Other diseases.
Diseases that are induced by water, all referred to under typhoid fever, but extending into such complaints as diarrhœa 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:—