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+The Project Gutenberg EBook of Rural Hygiene, by Henry N. Ogden
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Rural Hygiene
+
+Author: Henry N. Ogden
+
+Release Date: July 31, 2009 [EBook #29555]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK RURAL HYGIENE ***
+
+
+
+
+Produced by Tom Roch, Josephine Paolucci and the Online
+Distributed Proofreading Team at http://www.pgdp.net. (This
+file was produced from images produced by Core Historical
+Literature in Agriculture (CHLA), Cornell University.)
+
+
+
+
+
+
+
+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 debris in the soil. Since we have
+learned that malaria is carried by mosquitoes, we are less interested in
+the amount of organic matter in the soil. Its mere presence is not
+likely to be injurious.
+
+_Water in the soil._
+
+Only the hardest rocks are entirely solid, the others containing a
+certain percentage of voids or interstices. These voids are filled with
+air or water, as the case may be, and we may stop for a moment to
+inquire the effect of the presence of this air and water. In loose sands
+the amount of voids is 40 to 50 per cent of the total volume, in
+sandstone about 20 per cent, and in other rock reduced amounts. The
+volume of air, therefore, in the soil under a cellar to a depth of four
+or five feet, amounts to a good many cubic feet and would not be worth
+inquiring into except for the fact that it is continually in a state of
+motion. When the ground water, perhaps normally five feet below the
+cellar bottom, rises in the spring, this ground air is forced out, and
+in a cellar without a concrete foundation it rises into the cellar and
+penetrates into the house.
+
+A house artificially warmed by stoves is continually discharging heated
+air from the tops of the rooms and colder air is being brought in from
+below to take its place. This air comes from the ground below, and in
+open soil may come from a great depth. A case has been noted where gas
+escaping from a main in a city street twenty feet from a cellar wall
+was, by the suction due to heat, drawn into the cellar and thence into
+the rooms of the house. It is possible that air from cesspools and
+broken drains in the vicinity of a house may, in this same way,
+contribute to the atmosphere breathed within the walls of the house.
+Gravelly and sandy soils, therefore, in order to maintain the
+superiority which they furnish for building construction, should not be
+polluted, since any pollution in the vicinity influences the quality of
+air which may get into the house. The method of preventing such ingress
+is plainly to water-proof the outside walls of the cellar and provide an
+air-tight floor over the cellar bottom. Methods of doing this will be
+discussed in the next chapter.
+
+_Moisture in soils._
+
+The presence of water in the soil has usually been considered to be
+unhealthy because of the impression that it led to certain fevers. The
+writer has heard, for instance, of an attack of malaria being caused by
+a short visit to a damp vegetable cellar; and it is one of the triumphs
+of the century that the malarial parasite has been discovered, and the
+old theory of the dangers of moisture been done away with. A damp cellar
+has always been considered to be undesirable, but just why nobody
+knows. A damp cellar causes molds to form rapidly, thus destroying
+vegetables and other material which might naturally be stored there, but
+that the presence of moisture in a cellar in itself produces any organic
+emanation leading to disease is not true, although dampness is essential
+to the growth of certain organisms.
+
+In the latter part of the nineteenth century, Dr. Bowditch, of Boston,
+showed that consumption developed most where the surrounding soil was
+moist, and generally it is the impression that dry air is the only
+proper air for a consumptive person to breathe. This theory, however, is
+being rapidly exploded, and patients now remain outdoors in any weather,
+and no kind of air is objected to by physicians, provided it is outdoor
+air. Some little time ago the writer was called by a Board of Health to
+investigate a certain swamp which had some odor, was considered a blot
+on the landscape in an unusually picturesque village, and was said to be
+responsible for a long list of contagious diseases. A house-to-house
+inquiry in the vicinity showed that among some dozen families, only one
+illness in the last few years could be remembered, and that was an old
+lady who had been on the verge of the grave for forty years.
+
+It is curious to note the many examples which are cited by the earlier
+sanitarians to prove the dangerous effect of damp soil. For example,
+Pettenkofer, a very prominent German hygienist, says that in two royal
+stables near Munich, with the same arrangements as to stalls, feed, and
+attendance, and the same class of horses, fever affected the horses very
+unequally. In one stable, fever was continually prevalent; in the
+other, no fever was found. Horses sent from the unhealthful to the
+healthful stables did not communicate the disease. The difference
+between the two places, says Pettenkofer, was that in the healthful
+stables the ground water was five to six feet below the surface, while
+in the unhealthful ones it was only two and a half feet from the
+surface. A system of drainage by which the ground water was brought to
+the same level under both stables made them equally healthful. The
+writer cannot help but feel that some other factor was involved, and
+while he has no doubt that excessive dampness in stables or cellars is
+undesirable, he does not believe that such dampness can be directly the
+cause of fevers of any sort.
+
+It is not desirable, however, to live over a wet cellar nor to maintain
+a house in a constant condition of dampness, partly on account of its
+bad effect on the house and partly because such dampness may, by
+reducing the vitality of the household, become a predisposing factor in
+disease.
+
+_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 aesthetically objectionable and tending to make the house
+appear too high. Whenever gutters are built in driveways or ditches to
+intercept water coming down the slopes, a suitable outlet must be
+provided to carry the water thus collected either into underground
+pipes, by which the water is led to some stream or gulley, or directly
+into some well-marked surface depression.
+
+_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 anaemic 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 anaemic 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 cooeperation 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 x 140.7 x 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. AEsthetically, 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 aesthetic 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
+x 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 aesthetic 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 trichinae 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 trichinae 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 role 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 anaesthetic 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 anaesthetic, 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 preeminently 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 microoerganism which, if not met by the
+antagonistic agencies, finally pervades the whole system with its
+progeny or its virus. The microoerganisms 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 anaemia.
+
+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 reenforced 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 preeminently 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 larvae 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 larvae 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 larvae stage air must be supplied,
+curiously enough, through the tail which projects slightly above the
+surface of the water as the larvae hang head downwards (see Fig. 79). If
+the surface of the water is covered with some impervious material, the
+mosquito larvae 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 larvae. 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 larvae. These larvae 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 larvae, and it is hardly possible for a child to
+walk barefoot outdoors without becoming infected. When the larvae 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 larvae 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 anaemia 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
+preeminently 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.
+
+       *       *       *       *       *
+
+The following pages contain advertisements of a few of the Macmillan
+books on kindred subjects.
+
+
+Cyclopedia of American Agriculture
+
+EDITED BY L. H. BAILEY
+
+Director of the College of Agriculture and Professor of Rural Economy,
+Cornell University.
+
+_With 100 full-page plates and more than 2000 illustrations in the text;
+four volumes; the set, $20.00 net; half morocco, $32.00 net; carriage
+extra_
+
+VOLUME I--Farms    VOLUME III--Animals
+VOLUME II--Crops   VOLUME IV--The Farm and the Community
+
+     "Indispensable to public and reference libraries ... readily
+     comprehensible to any person of average education."--_The
+     Nation._
+
+     "The completest existing thesaurus of up-to-date facts and
+     opinions on modern agricultural methods. It is safe to say that
+     many years must pass before it can be surpassed in
+     comprehensiveness, accuracy, practical value, and mechanical
+     excellence. It ought to be in every library in the
+     country."--_Record-Herald, Chicago._
+
+
+Cyclopedia of American Horticulture
+
+EDITED BY L. H. BAILEY
+
+_With over 2800 original engravings; four volumes; the set, $20.00 net;
+half morocco, $32.00 net; carriage extra_
+
+     "This really monumental performance will take rank as a
+     standard in its class. Illustrations and text are admirable....
+     Our own conviction is that while the future may bring forth
+     amplified editions of the work, it will probably never be
+     superseded. Recognizing its importance, the publishers have
+     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._
+
+       *       *       *       *       *
+
+PUBLISHED BY
+THE MACMILLAN COMPANY
+64-66 Fifth Avenue, New York
+
+
+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
+  Climate and Plant Growth                                            4 00 net
+Isaac P. Roberts' The Farmstead                                       1 50 net
+
+On Tillage, etc.
+
+F. H. King's The Soil                                                 1 50 net
+Isaac P. Roberts' The Fertility of the Land                           1 50 net
+Elwood Mead's Irrigation Institutions                                 1 25 net
+F. H. King's Irrigation and Drainage                                  1 50 net
+William E. Smythe's The Conquest of Arid America                      1 50 net
+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
+H. Snyder's Soil and Fertilizers. Third edition                       1 25 net
+L. H. Bailey's Principles of Agriculture                              1 25 net
+W. C. Welborn's Elements of Agriculture, Southern and Western           75 net
+J. F. Duggar's Agriculture for Southern Schools                         75 net
+G. F. Warren's Elements of Agriculture                                1 10 net
+T. L. Lyon and E. O. Fippen's The Principles of Soil Management       1 75 net
+Hilgard & Osterhout's Agriculture for Schools on the Pacific Slope    1 00 net
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+On Plant Diseases, etc.
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+George Massee's Plant Diseases                                        1 60 net
+J. G. Lipman's Bacteria in Relation to Country Life                   1 50 net
+E. C. Lodeman's The Spraying of Plants                                1 25 net
+H. M. Ward's Disease in Plants (English)                              1 60 net
+A. S. Packard's A Text-book on Entomology                             4 50 net
+Stevens & Hall's Diseases of Economic Plants                          2 00 net
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+On Production of New Plants
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+L. H. Bailey's Plant-Breeding                                         1 25 net
+L. H. Bailey's The Survival of the Unlike                             2 00 net
+L. H. Bailey's The Evolution of Our Native Fruits                     2 00 net
+W. S. Harwood's New Creations in Plant Life                           1 75 net
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+On Garden-Making
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+L. H. Bailey's Manual of Gardening                                    2 00 net
+L. H. Bailey's Vegetable-Gardening                                    1 50 net
+L. H. Bailey's Horticulturist's Rule Book                               75 net
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+A. French's Book of Vegetables                                        1 75 net
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+L. H. Bailey's Fruit-Growing                                          1 50 net
+L. H. Bailey's The Pruning Book                                       1 50 net
+F. W. Card's Bush Fruits                                              1 50 net
+J. T. Bealby's Fruit Ranching in British Columbia                     1 50 net
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+On the Care of Live Stock
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+D. E. Lyon's How to Keep Bees for Profit                             $1 50 net
+Nelson S. Mayo's The Diseases of Animals                              1 50 net
+W. H. Jordan's The Feeding of Animals                                 1 50 net
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+George C. Watson's Farm Poultry                                       1 25 net
+C. S. Valentine's How to Keep Hens for Profit                         1 50 net
+O. Kellner's The Scientific Feeding of Animals (translation)          1 90 net
+H. R. Lewis' Poultry Laboratory Guide                                   65 net
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+Henry H. Wing's Milk and its Products                                 1 50 net
+C. M. Aikman's Milk                                                   1 25 net
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+W. D. Frost's Laboratory Guide in Elementary Bacteriology             1 60 net
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+L. H. Bailey's The State and the Farmer                               1 25 net
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+  In the Citizen's Library. Includes a chapter on Farming
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+G. F. Warren and K. C. Livermore's Exercises in Farm Management         80 net
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+On Everything Agricultural
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+L. H. Bailey's Cyclopedia of American Agriculture:
+  Vol. I. Farms, Climates, and Soils.
+  Vol. II. Farm Crops.
+  Vol. III. Farm Animals.
+  Vol. IV. The Farm and the Community.
+
+  To be complete in four royal 8vo volumes, with over 2000 illustrations.
+  Price of sets: Cloth, $20 net; half-morocco, $32 net.
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+       *       *       *       *       *
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+_For further information as to any of the above, address the publishers_
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+       *       *       *       *       *
+
+PUBLISHED BY THE MACMILLAN COMPANY 64-66 Fifth Avenue, New York
+
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+A Self-Supporting Home
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+By KATE V. ST. MAUR
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+_Cloth, Illustrated, 12mo, $1.75 net_
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+     Each chapter is the detailed account of all the work necessary
+     for one month--in the vegetable garden, among the small fruits,
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+     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.
+     In it he takes up the numerous questions that confront the man
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+
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+How to Keep Hens for Profit
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+By C. S. VALENTINE
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+_Cloth, Illustrated, $1.50 net_
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+     By the well-known writer on poultry raising in the New York
+     _Tribune Farmer_.
+
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+Manual of Practical Farming
+
+By DR. JOHN McLENNAN
+
+_Cloth, Illustrated, 12mo, $1.50 net_
+
+     A book "worthy of a hearty welcome," says the New York Times, a
+     help to orderly, practical farm management, an application of
+     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.
+
+       *       *       *       *       *
+
+PUBLISHED BY
+THE MACMILLAN COMPANY
+64-66 Fifth Avenue, New York
+
+
+
+
+
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