single state, it is not subject to the
national law, nor could this national law be applied to the production
or sale of any article from a farm unless that article was well enough
known to be generally distributed. For example, maple sirup, widely
advertised and generally sold, would be subject to the provisions of the
national law. Butter and cheese, sold locally, would not be subject to
such a law. It is evident, therefore, that this law does not usually
apply to farm products, unless, as in the case of some sausages, for
example, a widely advertised campaign has been instituted to promote
their sale.

There are, however, in the different states, laws which do apply locally
and which prohibit adulteration of all sorts. In New York State, for
example, the law says that no person shall, within the state,
manufacture, produce, compound, brew, distill, have, sell, or offer for
sale any adulterated food or product, and the law further specifies that
an article shall be deemed to be adulterated:--

     "1. If any substance or substances has or have been mixed with
     it so as to reduce or lower or injuriously affect its quality
     or strength.

     "2. If any inferior or cheaper substance or substances have
     been substituted wholly or in part for the article.

     "3. If any valuable constituent of the article has been wholly
     or in part abstracted.

     "4. If it be an imitation or be sold under the name of another
     article.

     "5. If it consists wholly or in part of diseased or decomposed
     or putrid or rotten animal or vegetable substance, whether
     manufactured or not, or in the case of milk, if it is the
     produce of a diseased animal.

     "6. If it be colored, or coated, or polished, or powdered,
     whereby damage is concealed, or it is made to appear better
     than it really is, or of greater value.

     "7. If it contain any added poisonous ingredient, or any
     ingredient which may render such article injurious to the
     health of the person consuming it. Provided that an article of
     food which does not contain any ingredient injurious to health
     shall not be deemed to have been adulterated, in the case of
     mixtures or compounds which may be now, or from time to time
     hereafter, known as articles of food under their own
     distinctive names, or which shall be labeled so as to plainly
     indicate that they are mixtures, combinations, compounds, or
     blends, and not included in definition fourth of this section.

     "8. If it contains methyl or wood alcohol or any of its forms,
     or any methylated preparation made from it."

These provisions, just mentioned, are provisions of the New York State
Health Law, and violations are in defiance of that law, the penalties
for which are specifically stated to be $100 for every such violation.

There is also in New York a police code that prohibits adulteration of
food, and in this code the adulteration of maple sirup or fruit juices
or spoiled articles of food of all sorts, of milk from which part of the
cream has been removed, and the sale of any article which is printed or
labeled in such a way as to misrepresent the article, is called a
misdemeanor, the penalty for which is left to the discretion of the
judge and which would, under ordinary conditions, be a fine of several
hundred dollars or imprisonment in a county jail for a term of months,
or both.

_Basis of pure food laws._

Adulteration of food may be considered from two points of view, the
hygienic and the economic, and, while the laws are generally intended to
preserve the public from impure food on account of the economic loss
involved thereby, the hygienic aspect is really the more important.
Adulterations which are plainly injurious to health are very few in
number, and it is rather desirable that the economic phase should be the
one to command attention of legislators, since, when that objection to
adulteration has been so voiced as to result in laws prohibiting
adulteration, the health of the public will be promoted by the
elimination of objectionable foodstuffs. The long-continued discussion
over the use of benzoate of soda in foods is an example of this twofold
aspect; some, arguing against its use, protested that when long
continued, it had a decidedly injurious effect upon the health of those
eating or drinking it; others objected to the chemical, but contended
that its use enabled spoiled fruits, like tomatoes, to be substituted
for fresh fruits, and the price of the latter obtained where the value
of the former only was given. No one seriously thinks that butter with a
small amount of butter color added could have any injurious effect upon
the human system, yet it is, in the eyes of the law, an adulteration
because its appearance indicates a quality of the butter which it does
not naturally possess.


PROTECTION OF MILK

The one article of food produced on the farm about which the greatest
amount of agitation has been centered has been the adulteration of milk,
as well as the question of the production of milk under unclean
conditions. The responsibility for pure milk rests on the Department of
Agriculture of the State, on the Department of Health of the State, on
the Department of Health of the city where the milk is sold, and on the
Board of Health in the village or town where the milk is produced. In a
way, these four departments divide the responsibility for the milk, and,
as in all cases of divided responsibility, the very fact of the number
subtracts from their efficiency. The local Board of Health of the
village or town where milk is produced is not usually interested or
concerned particularly in the question of its quality.

If a case of contagious disease in any farmhouse occurs, the local
health officer should see that a proper quarantine is established and
that the individuals in such a house are instructed in the danger of
contamination and in the necessity of avoiding infection in the dairy.
It is, however, the Board of Health in the city where the milk is
consumed who have a particular responsibility. Such a board has no
jurisdiction or authority over matters outside of their city, so that
their executive cannot go out into the country, into the district of
another health board, and order improvements made in the methods of
production. All that a city board can do is to enact and publish
restrictions under which milk must be sold in that city.

This is the method pursued in the city of New York, where tons of milk
are consumed every day and where manifestly the jurisdiction of the city
officials cannot extend over the thousands of farms located in the five
states from which the milk supply is drawn. In New York City the local
sanitary code provides that no milk shall be received, held, kept,
offered for sale, or delivered in the city of New York without a permit
from the Board of Health, and the Board makes this permit depend upon
the sanitary conditions existing at the dairy or farm where the milk is
produced or handled. In order to find out whether the conditions at the
dairies and farms throughout these five states are in a sanitary
condition, the city has a force of twenty-five inspectors who are
continually engaged in traveling among the farms and in reporting on
their condition. If a farm is found where the cows are diseased, or if
the buildings in which the cows are stabled or in which the milk is
cooled and strained are not clean or are lacking in proper ventilation
or otherwise unhygienic, or if the water-supply is bad, the farmer is
notified that conditions are such that the city of New York will refuse
to receive his milk. He is not forced to clean up, and no orders are
given him, but the attitude of the city authorities is made plain, and
then it is left to him to decide whether it may not be wise for him to
accept the suggestions made by the inspectors. Dr. Darlington, late
Health Commissioner of the city of New York, reported in 1907, after two
years of inspection, that out of 35,000 dairies inspected, only 47 were
shut out on account of unclean conditions, although many more were
warned with the result that remedial measures were at once taken. The
same sort of procedure may be adopted by any city, and is, in fact,
practiced by a number.

Another method of securing a better grade of milk which results in
forcing farmers to clean up the barn and barnyard, at the same time
allowing the local official to remain within the strict letter of the
law, which gives him no direct authority over conditions on farms
outside a city, is to limit the number of bacteria found in samples of
milk supplied by the dealer. A common rule is that no milk shall be
distributed which contains more than 50,000 bacteria per c.c., and when
milk contains a number in excess of this, the milkman is warned, and if,
at the next sampling, the number is still higher, the milkman is
notified that his milk will no longer be received. Experience has shown
that a reasonable regard for cleanliness in the stable and dairy room,
with a prompt cooling of the milk, will limit the bacterial growth to
this standard, and the requirement, meaning, as it does, only a decent
regard for such cleanliness as a self-respecting dairyman would
recognize as essential, works no hardship on any one. New York City
prints its dairy rules on linen and has them tacked up in every cow barn
concerned in the city milk supply, and while they have merely the force
of suggestions only, practically they have the force of law in that a
disobedience to these rules is likely to involve the refusal of the milk
from that particular dairy.


LAWS GOVERNING QUARANTINE

It is much to be regretted that, in these days of scientific knowledge,
when the exact and fundamental causes and processes of diseases are so
clearly known to medical men and when laws based on this knowledge have
been enacted for the purpose of reducing mortality and preventing the
spread of disease, ignorant individuals should allow their prejudices to
stand in the way of compliance with the spirit of these laws.

In New York State, Section 24 of the Public Health Law requires the
local Board of Health to isolate all persons and things infected with or
exposed to infectious diseases. They are required to prohibit and
prevent all intercourse and communication with or use of infected
premises, places, and things, and to require and, if necessary, to
provide the means for the thorough purification and cleansing of the
same before general intercourse with the same or use thereof shall be
allowed. The Penal Code of the state further provides that a person who,
having been lawfully ordered by a health officer to be detained in
quarantine and not having been discharged, willfully violates any
quarantine law or regulation is guilty of a misdemeanor, punishable by
fine or imprisonment or both. In spite of this prohibition, it is very
rare to find that a person in a quarantined house feels any personal
obligation. He stays in or out, if obliged to by a policeman, or, if the
sentiment among the neighbors is aroused in favor of quarantine, he
waits until dark enough to escape observation.

In New York, two years ago, a case of diphtheria broke out in the family
of a Christian Scientist. The health officer visited the house, offered
to use antitoxin, which was refused, and instructed quarantine. The
mother and one daughter died, and the healer was imprisoned for entering
the house in defiance of the quarantine law. This case illustrates how
the moral obligation may be distinctly repudiated because of religious
prejudice. But even religious belief must be subservient to the laws
governing the community in which a man chooses to live, and, so long as
the residence continues, the laws governing quarantine, as all other
laws, must be obeyed. In this case another count against parents may be
found. Section 288 of the Penal Code provides "that a person who
willfully omits without lawful excuse to perform a duty by law imposed
upon him to furnish food, clothing, shelter, or medical attendance to a
minor is guilty of a misdemeanor." It would seem, therefore, that the
law is provided by which fanaticism may be overruled in the interests of
the health of children, although it must be said that this phase of the
law is generally disregarded. Again, in spite of the ample proof to the
contrary, there are to be found persons who refuse to be vaccinated even
in the midst of a smallpox epidemic. A law in New York State provides
that no unvaccinated child shall attend public schools, the law being
mandatory upon the school trustees. If this law were faithfully carried
out, smallpox would entirely disappear from the state within a few
years.

Other instances might be cited to show how the force of the law is
invoked to minimize the effects of unhealthy living and to prevent that
perfect individual liberty which a few irresponsible persons would
assume to themselves. But it will always remain for the good sense of
the individuals to direct their actions in such a way as to inflict no
evil on the community. Unfortunately, laws are generally the result of
some calamity. A law prohibiting child labor is passed only after the
evil effects of such labor have been demonstrated by sad experience.
Laws forbidding the sale of diseased meat or of spoiled fruit are passed
only after repeated cases of illness have demonstrated the need of such
laws. Laws involving quarantine are the result of epidemics which have
showed plainly, at the cost of valuable lives, perhaps, the need of such
quarantine.

It is the aim of hygiene, whether rural or urban, to raise the
standards of living to such a degree that not only will any violation of
health laws seem unreasonable and obnoxious, but also every instinct, of
the individual will, even without specific laws, direct him so to live
that no hygienic offense will be directed towards those with whom he
comes in contact. Only in this way will the present violations of the
requirements of hygienic living be avoided, and the normal man be
enabled to live as he should in absolute harmony with his environment.




INDEX


Accuracy of death-rate records, 6.

Adenoids, 288.

Advantages, of gravity water-supply, 168, 169;
  of hydraulic rams, 172;
  of pond or lake water over brook water, 128.

Age and sex in disease, 299.

Aim of hygiene, 424.

Air, for breathing, 68;
  for consumptives, 341; in soils, 39.

Air-lifts for pumping, 107, 183.

Air-space in cellar walls, 53.

Alcohol as a stimulant, 275.

Allegheny Valley and cancer, 34.

Amount of food required, 269.

Analysis of proposed water-supply, 143.

Animal heat in barn, 88;
  pollution of water, 136.

Animals, fit for butchering, 306;
  in the study of disease, 250.

"Anopheles" mosquito, 380.

Antiseptics, 316; in milk, 235.

Antitoxin, 306; and disease, 396;
  for diphtheria, 403;
  for hydrophobia, 408;
  for tetanus, 408;
  for typhoid fever, 363.

Apparatus for driving wells, 119.

Appendicitis, 33.

Appetite for food, 266.

Application of sewage to land, 218.

Area for subsurface sewage disposal, 223.

Artificial sewage beds, 219.

Asphalt for cellar walls, 53.

Auto-intoxication, 312.

Automatic sewage syphon, 225.


Babylon, L. I., water-supply, 187.

Bacillus of typhoid fever, 351.

Back of cellar walls, 56.

Bacteria, and parasites, 302;
  and sewage purification, 213; in milk, 235.

Bacterial agencies, 304.

Bad air and its effects, 69.

Balanced rations, 263.

Barn ventilation, 88.

Barnyard drainage, 141.

Bathing for hygienic purposes, 285.

Beneficent bacteria, 304.

Billings's suggestion for ventilation, 80.

Billings's ventilation by stoves, 83.

Blankets, 281.

Blood resistance and disease, 297.

Bob-veal, 252.

Boiler for hot water, 198.

Boiling water for disinfection, 329.

Boston, Mass., water used in, 93.

Box radiators at window, 80.

Bright's disease in the country, 20.

Brooks as water-supply, 124.

Brush dam, 163.

Bubonic plague, 393.

Bucket water wheel, 175.


Cancer and soils, 33;
  in Europe, 34.

Carbohydrates and digestion, 261.

Carbolic acid as disinfectant, 322.

Carbon dioxid in the air, 75.

Causes of typhoid fever, 350.

Cell disintegration, 297.

Cellar, floors, 59;
  in limestone rock, 47;
  ventilation, 60;
  walls of dry masonry, 55.

Cellars and their drainage, 28.

Cement joints for well walls, 115.

Cesspools and wells, 116.

Changes in air breathed, 75.

Chemical poisons, 311.

Chicken pox, 375;
  preliminary symptoms of, 367.

Children, as affecting the death rate, 8;
  in Otsego and Putnam counties, 9.

Children's diseases, 364.

Chloride of lime, 325.

City milk, 247.

Cleanliness of stables, 63.

Clean milk, 242, 421.

Clean stables and their effects, 237.

Clothing, 280.

Coal-tar disinfectants, 323.

Coffee and tea, 272.

Cold baths, 286.

Composition, of air, 75;
  of soils, 32.

Computations for rain-water storage, 101.

Concrete, core for dam, 159; dam, 160;
  for spring-chamber, 158;
  in cellar floor, 60;
  in stables, 64;
  method of mixing, 66.

Construction, of air-tight barns, 89;
  of dug wells, 113;
  of houses, 49;
  of septic tanks, 230.

Consumption and bad ventilation, 74.

Contagion in children's diseases, 386.

Contagious diseases, 305.

Cooking and digestion, 268.

Cooling of milk, 242, 247.

Corn and pellagra, 391.

Corrosive sublimate, 324.

Cost, of driven wells, 121;
  of flush tank, 207;
  of fuel for pumping, 178;
  of operating gas engines, 178;
  of plumbing, 200; of ventilation, 87;
  of water pipe, 168.

Cows and ventilation, 71.

Cow stables, ventilation of, 62.

Creamery and typhoid fever epidemic, 147.

Creosols, 323.

Crib dam, 163.

"Culex" mosquito, 380.

Curb for well, 141.

Cure of hookworm disease, 390.

Cut-off wall for dam, 160, 161.


Damp cellars, 27.

Damp courses in house walls, 56.

Dampness, and disease, 26;
  of cellar walls, 52.

Damp soils, 27; and their effects, 40.

Dams for reservoirs, 158.

Danger, from drainage of barns and barnyards, 137;
  from leachings from privies and cesspools, 138.

Dangers, of polluted air, 73;
  of polluted water, 144.

Death-rate, from typhoid fever, 11;
  from typhoid fever in New York State, 15;
  of babies in Rochester, 237;
  records, accuracy of, 6.

Death-rates, at various ages, 10;
  in general, 2;
  in New York State, 4;
  in rural communities, 8;
  in various countries, 3;
  of children, 9;
  outside of New York City, 7.

Deaths from measles and scarlet fever, 365.

Decomposition in sewage, 209.

Deep well pump, 106.

Deep wells, 115.

Deficiency of water from well supply, 104.

Definition of sewage, 208.

Deodorizers, 317.

Detection of animal pollution, 137.

Diagnosis of diphtheria, 404.

Digestion and its requirements, 261.

Digestive processes, 259.

Dimensions of hydraulic rams, 173.

Diphtheria, 401;
  and milk, 239;
  antitoxin, 310, 402;
  in the country, 19.

Direct causes of disease, 302.

Dirt and disease, 296.

Dirt dam, 159.

Disadvantages, of hydraulic rams, 171;
  of windmills, 169.

Disease, the causes of, 295.

Diseases caused by milk, 238.

Disinfecting, agents, 315;
  a room, directions for, 319;
  gases, 318.

Disinfection, 314;
  by heat, 327;
  for chicken pox, 376;
  for consumption, 337;
  for measles, 373;
  for scarlet fever, 371;
  for whooping cough, 375.

Disposal of sewage and water-supply, 141.

Distilled water, 131.

Dogs and hydrophobia, 406.

"Don't Spit" axioms, 334.

Drafts from windows prevented, 79.

Drainage, 41;
  around the house, 44, 50.

Drain, for house on side hill, 42;
  from house plumbing, 200.

Drains leading to dug well, 104.

Driven well, in dug well, 105;
  machinery, 119.

Driven wells, 118.

Drugs and their immoderate use, 275.

Dry heat for disinfection, 328.

Dry masonry for cellar walls, 55.

Dug wells, 112.

Dust and its dangers, 301.


Earache, 288.

Effect of bad ventilation, 73;
  of hard water on health, 133;
  of vegetable pollution of water, 135.

Elimination, of dangers of surface pollution, 140;
  of mosquitoes, 381.

Enameled iron for plumbing fixtures, 196.

Epidemic diseases, 305.

Epidemics of typhoid fever, 354.

Eruption of measles, 372.

Eucalyptus trees and malaria, 378.

Evaporation from reservoirs, 103.

Exercise, after meals, 271;
  of the body, 278.

Expectorations in cases of consumption, 334.

Exposure, and pneumonia, 346; of a house, 29.

External causes of disease, 312.

Eyes and their troubles, 290.


Factory life and disease, 301.

Fall River, Mass., water used in, 93.

Faucets for plumbing, 195.

Field-stone dam, 160.

Filter beds for sewage in winter, 221.

Filtration of sewage, 219.

Finishing concrete surfaces, 67.

Fire protection and water-supply, 98.

Fire streams and water flow, 97.

Fish as destroyers of mosquitoes, 381.

Fixtures for plumbing, 191.

Fleas and the bubonic plague, 393.

Fletcher, and chewing, 259;
  and his two meals, 269.

Flies and typhoid fever, 359.

Floods and stone dams, 161.

Floor of cellars, 59.

Flow of underground water, 111, 143.

Flush tank for water-closet, 206.

Food, for consumptives, 340;
  for various body needs, 258.

Food adulteration laws, 416.

Foods and beverages, 257.

"Foos" gas engine, 178.

Formaldehyde, 321.

Forms for concrete cellar walls, 65.

Foul-air outlet for ventilation, 81.

Foundation for dam, 160.

Freezing in plumbing, 190.

Fresh-air inlet for ventilation, 77.

Friction with fire streams, 98.

Fried foods, 269.

Fuel for pumping, 178.


Galvanized iron water tanks, 185.

Garbage for filling low ground, 37.

Gas engines for pumping, 177.

Gastric juice, 260.

Gate house for reservoirs, 165.

Goiter and soils, 33.

Goulds Manufacturing Co. pumps, 181.

Grade, for house drains, 45;
  for cellar drains, 51;
  of subsurface tile, 222.

Ground water, 43.

Growth of mosquitoes, 384.


Habit and food, 267.

Hand basin in bath-room, 199.

Hands to be washed frequently, 287.

Hand valves for sewage tanks 227.

Hard water, 133.

Health departments, 416.

Heat, and plumbing, 190;
  as a disinfectant, 327.

Heating and ventilation, 87.

Heredity and health, 298.

Homer, N. Y., water-supply, 105.

Hookworm disease, 302, 388.

Hot-air engines for pumping, 175.

Hot-water boiler, 198.

Hot-water circulation, 194.

House drainage, 200.

House drains, 44.

Hydraulic rams, 171.

Hydrophobia, 407.

Hygiene, and its laws, 410;
  and its true purpose, 23.


Ice and typhoid fever, 353.

Ideality of life, 22.

Immunity--natural and artificial, 310.

Importance of bacteria, 305.

Impurity of surface water-supply, 140.

Indians and ventilation, 74.

Indirect causes of death, 312.

Infection in pneumonia, 348.

Influenza in the country, 19.

Inlet for fresh air, 78, 81.

Inspection of dairies, 421.

Installation of plumbing, 189.

Intermittent application of sewage on land, 213.

Iron pipe for conveying water, 167.

Irrigation and sickness, 36.

Irritation of cell tissue, 297.

Ithaca typhoid epidemic, 354.


Joints in soil-pipe, 203;
  in tile pipe, 167.


Kerosene and mosquitoes, 383.

Kewanee Water Supply Co. tanks, 187.

King of ventilation, 86.

King's experiments on ventilation, 70.

Kitchen sinks, 196.

Kitchen stove and hot water, 195.

Koch and consumption, 333.


Land treatment of sewage, 216

Laundry tubs, 196.

Law and hygiene, 410.

Laws against impure food, 416.

Lesions of tuberculosis, 252.

Level for house drain, 200.

Light, as a disinfectant, 330;
  in cow stables, 62.

Lime for disinfecting, 324.

Liquid disinfectant, 321.

Location, of a house, 29;
  of a house on a side hill, 32;
  of privies and cesspools, 31;
  of windmill, 171.

Long Island wells, 112.

Loss of head by friction, 129.

Lowell typhoid epidemic, 355.

Lungs, air required by the, 68;
  developed by exercise, 279.


Made ground and health, 37.

Malaria, 302, 377;
  caused by soil formation, 33;
  from cellars, 39.

Malarial attacks, 385.

Manure from cow stables, 244.

Maximum rate of water consumption, 95.

Measles, and its virulence, 371;
  preliminary symptoms, 367.

Meat and its dangers, 249.

Mercury as a disinfectant, 324.

Metchnikoff's theory of auto-intoxication, 233.

Methods of collection of water, 153;
  of securing fall for hydraulic rams, 175.

Milk, and its adulteration, 419;
  and its care, 233;
  and typhoid fever, 358;
  of lime, 325;
  supply of Rochester, N. Y., 237.

Milk-pail for clean milk, 245.

Mineral matter in water, 132.

Minimum rainfalls, 100.

Mixing concrete, 66.

Moisture and its dangers, 39.

Montclair typhoid epidemic, 359.

Mosquitoes, and malaria, 380;
  and yellow fever, 387.

Mount Savage typhoid epidemic, 357.

Mouth breathing, 287.

Muslin cloth to prevent drafts, 81.


Narrow-topped milk-pail, 245.

Natural immunity, 310.

Need for rural hygiene, 21.

Newton, Mass., water used in, 92.

New York State, death-rates in, 6.

Night air and malaria, 26.


Objectionable construction work at a spring reservoir, 154.

Objections to brooks as source of water-supply, 125.

Occupation and disease, 301.

Old age mortality in the country, 20.

Openings for ventilation, size of, 85.

Organic matter, in soil, 38;
  in the air, 76.

Outfall for cellar drain, 52.

Outlet, for drains, 47;
  for foul air, 81.

Ownership in streams, 415.

Oxygen in the air, 75.

Oysters and typhoid fever, 361.


Pancreatic juice and digestion, 261.

Parasites as causes of disease, 302.

Pasteurization for typhoid fever, 352.

Patented disinfectants, 317.

Patent medicines, 276.

Peeling, in measles, 373;
  in scarlet fever, 369.

Pellagra, 391.

Pipe lines, 165.

Plank dam, 159.

Pleasure in eating, 270.

Plumbing, 189;
  and heating, 190;
  and water consumption, 93.

Pneumonia, 333;
  germ, 344;
  in the country, 20.

Pollution, of streams, 211;
  of water, 414;
  of water by animal matter, 136;
  of wells, 142.

Ponds or lakes as water-supply, 127.

Position of fresh-air inlet, 81.

Precautions on part of consumptive, 337.

Preparation of rabies antitoxin, 309.

Pressure for water-supplies, 128.

Pressure tanks, 186.

Prevention of pneumonia, 346.

Principle of hygienic law, 411.

Privy, construction of, 61.

Process of bacterial attack, 307.

Production of diphtheria antitoxin, 403.

Protection, against mosquitoes, 385;
  against smallpox, 398.

Proteids in food, 260.

Ptomaines, 250.

Pump for deep well, 106.

Pumping water, 168.

Purity of water-supply, 131.


Quantity of water in stables, 94;
  of water per person, 92;
  of water used, 90.

Quarantine, regulations, 422;
  for scarlet fever, 369.

Quinine and malaria, 378, 386.


Rabies, 406; antitoxin, 309.

Radiators by windows, 79.

Rain-water, storage, 101;
  supply, 99.

Rates of water consumption, 95.

Rations for daily use, 263.

Register in the ceiling, 85.

Remedies, for consumption, 340;
  for pneumonia, 347.

Reservoir, for brook supply, 126;
  on a brook, 102.

Resistance, of body to disease, 297, 308;
  to tuberculosis, 335.

Rest for consumptives, 340.

Results of measles and scarlet fever, 366.

Rochester and the milk supply, 237.

Rock formations and hygiene, 35.

Roof of spring-chamber, 157.

Rubber boots, 283.

Running trap for main drain, 201.

Rusting of driven-well casing, 119.


Saliva from mouth, 260.

Sand filter beds for sewage, 219.

Scarlet fever, and milk, 240;
  preliminary symptoms of, 367;
  quarantine, 369.

Scarlatina, 369.

School vaccination, 412.

Scurvy and fresh vegetables, 266.

Sedimentation of sewage, 227.

Septic tanks, 229.

Sewage disposal, 208.

Sewage-sick land, 214.

Sewage treatment on land, 213.

Sewer pipe in wells, 105.

Sewers and sickness, 36.

Sex and age in disease, 299.

Shallow wells, 113.

Sinks, for kitchen, 196;
  and their discharges, 214.

Size, of openings for fresh air, 85;
  of pipe for conveying water, 166;
  of spring reservoir, 156;
  of waste weir, 163.

Slaughter-houses, 255.

Sleep, 292.

Smallpox, 396;
  and chicken pox, 399;
  instead of chicken pox, 376.

Smoking and its effects, 275.

Soap, as an antiseptic, 326;
  its relation to hard and soft water, 134.

Soil, air and its exclusion, 49;
  for disinfection, 331.

Soil-pipe in house, 201.

Somerville typhoid epidemic, 359.

Sources of water-supply, 108.

Space between houses, 30.

Spring-chamber, 157.

Spring, extensions, 123;
  reservoirs, 155.

Springs, 121;
  and their formation, 109.

Squirrels, and the bubonic plague, 395;
  in the attic, 30.

Stables, and dirty milk, 237;
  and water consumption, 94;
  for clean milk, 242;
  space required per cow, 63;
  ventilation, 86.

Stamford typhoid epidemic, 359.

Steam, for disinfection, 329; pumps, 179.

"Stegomyia mosquito," 386.

Sterilization of milk, 234.

Stone dam, 159.

Storage, on a brook, 102;
  reservoirs, 127;
  tank for rain-water, 101.

Stoves used in ventilation, 82.

Strainer for milk-pail, 246.

Stream, pollution, 210;
  supplies, 158.

Subsurface, irrigation field, 224;
  sewage disposal, 223.

Sulfur as a disinfectant, 318.

Sunlight as a disinfectant, 331.

Supply tank for domestic plumbing, 192.

Surface use of land for sewage treatment, 216.

Swamps and malaria, 381.

Symptoms of diphtheria, 401,404;
  of smallpox, 399;
  of yellow fever, 387.

Syphons, for automatic discharge, 225;
  for septic tanks, 229.

Systems of house drainage, 45.


Tanks, for sedimentation, 228;
  for water storage, 183.

Tannin in tea, 274.

Tapeworm, 303.

Tar, for cellar walls, 53;
  paper for water-proofing, 54.

Tea as a drink, 273.

Teeth and their care, 291.

Tetanus, 408.

Thymol for hookworm disease, 390.

Tile pipe line, 166.

Tobacco and its effects, 275.

Topography and hygiene, 34.

Toxic action, 308.

Transmission of typhoid fever by polluted water, 145.

Traps for plumbing, 204.

Trap-vents, 203.

Treatment, of hydrophobia, 408;
  of sewage on land, 213;
  of smallpox, 400;
  of typhoid fever, 361.

Trees and the hygienic home, 30.

Trichinosis, 253, 303.

Tuberculosis, 332;
  and milk, 240;
  death-rates, 18;
  in the country, 19;
  in the United States, 18.

Tuberculous meats, 251.

Typhoid bacillus, 351.

Typhoid fever, 308, 349;
  and milk, 238;
  epidemic at Butler, Pa., 146;
  epidemic at Caterham, England, 145;
  epidemic at Kerhonkson, N. Y., 150;
  epidemics, 354;
  in ice, 353;
  in New York State, 13;
  in small cities, 14;
  in Spanish-American War, 360;
  rates in the country, 12.


Unadilla Valley and cancer, 34.

Uncinariasis, 389.

Underdrains for sewage disposal, 231.

Underground waters, 109.

Underwear, 281.

United States Department of Agriculture and diseased meat, 251.

University of Pennsylvania radiators, 79.

Use of cement in well walls, 115.


Vaccination, 397.

Variation in maximum rates of water use, 96.

Vegetable, beds and sewage, 218;
  pollution of water, 135.

Ventilation, 68;
  experiments on hens, 71;
  by stoves, 82;
  of bedrooms, 283;
  of cellars, 60;
  of stables, 86;
  through walls, 72.

Vents for traps at fixtures, 203.

Vitality of the typhoid germ, 352.

Volume, of sewage, 209;
  of space in cow stables, 63.

Vomiting in whooping cough, 374.


Walls for spring reservoirs, 155, 156.

Wash-basin in bath-room, 199.

Washing, milk-pails, 246;
  soda for disinfection, 329.

Wash-tubs, 197.

Waste weirs, 163.

Water, in the soil, 38;
  needed for house, 90;
  transmission of typhoid fever, 354;
  used per head, 92;
  with meals, 272.

Water-closets, 205.

Water-proofing of cellar walls, 58.

Water-supply and intelligence, 91.

Water tanks, 183.

Water-tight masonry for wells, 142.

Weather and pneumonia, 345.

Wells, and cesspools, 31;
  and typhoid fever, 357;
  on Long Island, 112.

Well supplies, 104.

Whooping cough, 373.

Will power and sleep, 293.

Windmills, 169, 170.

Windmill with pressure tanks, 188.

Window openings for ventilation, 78.

Winter care for sewage beds, 221.

Wooden tank for water, 193.

Work of a farmer's day, 21.

Worthington pump, 182.


Yellow fever, 386.

       *       *       *       *       *

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     amplified editions of the work, it will probably never be
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     given it faultless form. The typography leaves nothing to be
     desired, the paper is calculated to stand wear and tear, and
     the work is at once handsomely and attractively bound."--_New
     York Daily Tribune._

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PUBLISHED BY
THE MACMILLAN COMPANY
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BOOKS ON AGRICULTURE

On Selection of Land, etc.

Thomas F. Hunt's How to Choose a Farm                                $1 75 net
E. W. Hilgard's Soils: Their Formation and Relations to
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Isaac P. Roberts' The Farmstead                                       1 50 net

On Tillage, etc.

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Edward B. Voorhees' Fertilizers                                       1 25 net
Edward B. Voorhees' Forage Crops                                      1 50 net
H. Snyder's Chemistry of Plant and Animal Life                        1 25 net
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W. C. Welborn's Elements of Agriculture, Southern and Western           75 net
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T. L. Lyon and E. O. Fippen's The Principles of Soil Management       1 75 net
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On Everything Agricultural

L. H. Bailey's Cyclopedia of American Agriculture:
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  Vol. III. Farm Animals.
  Vol. IV. The Farm and the Community.

  To be complete in four royal 8vo volumes, with over 2000 illustrations.
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_For further information as to any of the above, address the publishers_

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BOOKS OF GENERAL INTEREST

A Self-Supporting Home

By KATE V. ST. MAUR

_Cloth, Illustrated, 12mo, $1.75 net_

     Each chapter is the detailed account of all the work necessary
     for one month--in the vegetable garden, among the small fruits,
     with the fowls, guineas, rabbits, cavies, and in every branch
     of husbandry to be met with on the small farm. The book is
     especially valuable and simple for the beginner.

     "One of the most sensible, practical books of the kind ever
     published."--_Louisville Courier-Journal._


How to Keep Bees for Profit

By D. E. LYON

_Cloth, Illustrated, 12mo, $1.50 net_

     Dr. Lyon is an enthusiast on bees. His work is a practical one.
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How to Keep Hens for Profit

By C. S. VALENTINE

_Cloth, Illustrated, $1.50 net_

     By the well-known writer on poultry raising in the New York
     _Tribune Farmer_.


Manual of Practical Farming

By DR. JOHN McLENNAN

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     A book "worthy of a hearty welcome," says the New York Times, a
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     economic scientific methods to the common matters of the farm.


Manual of Gardening

By L. H. BAILEY

_Cloth, Illustrated, 12mo, $2.00 net_

     This new work is a combination and revision of the main parts
     of two other books by the same author, _Garden Making_ and
     _Practical Garden-Book_, together with much new material and
     the result of the experience of ten added years.


The Book of Vegetables and Garden Herbs

By ALLEN FRENCH

_Cloth, Illustrated, 12mo, $1.75 net_

     A practical book "from the ground up." It gives complete
     directions for growing all vegetables cultivatable in the
     climate of the northern United States. It represents a
     departure in vegetable-garden literature. It does not
     generalize. The illustrations, numbering about 150, are all
     from original drawings.

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PUBLISHED BY
THE MACMILLAN COMPANY
64-66 Fifth Avenue, New York