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WORKS OF BRIGADIER-GENERAL WOODHULL
PUBLISHED BY
JOHN WILEY & SONS
Military Hygiene for Officers of the Line.
Fourth Edition, Rewritten and Greatly Enlarged. Large i2mo, vi + 384 pages. Cloth, $1.5° net.
Personal Hygiene.
Designed for Undergraduates. i2mo, vii + 221 pages. Cloth, $1.00 net.
Personal Hygiene
Designed for Undergraduates
ALFRED A. WOODHULL, A.M., M.D., LL.D. (Princ.)
Brigadier General U. S. Army, Retired Lately Colonel, Medical Department, U. S. Army
FIRST EDITION
SECOND THOUSAND.
NEW YORK
JOHN WILEY & SONS
London: CHAPMAN & HALL, Limited
Transferrer?
Copyright, 1906
BY
ALFRED A. WOODHULL
PRESS OP
BRAUNWORTH & CO.
BOOK MANUFACTURERS
BROOKLYN, N. Y.
•ro Ubc Princeton Class ot 1906
AND Its Immediate Successors,
In Cordial Recognition of Theie Appreciative
Reception of the Spoken Words.
Preface
"^ I "'HIS book is intended for undergraduate students and contains the substance of lectures on Per- sonal Hygiene given at Princeton during the last few years. It is published because the oral delivery of its material has been accepted so pleasantly as to suggest that it may be useful elsewhere in this form. Ab- stract physiology has been kept at the lowest point, and as far as possible technical phrases have been avoided. The constant aim has been to present actual conditions in the simplest language. One lecture, on the Avoidable Diseases, is not printed. A little First Aid was mingled with the Hygiene in the lecture-room, but that is omitted here because it is an independent subject on which admirable books are readily accessible.
As the subject is public property and the lectures were prepared without thought of publication, no record of the authorities drawn upon was kept; so that in some instances their very words may have been appropriated. As far as possible credit is now given,
Vi Preface
but doubtless coincidences of expression may be found. A part of the discussion of alcohol, a general position held for years, is a paraphrase of the admi- rable Report of the Committee of Fifty on the Liquor Problem.
Pbinqeton, December, 1905.
Contents
CHAPTER PAGE
I. The SKELETON' I
II. The Muscular System i_^
III. The Lungs and Respiration 17
IV, The Heart and the Circulation 25
V. The Nervous System.
37
52
VI. The Contents of the Abdomen
VII. Digestion, and the Care op the Digestive Appa- ratus. . 57
VIII. The Development and Care of the Body 74
IX. Physical-Culture Exercises 94
X. Fatigue 103
XI. The Elimination of Waste and the Care of the
Skin m
XII. Catching Cold, Swimming, Bathing 124
XIII. Clothing 134
XIV. Food 144
XV. Tobacco 163
XVI. Alcohol » 183
vii
Personal Hygiene
I
The Skeleton
'nPHE study of Personal Hygiene has an immediate, direct and personal application, and this presen- tation of it contains very little that is speculative or that bears upon any future profession of the student. It offers certain ascertained conditions of the physical organism and of exercise, food, clothing, habits, and similar matters of daily individual concern. That the principles upon which Personal Hygiene depends may be appreciated, some elementary points of anatomy and physiology must be presented, but these will be only those absolutely necessary to its reasonable un- derstanding. "It is no part of a university education to be showered with disconnected facts." There are certain ultimate conditions which cannot be, or have not been, cxj)lained, such as the saltness of salt, or the power of gravitation; but such conditions obtrude
2 Personal Hygiene
very little in this subject, and one should not be satis- fied until the reason for, as well as the method of, any process, mechanical or physiological, is understood.
Anatomy is the science of organized bodies; and human anatomy explains the structure of man, as human physiology explains the operation of his vital functions. The human organism is roughly separable Extremis into the cavities of the head and the trunk *'®^ containing the organs of life, and the extremi-
ties or limbs, solid appendages which are the organs of touch, prehension, and transportation. The latter, which are not essential to life, exist for the care and convenience of the former. The man is contained within the cavities, and the removal of all the limbs should leave the vital functions unimpaired.
The skeleton, a bony frame clothed with flesh and
supporting other soft structures, protects the vital organs
from violence and serves as a base for the Bones ^ . . . , -r •
functions of graspmg and movement, it is
made up of about two hundred bones, varied in shape so as to be adapted to their respective uses, which are compact on the surface and cancellated within and thus combine lightness and strength to the best advantage. The shaft of a long bone is approximately a hollow cylinder, which secures a maximum of strength with a minimum of material; and its extremities, which en- dure pressure or play upon other parts, have their cancellated plates geometrically arranged to sustain strain without being unduly heavy. All the short bones are cancellated within and are relatively light.
The Skeleton 3
The vitality of all bones is chiefly maintained through the periosteum, a closely-adherent, very tough membrane rich in blood-vessels. When a Perios- part of the periosteum is removed or dies *®"™ as the result of either violence or disease, the bone next to it dies also. The leg-guards that protect the ex- posed shins in kicking games, besides defending against fracture guard the periosteum from bruises that may be more serious than the mere pain they cause. On the other hand, the periosteum throws out the new material that reunites broken bones, as shown in the knot of extra callus remaining from excess of the fresh bone after a fracture. Besides the periosteal action, bones, particularly the long ones, arise from several centres; and the various parts are not always sufficiently united be- fore adult life to prevent them from being pulled apart occasionally under violent exertion. In early life bones are actually softer, and the long bones then are liable to bend under the weight of the body; and as old age approaches they become more rigid and brittle.
The spinal column is not a solid cylindrical body, as the name might imply, but consists of twenty-four separate bones called vertebrae, lashed to- gether by tough ligaments. Each vertebra is capable of slight rotation, the sum being considerable, allowing flcxibihty in all directions. This flexibihty is not only useful in common life, but makes easy the deformities due to the carelessness of youth as seen
^ Personal Hygiene
in bent and twisted spines. It also, fortunately, allows their rectification when taken in time. Each vertebra is pierced for that great extension of the central nervous system known as the spinal cord. Between every two vertebrae an elastic cartilage takes up shock in walking or leaping, and by the close of the day each is sufficiently compressed for the sum to make a measurable difference in the height of the person. It is the gradual wasting of this elastic tissue, not of the bone, in addition to the stoop of careless or feeble old men, that leads to the diminished stature com- mon to advanced years.
The first two are the only vertebrae requiring special notice. The first is substantially a shallow
ring which supports the skull, and hence Atlas . ° . \^, . ..
its name, atlas. The skull rests upon two
broad facets, which allows the nodding motion. The
second vertebra has an upright part, or process, which
extends directly against the inner side of the front
. . of the atlas at right angles to the rim
A.xis
This is restrained from slipping backward
by a tough ligament, and as the atlas plays around this projection it becomes literally an axis, as it is called. By this play we move the head over a con- siderable arc of a circle, much farther than we can turn the body. In a legal execution by hanging, the intention always is to break this projection, with the consequence that the spinal cord is also torn or crushed. The cranium or skull rests on the spinal column.
The Skeleton 5
The skull and the bones of the face make up the head. The brain, enclosed by the skull, is directly continuous with the spinal cord.
Twelve enclosing ribs spring from the spine on each side and unite directly or indirectly, except the
lowest two, with the breast-bone. The ribs,
Chest the spinal column, and the breast-bone com- bine to make the flexible cage known as the chest, which contains the heart and lungs.
The bones of the chest are reinforced above by the collar-bones (clavicles) and behind by the shoulder- blades (scapulae). The curved and slender collar- bone assists in keeping the shoulders the CoIIar= proper distance apart. It is easily broken *'**"® by direct violence and usually heals promptly but with some deformity, for the edges invariably overlap from the drawing together of the shoulders and there is usually new bone, callus, thrown out in excess from the torn periosteum. As the collar-bone is out- side of the chest-walls, this common accident has no direct effect upon the chest as a vital receptacle.
The shoulder-blade is an irregular flat bone lying across the back outside of the chest, with two tips that overhang the shoulder- joint. The shoulder- body of the shoulder-blade is never broken •''^^^ except by a crushing force which ordinarily would destroy life. Either of the tips is liable to fracture by direct or by indirect violence.
The upper limb, or extremity, contains one bone in the arm, two in the forearm, and numerous small ones
6 Personal Hygiene
in the wrist and hand. Popularly the arm extends from
the wrist to the shoulder, but proper exact- Arm
ness limits the arm to the part above the
elbow, and the forearm to that between the elbow and
the wrist. The arm-bone (humerus) is semi- spherical
at its upper end, and the socket, against which it
may revolve throughout an entire circle, is so shallow
that dislocations — out-of-places — are frequent. These
usually occur downward and inward into the armpit,
an accident that treated at once may usually be
promptly relieved. Such relief, however, is beyond
the sphere of hygiene.
There are two bones in the forearm : the radius on the
thumb side, the ulna on the little-finger side. The
^ ulna hooks into the lower part of the arm-
Forearm ^
bone and has only the up-and-down motion. But the radius rolls upon the ulna near the elbow and carries in its rotation the hand, which is attached to its lower end. The practical interest lies in the fact that when the radius is so damaged that it cannot revolve, or when after breaking it grows to the ulna, the rotation of the hand is interfered with. If the radius fails to revolve, the hand can no more be turned, except as the humerus itself turns, than the mouth may be closed by bringing down the upper jaw. Should the forearm be broken, it is important to avoid deranging the proper relation of the fragments; and to that end it should be carried horizontally with the thumb up and pains be taken not to disturb the padding arranged to keep the bones apart after they are dressed.
The Skeleton 7
The various troubles attributed to the elbow in base- ball and tennis practice usually depend upon excessive use of the muscles which move the radius, and not to real trouble in the joint itself. The part of the ulna that hooks into the humerus, or the projections at the sides, may be chipped off by a fall or a blow; but the ordinary tennis elbow, for instance, is a strain of the soft parts about the joint. It is a common fault in tennis to depend too much upon the forearm and wrist, and to neglect the shoulder from which the arm may swing freely in every direction.
The hand and wrist require no comment beyond attention to the thumb, in which lies the special phys- ical distinction between man and the higher apes that bear a general resemblance to him. The thumb is the potential factor of civilization, for it enables man to perform those mechanical arts upon which civilization depends. It qualifies its possessor for spinning, for drawing the bow, and for all .those acts of grasping which require opposition within the hand itself (Whitehead). Closely as they resemble man in other ways, the higher types of monkeys and apes have no capable thumb.
At the lower end of the spinal column are the sacrum
and the coccyx, made up respectively of five and four
rudimentary vertebrae consolidated. The
Pelvis coccyx is really a rudimentary tail, curved
forward. Together they form a wedge tilting to the front, which is the back of the bony basin. The remain- der of the pelvis consists of two large irregular bones,
8 Personal Hygiene
one on each side, originally consisting of three apiece. These are the innominate or haunch bones, sometimes called the hip-bones, and we sit on their lower parts. These bones arise from several centres and slowly weld together, solidification being deferred until the twelfth, and sometimes until the twenty-fifth, year. This has no immediate bearing upon the health of either sex, but deferred ossification, which permits changes of form under privation and stress, is liable seriously to interfere with the most important physio- logical function of the mature female and to render the male inefficient for such heavy work as requires vigorous use of the lower back and the lower limbs. The submerged classes with chronically impaired health are those most liable to this deformity, but it may occur in any station where the bones do not coalesce normally and are affected by disease with or without strain. The female pelvis should be, as it is, flatter and broader than that of the male. The conception of a broad pelvis is essentially associated with female beauty, just as a truly vigorous man is deep-chested, broad-shouldered, straight-legged. The willowy young women with tenuous hips, celebrated by ignorant writers and figured by untaught illustrators, are malformed; and taste should be cultivated along the lines of nature and not be vitiated by an approval of disproportion.
The pelvis supports the spinal column and is itself supported by the thigh, the leg, and the foot, which together make up the lower extremity. The thigh-
The Skeleton g
bone (femur) is single like the arm-bone (humerus) and moves at the hip by a ball-and-socket _ joint, as the arm at the shoulder.
The leg-bones, like those of the forearm, are two, the tibia and the fibula, and meet the thigh-bone in a hinge- joint at the knee. The tibia (shin-bone) is relatively large, and the fibula is very slender. Occasionally the tibia is broken by gunshot, or otherwise, while the fibula remains intact until the subject bears his weight upon it. It is important, therefore, after such an accident not to attempt to walk until expert opinion is had as to the extent of the injury; otherwise there will be serious risk of sacrificing the natural splint that nature supplies to assist in maintaining the normal length and direction of the broken limb. The fibula is the outer and the tibia the inner of these two bones, and their lower extremities are popularly known as the outer and
inner ankle- bones. The ankle strictly is ...
. Ankle
the joint, and the only true ankle-bone is a
curved small bone, the astragalus, upon which the leg-bones play. This is never broken except by a crushing force. The common expression "a small bone of the ankle " has no foundation in fact, and fractures of the ankle are breaks of the slightly enlarged lower tips of the leg-bones. The foot resembles the hand ; except that the instep, partly corresponding to the wrist, supports the weight of the body and there- fore its strength and elasticity arc important, and the toes lack the prehensile power of the fingers.
to Personal Hygiene
The great toe corresponds, in a degree, in importance
and anatomically to the thumb, but it may not be
^ ^ ^ opposed, as the thumb, to the rest of the Great toe ^^ '
foot. But the act of progression largely depends upon the pressure of the ball of the foot and of this toe against the ground as the body is thrown forward.
Pressure at the base of the great toe from a tight shoe or from one too short may positively displace the member and almost certainly causes at the joint a tender swelling, a bunion. This is very obstinate, and is a grave impediment in prolonged walking. The short shoe, which does not allow free expansion of the foot forward, is probably as hurtful as the tight shoe, which bears the popular blame. In some unshod or loosely shod races the great toe remains disjunctive and almost prehensile. Certainly were our feet less cramped by special clothing, their shape and comfort would be much enhanced.
The arch of the foot, the instep, assists the act of walking by its form and elasticity, qualities that grow Ingrowing with its freedom. An ingrowing nail, usually toe-nail q£ ^-^^ great toe, is very painful and dis- qualifies for serious work. In the intervals of pro- fessional treatment the nail should always be cut straight across and not round at the corners, which is the constant temptation. The lesser toe-nails should always be carefully trimmed, to avoid wounding the neighboring toes. One's feet should be bathed at the close of the day as regularly as his teeth should be
The Skeleton 1 1
brushed. The dust and perspiration that cling about the toes are apt to be more offensive than those in other parts of the person. The foetid perspiration that afflicts the feet of an occasional victim is a disease deserving of commiseration and treatment, not of censure or obloquy.
The skeleton exhibits prominences, ridges, grooves, where the contractile agents that govern motion, the muscles, are attached. In prehistoric bones these are sometimes excessive, indicating a much greater develop- ment of the active muscles.
As a resume remember that in early life bones may bend and in old age they are brittle, and that some are not consolidated before the age of twenty-two or later. It is thus possible for the epiphyses in the young to separate under severe strain. The moral is that political maturity and physical maturity are not attained simultaneously. The statute but physical not the physical law bestows majority at maturity the age of twenty-one; but nature's work is not com- plete when the ballot is conferred.
A practical example is found where immature men are allowed to attempt severe continuous labor, as when recruits at the age of eighteen or a little more are accepted, as legally permitted, for active military service. It is equally true that in academic life the immature cannot bear continued strain, whether of mind or body, with impunity. An exploit of memory in class or a dash upon the track is no evidence of capability of endurance before time gives lasting
12 Personal Hygiene
power. It is not a disgrace to be immature, but it is a sign of mental weakness not to recognize the signi- ficance of immaturity.
The bones are bound together, with varying degrees of play between them, by strong inelastic fibrous Strain and bands, the ligaments, A strain is the sprain stretching of one of these from stress; a sprain is a severe strain, sometimes a tearing. The difference is more of degree than of kind. A badly stretched ligament may be permanently weakened, and a sprain from its liability to recur should be respected for a long time. The best immediate treatment for a sprain is prolonged immersion in hot water, or hot applications, followed by careful rubbing toward the body. When ligaments are torn, as by direct force, complete, not imperfect, rest should be steadily main- tained. A joint once weakened may be a life-long infirmity, and a severe sprain may be much worse in its consequences than a break.
To distinguish between a dislocation and a fracture, whose names explain themselves, it must be remem- bered that, in general terms, a bone which has motion where it should not is broken. When a limb does not move where it should, it is out of place.
II
The Muscular System
"D OUGHLY, one-half of the weight of an adult is
flesh. In a child it is somewhat less. This
is found in independent sections of varying shapes
called muscles. These, through their contractility,
carry on the more conspicuous mechanical
• r 1-r All ■ 1 1 Muscles
operations of life. All appreciable move- ment occurs by their action, which is always accom- panied by change of form. No change of posture, even no play of feature, happens without muscular action and consequent changes of outline. That a muscle grows with its exercise is as applicable to those which mark expression as to those that carry on labor. The face as well as the back is covered with muscles, and the dominant disposition is shown in their development as clearly as the work of the blacksmith or of the porter is displayed by the arm or the loins. Nearly all the muscles have a fixed attachment to bone, which limits their movement; but there are a few known as the sphincters, mere fleshy rings to which other muscles are attached. The muscle surrounding the mouth is the most obvious example, both of their
»3
14 Personal Hygiene
essential nature and of the influence brought to bear on them. On the table muscle is known as meat. Fibrous tissues or sinews (gristle), attached in sheets or strings, make muscles fast to other structures, usually bone. These tendons are inelastic and grow disproportionately with age, which is the main reason why an elderly person whose strength is not seriously impaired may not rival a younger one in agility. Nevertheless continual practice, far short of severe exertion, will maintain high efficiency to an advanced period. It is not an object to burden oneself with masses of muscle, any more than with fat, as evidence of health. The design should be to preserve the active efficiency of all the bodily functions, including those of the muscular system.
There are about four hundred muscles, diverse in shape and size, concerning which it is sufficient simply to understand their more conspicuous work and to recognize their general character. A general classi- fication, having a microscopical but also a functional distinction, is the division into plain and unstriped muscle. All muscle is irritable and contracts under stimulation. This contraction involves a change of form, not of volume. Practically the stimulus to which muscle responds is exercised through the nervous system. Speaking generally, the striped are the voluntary muscles; that is, those whose operation is con- Striped trolled by the exercise of the will or muscle ordinarily are moved by the voluntary nerves. For instance, the muscles of the arm, the leg,
The Muscular System 15
or the face remain quiescent although themselves intact, when the nerves going to them are disabled. The energy passes through the nerves; the muscles do the work. When the nerve is severed by a knife, or disabled by disease, the muscle cannot contract. Plain, or unstriped, muscle is not under the influence of the will, but is controlled by the organic (or sym- pathetic) nervous system, of which later. Unstriped Unstriped muscle contracts and relaxes more "i"scle slowly and more persistently than the striped muscle; but it must never be forgotten that its operation is also controlled by the nervous system, although not by that part ^vf the nervous system which acts through the will. Hence the regulation of the whole nervous system is of prime importance. For instance, unstriped muscular fibres encircle the blood-vessels, and when by their contraction the diameter of those vessels is lessened the quantity of blood flowing through them is diminished. Now one of the effects of nicotine upon the nervous system is for the latter to cause the muscle to contract, which in turn diminishes the bore of the minute blood-vessels and reduces the blood-supply. This is one of the ways by which those who use tobacco prematurely or in excess dwarf their bodies and reduce the normal supply of nutriment to the brain. Un- striped muscles make up a part of the blood-vessels, the most of the hollow viscera, and the walls of the intes- tines. They carry on the automatic changes in the capacity of the lungs, and they form the bulk of the heart. Hence if the general nervous system is dis-
1 6 Personal Hygiene
turbed, these concealed but important organs may be correspondingly affected. We influence the unstriped muscle not by the will but by our care or want of care of the organic nerve.
Muscular work in its ultimate analysis represents the transformation of energy, through the transmuta- tion of food into muscle and other constituents of the body. The manifestation of muscular work is in great part governed by that form of nervous energy which we speak of as "spirit," or "grit," and two vital machines cannot be compared until this factor is estimable.
Ill
The Lungs and Respiration
TMMEDIATELY behind the palate, from the com- mon vault in which the cavities of the mouth and nose unite, two distinct channels descend. The wind- pipe (trachea) in front goes to the lungs, Windpipe the gullet (oesophagus) behind it to the and gullet stomach. That all one's food and drink doesn't pour into the lungs depends upon the automatic closure of the larynx, at the top of the trachea, during the act of swallowing. Whatever else may happen in a case of drowning, for example, water does not ordinarily enter the lungs before actual death, even if it does then. That is to say, a person does not drown by the lungs primarily filling with water. The chest (thorax) is separated from the belly (abdomen) by the diaphragm (midriff), a broad, thin, curved muscle, and it contains the heart and lungs.
The respiratory organs are one windpipe and two lungs. The windpipe divides at the depth of Organs of 4^ inches into two smaller tubes (bronchi), respiration one for each lung. These subdivide rapidly into very
17
1 8 Personal Hyg
lene
many smaller tubes which end in minute pouches, whose walls are hollowed into still more minute ves- Vesicles, ides (alveoli) whose presumed number is or alveoli y^o,ooo,ooo, each having an average diam- eter of jj^ inch. The walls of these subdivided tubes are of almost inconceivable delicacy, and their essential object is to support, as would a frame, an innumerable
^ ... , multitude of microscopical blood-vessels Capillaries
(capillaries). The essential nature of res- piration will be explained under the circulation. The important point to remember now is that the air must be in contact with the walls of the capillaries, so that respiration may go on. These blood-vessels ramify over all the little pouches or vesicles at the extremities and in the course of the air-tubes. The popular con- ception seems to be that a lung is a soft, semi- solid mass through which the air drifts as it might through loose sand. That is entirely wrong. The lungs are
a symmetrical collection of correlated cavi- Lungs ...
ties which exist not merely at the extremity
of some particular line of tubing, but branch from all the tubes, as microscopical as they are themselves, in all directions, so that a rude illustration might be that of a tree in full leaf. The tubes, therefore, through which the outer air enters are not the lungs ; the cavities,, that is the air-spaces, are not the lungs; but the very Lung- delicate membrane which is the end and membrane limitation of the labyrinth may be thus regarded. It is in this membrane that occurs the deposit of tubercle which causes consumption. This
The Lungs and Respiration 19
delicate membrane is the mechanical support of the invisibly minute blood-vessels which com- pletely overlace its surface, and it has an available exposure to the air variously estimated at from 870 to 2140 square feet. The surface of the body runs from 16 to 21 J square feet, so that the un- folded lung-sheet would be from 50 to 100 times the area of our skins. The lungs may be thought of as
two collections of delicate film arranged in
., , - . , , , Lungs
a wilderness of mmute tubes, and covered
with a close network of microscopical blood-vessels,
so that the air passes on both sides of this supporting
membrane and bathes the vessels' walls.
The mechanical action of the lungs is this: The
chest-walls, the ribs covered with muscles, are flexible
and the chest capacity may be altered Mechan-
T 111 1 • isiti of
laterally and perpendicularly by their move- breathing
ment and that of the diaphragm. The air enters the
lungs by atmospheric pressure as the walls expand, and
it is forced out as they contract. As the windpipe is
merely a supply-pipe, to cut it and thus make an
additional entrance for air is not fatal as popular
fiction sometimes represents.
As the membrane that forms the finer air-channels is
clastic and the chest-walls are movable, when more air
enters these passages they expand and may be stretched.
When the air escapes or is not present in fair amount,
they contract. Hence they may be strained Straining
under severe exertion, so as to fail to contract passages
normally afterward. This condition in man is called
20 Personal Hygiene
emphysema, in horses heaves. When inadequately supplied with air, particularly after unusual develop- ment, as in athletic training, they may come together and in the outer portions of the lung may even col- Collapse lapse. But the ordinary evil is insufficient of air- ^ . .,.,...
passages expansion, so that the aerial tide fails to
bathe all the recesses.
What is the object of respiration, and how is it accomplished? The enormously extended and pro- portionately plicated pulmonary membrane, which sustains and exposes to the air the innumerable microscopic blood-vessels, has no active function. Respiration effects the purification of the blood by the action of the air directly through the capillaries. The capillary blood-vessels are somewhat elastic, microscopic tubes filled with blood, whose walls are so thin and their structure so simple that, within the lungs, carbon dioxide (CO2) con- tained in the blood is given out as a gas and oxygen (O) is absorbed directly from the air through them. Such elimination of gaseous waste and absorption of fresh oxygen is an essential condition of animal life. The carbon dioxide taken up by the blood in its passage through the body (to be explained later) is carried to the lungs, where it simply escapes. The lungs afford the blood this opportunity to purify itself, and respira- Respira- tion is essentially the absorption by the blood ****" of a vital quality from the fresh air and
the emission of impurities into that air. Why this is necessary will be explained in another chapter; but
The Lungs and Respiration ±1
the special point is, always to regard breathing as con- nected with blood-making. The quantity and espe- cially the quality of the air we breathe is more important than that of the food we eat. Respiration is essentially a vital process, whose cessation quickly terminates life. To take in impure air or insufficient air is a step toward not breathing at all.
Breathing is better carried on through the nose with the mouth closed. In cold climates Nose- the air is somewhat warmed, gross floating breathing particles are strained out, and some offensive impuri- ties may be detected by the sense of smell. The rate of respiration varies with the age. It is about once in four seconds for an adult man sitting quietly, that is, from fourteen to sixteen times a Rate of ' minute. It is greater in youth and still respiration greater in childhood. It is very readily disturbed by emotion? or by muscular activity; a small man breathes a little more frequently than a large one, and a woman than a man. The rate is less when sitting than standing, and when lying than sitting. It is about one-fourth less when sleeping, and it increases a little after meals. All this shows its relation to the circulation, and remembering that respiration means blood-renovation, it is evident that as the heart beats faster we must breathe faster. As compared with the throb of the pulse, adult undisturbed respiration is about one to four, and between the ages of fifteen and twenty it is one to three and a half.
The range of voluntary modification of respiration
11 Personal Hygiene
is very limited, and it is quite impossible to commit suicide by holding one's breath, although choking by Modified violence is quickly fatal. It is not so gen- respiration Q^Q\\y appreciated, but it is perfectly true, that impure or insufficient air, whether the insufficiency is due to a really inadequate supply, to imperfectly expanded lungs, or to a vitiated atmosphere, diminishes strength and deteriorates health. All the air in the lungs is constantly changing, and "tidal air" means Nomen= the volume which comes and goes in ordinary clature respiration ; " complemental air " is the addi- tional amount that it is possible to inspire; and " residual air " is the quantity that always remains in the lungs, is directly charged with the interchange of gases from the blood, and which cannot be expelled.
The extent of the breathing space is important. It is the measure of air that can be expired after forcible Vital inspiration, and is known as the vital
capacity capacity. It represents the entire volume of air concerned in forcible respiration exclusive of the residual air, and is, not the measure of what ordinarily is respired, but, of what may be respired, of what a person may depend upon in an emer- gency, and it bears a relation to height so nearly fixed that a standard table may be formulated. The factors determining vital capacity are chest measure- ment, which is the circumference of the chest at the points of the shoulder-blades in extreme expiration, and chest mobility, which is the difference .over the same circle between the extremes of forcible expiration
The Lungs and Respiration 23
and inspiration. Of these chest mobility is much the more important, for in taking chest measurement allowance cannot well be made for an excess of fat, or occasionally of muscle. For convenience, the nor- mal weight in proportion to the height is added. All the figures represent the subject stripped. To obtain approximate weight when clothed, add ten pounds. The present military standard for recruits, which is rather below the ideal, is:
Table of Vital Capacity and Weight.
Chest. Height in Inches. ' * ] ^ Weight in Pounds.
Measurement. Mobility.
64-67 — - — h J inch 2 inches 2 to the inch
68-70 ^^^g^^ . ] 2 to the inch
2 I 2| inches ( phis 5 for every
71 and above \ height , . u ^ • y, f inch above 5 ft.
72 and above / 2 * ^ J 7 i^-
The contents of the chest, the heart and lungs, generate the steam that drives the animal mechanism, and the capacity of the chest is a measure importance of vitality. The fuel-box is below the chest diaphragm. Arms and legs are mere accessories, of no vital importance. Excess of stature from long legs and a long neck is a physiological blemish, rather than an advantage. The physical essentials of a sound heart and capacious lungs are worth all possible exer- tion to secure and retain. But to attempt to increase capacity beyond the standard of the par- Over= ticular type is an error, for strain may strain damage the elasticity of the air-vesicles. So, when they
^4 Personal Hygiene
suddenly pass into disuse after unusual development, there is risk that they may collapse upon themselves and yield opportunity for the deposit of tubercle and the development of consumption. Boating contests and the racing-track furnish ultimate victims from this very cause, and the football contingents are not always free from this unhappy record. The general lesson applicable to all physical exercise is, not to develop the chest to the point of strain, and after training always to resume ordinary, and especially sedentary, occupa- tions gradually.
With age the costal cartilages stiffen and the ribs lose part of their mobility; but systematic exercise will Continued preserve the elasticity of the chest into exercise mature and even advanced years, so that it should not be abandoned when youth has passed.
IV
The Heart and the Circulation
TDESIDES the lungs, the chest contains the heart. "^^^ This is a hollow muscle, approximately the size of the fist, divided into four chambers, and j^t. i. ^ enclosed in a bag (pericardium) whose lower part is attached to the diaphragm. The muscular walls of these four chambers are woven together so as to form two pumps. One of these pumps sends the blood through the lungs for purification by the air; the other impels it through the body at large, carrying nutriment to and waste from all parts. Lying in two pairs, side by side, these chambers are conveniently known as the right and left hearts. The upper cavi- ties are the auricles, the lower the ventricles — designa- tions having no application to their functions. The blood that has just made the round of the body flows into the right auricle. When nearly full. Course of this contracts and the blood passes through ^^^ blood an opening guarded by valves into the right ven- tricle. When the ventricle is full, it contracts and the blood escapes into an artery which carries it to the lungs. After passing through the lungs it enters in
25
26 Personal Hygiene
succession the left auricle and ventricle and then into a very large artery for distribution, through subdividing arteries, throughout the body. When the blood reaches the extremities of the arteries, whether those carrying it to the lungs or to the body at large, it enters very minute vessels known as capillaries, and ffom these it passes into the veins and so back to the heart. The only special feature of the circulation important to remember in this connection is the valves, why they exist and how they may be damaged. The right and left hearts have no direct intercommunica- tion, but there is necessarily an opening between the auricle and ventricle of each pair. These openings are protected by valves which shut very much like folding doors, or like the gates of a canal-lock, yielding at the proper time to the natural, but closing against the reverse, current. Should they become impaired by disease or damaged by strain, a backward current might be set up. Now it is possible, either from overfilling or by extreme pressure under exertion, for a valve to be stretched or strained so that it may leak a little; and one form of valvular disease of the heart begins in exactly that way, by mechanical strain. This vital organ, the Growth of heart, which cannot be tampered with the heart -^{i}^ impunity, develops very irregularly. It grows rapidly in infancy; between the ages of 7 and 14 its annual increase is only about 8 per cent.; but during the period of puberty it doubles in volume, and after puberty it increases in capacity and strength
The Heart and the Circulation 27
until the age of 25, sometimes of 30 years. A knowl- edge of these changes is important to the young. The demands upon the heart of the growing age, and immediately thereafter, are very great. As with all organs that have grown rapidly, there is usually a lack of reserve energy in the youthful heart for special emergencies. This is particularly the case with those who have grown very quickly, and especially for those much above the common height. Besides, during this period the heart is especially susceptible to irritable agitation through disturbance of the general heart nervous system by vices connected with the reproduc- tive apparatus, by the premature use of alcohol, and particularly by tobacco poisoning, of which that due to cigarette smoking is peculiarly pernicious. Through these artificial and damaging influences the heart becomes irritable, easily excited, and does not soon recover its steadiness; and an irritable heart is always a serious handicap. Besides, the growing heart has normally little reserve force. It may easily Heart- be strained by racing, whether on foot or strain on the wheel, by cross-country runs when carried to exhaustion, and by injudicious gymnastics and unregu- lated athletics. There is also danger from simple feats of strength when unduly prolonged. In the young recovery fortunately occurs after prolonged abstinence from such exertion, but it is unwise to risk the integrity of the heart by exertion recognized as extreme. It is probable that some heart is damaged in every great athletic contest when the participants arc young, and
28 Personal Hygiene
among those who fail to quahfy for such undertakings actual or threatened physical harm is quite as sure a factor as mere inaptitude. Even the considerable honor of class numerals, or a 'varsity letter, does not v^arrant the risk of weakening a valve or dilating a chamber with an overcharge of blood. This serious warning as to reasonable caution is not intended to deter those tempted into the arena who are properly equipped, still less to discourage systematic gymnasium work, which every man physically qualified should pursue under competent supervision. It is admonition against wrong methods, and especially against exhaust- ing effort, for fear of consecutive heart-strain. A
Inflanima= particular condition, however, does call for tory rheu=
matism a special caution. Inflammatory rheuma- tism is liable, not certain, to damage a valve, although not painfully, at the same time that the joints are affected. This is not unfrequent in childhood, and a youth who has had that disease should not indulge in exhausting, or even in very violent, exertion with- out being assured by competent medical examination that his heart is sound. It is much better to forego a moderate pleasure and to relinquish a minor triumph than to run a serious risk. But the occasional painful
Tearing of twinges in the chest- walls after sharp ffvm- muscular ? „ i i • i
fibres nastic effort are not to be confounded with
harm done the heart. These are merely the stretching
or tearing of some trifling muscular fibre, and are of
no consequence. Strain of the heart, or valvular
disease, is rarely marked by pain. There may be
The Heart and the Circulation 29
breathlessness upon moderate exertion and a sense of oppression; seldom, if ever, sensitiveness.
Blood-vessels are of three distinct classes, arteries, veins, and capillaries. For all vital purposes the capillaries are by far the most important. Blood= The blood passes from the heart by way 'vessels of the arteries through the entire body and returns to that centre by way of the veins. Both of these are mere passive channels. They are important as chan- nels, but they do not contribute directly to vital changes. Every artery divides in its course into two others each of more than half its own capacity, or the main stem gives off branches which collectively have a greater diameter than the parent vessel. The cross-section of all the minor arteries exceeds that of those from which they are derived, consequently the friction is less and the flow of blood is facilitated. The reverse is true with the veins. The smaller veins coalesce into larger ones as they approach the heart. The walls of the arteries are relatively thick and elastic and do not collapse when cut across. Upon this elasticity depends
the phenomenon known as the pulse. A ^ .
• -11 Pulse
pulse is the wave of blood driven by the
contraction of the heart through the arteries, and recognized anywhere by gentle compression against a resisting background. The beat does not interpret the forward movement of the blood so much as it does the wave-like impulse, the undulation, the propagated motion from the heart, recognizable through the plas- ticity of the arterial walls. There are numerous acessi-
30 Personal Hygiene
ble pulses, but the one ordinarily used is where the artery is gently compressed against the radius, on the thumb side of the wrist. An unskilled person who attempts to feel the pulse in accident or sudden illness, to determine whether the heart still beats, is some- times deceived by the vessel lying too deep for easy recognition. Therefore failure to find the pulse at the wrist is not a surely fatal sign. There are accessible pulses in the neck, over the temple, at the angle of the jaw, in the groin, in the inner part of the arm and of the 'thigh, and under the inrier ankle, any of which may be used to determine the action of the heart or to control adjacent bleeding. The normal pulse-rate,
_. , ^ that is the heart-beat, for an adult man in Pulse=rate
repose is 72 a minute. This is increased by muscular exertion, sometimes to more than 200 a minute for a short time, which involves tremendous strain of the heart ; and it may vary between recumbency, sitting, and standing by eight to ten beats a minute. It also re- sponds quickly to emotion. A pulse persistently much slower or much faster than normal usually, not always, is a sign of ill health. An excitable and rapid pulse, in a youth otherwise well, generally means an irritable heart from the abuse of tobacco or from vice. In women the pulse is normally slightly faster than in men, in children it is much, and in youths it is moderately, faster than in adults. In the old it is apt to be somewhat slower. Veins are much softer and more collapsible than Veins arteries, and the most of them have pocket-
like valves in the walls to support the column of blood.
The Heart and the Circulation 3 1
Neither arteries nor veins contribute directly to vital
action. But between the smallest arteries and the
smallest veins are interposed the capillaries, ^ ...
, , , , , r Capillaries
distmct from both the others, by means of
which all the vital action in which the blood takes part
is carried on. They are, therefore, of the utmost
physiological importance, but their significance is
popularly overlooked.
The capillaries, which are infinitesimally short as
well as slender, are of the practically uniform diameter
of about a five-thousandth of an inch, and the blood
carries on its peculiar work while traversing them.
The blood transports nutriment to all Province
c ^ ^ ^ - ■ i • Of thC
parts of the body; it carries to the various blood tissues the oxygen so necessary to their life, which it absorbed while in the lungs; and it bears the waste products from the tissues and disposes of them in various ways. These somewhat elastic, very minute, vessels have walls so thin and with a struc- Osmotic ture so simple that through them in the the caoil- lungs the carbon dioxide passes in one direc- laries tion and oxygen in the other; in such organs as the liver they supply material for secretion; in the intes- tines they take up the digested food; in the excretory organs, as the kidneys, they emit the waste ; and always and everywhere there is going on that interchange upon which depends the life of the body. Speaking generally, this action is one of osmosis, and the capillary walls are osmotic membranes. Nutrition and waste are accomplished not only by means of the capillaries, but
32 Personal Hygiene
directly through their walls, as the juice of crushed fruit oozes through a linen bag without rupture of the texture, and these minute elastic tubes are in some respects the most important of the physical agencies. Ri hi They are also capable of dilatation, as seen in blushing when nervous control is tem- porarily lost through emotion, and in the permanent flush of a drunkard's face and the congestion of his interior economy.
The arteries, the capillaries, and the veins, each a distinct class, are all continuous and designed to con- vey the blood about the body. But it is through the capillaries that the blood itself carries out its physio- logical purpose. The blood, for whose circulation this Nature of complicated network is arranged, is a blood watery fluid, or plasma, in which float
innumerable small corpuscular bodies. The plasma is a mixed solution of nutritive material and waste. The most of the floating corpuscles individually are a dirty yellow, and in mass they are red. About one in three hundred is white. The white corpuscles are important, but their functions do not concern us in this connection. The blood that returns to the heart through the veins, from the body, is a dark-red or purple, because of the carbon dioxide it holds in solu- Carbon tion. Complex tissues have broken down dioxide ^^^ carbon dioxide has diffused into the blood in the capillaries on its way to the veins. This dark-red blood is driVen by the right heart into those other capillaries that lie in the great multiple membranes
The Heart and the Circulation 33
that we call the lungs, and the carbon dioxide escapes by osmotic action through the capillary walls into the aerial tide which flows around the pulmonary alveoli, and thence by expiration into the general atmosphere. Should the carbon dioxide not escape, the animal is made ill by self-poisoning and ultimately dies. Simul- taneously oxygen from the fresh air that has been drawn into the lungs passes through the capillary walls and is absorbed by the red corpuscles, changing their color to scarlet. The red corpuscles are essentially oxygen-carriers, and when the freshened blood passes from the heart into the capillaries of the body they yield the oxygen, which escapes through the walls and the carbon dioxide in turn is taken up. The student must not suppose that these are in the arteries and veins in gaseous form, but remember that they are held in solution in the blood ready to escape as gases under proper conditions.
The adaptation to life of the atmospheric ocean at whose bottom we live is remarkable. In general terms we breathe a mixture, not a union, of Atmos- oxygen and nitrogen, containing also minute P''®*'® quantities of other gases which, as far as we now under- stand them, are negligible. The oxygen and nitrogen are not united to make a third, but for convenience we give the mixture a new name and call it air. Chem- ically the gases are unaltered and we are able to breathe the air because the oxygen is free, is in com- panionship, not in union, with the nitrogen. A dis- advantage is that the mixture may, and sometimes does,
34 Personal Hygiene
receive contaminating gases, as from factories and
sewers, from combustion and from respiration itself,
when their products are not properly removed; that
Contami- jg when there is not the adequate ven-
nating ,, . ,.,.„. ,
gases tilation which mtelligence and energy may
always provide. It must not be forgotten that the character of our blood, and hence our inherent Air makes vitality, depends more upon the air we blood breathe than upon the food we eat. Cer-
tainly impure air means impoverished blood; and, equally, insufficient air means inadequate blood. It cannot be too clearly remembered and acted upon that respiration is a vital process, and that the gases which enter the lungs are taken up by the blood for good or for evil. If the air is pure, the blood is renewed; if it is breathed-over air, the blood is contaminated ; if it is poisonous air, from a sewer or a cigarette, the blood is poisoned. These conditions apply to daily life, particularly to. residence within doors, and to the Ni ht I watches of the night as well. Many a man who opens his windows by day closes them at night. There is no better reason why he should suffocate himself in any degree by night than by day. If the domestic ventilation is sufficiently inadequate to require such air- channels at one time, it would also at another, especially as the occupation is more con- tinuous and the incidental currents from doors and passageways are less. He is apt to plead fear of the night air. At that season the night air is all the air there is, and there is no good reason to exclude it
The Heart and the Circulation 35
merely because of the time of day. Noxious insects, more prevalent at night, should be guarded against; dampness, due to the absence of the sun's warmth, should be antagonized; but it is hurtful to exclude the fresh atmosphere because of non-essential inci- dents which may be neutralized. Some gases quickly destroy life, others slowly undermine health. The latter are generally of our own making, and both should be avoided.
The normal quantity of blood in the body is estimated at about /j, or 7.7 per cent., of the gross weight. • Thus, a man weighing 140 lbs. would have about Amount io| lbs., or II pints, of blood. Any partic- *** blood ular portion of blood is supposed to make the circuit of the body in about 23 seconds. A man may lose at one time nearly 3 per cent, of his own weight, or about 4^ pints in volume, of blood without necessarily fatal results. Accidental bleeding to any extent is to be deprecated, but the amount lost is easily overestimated, especially if it is caught in a vessel where there already is water. A little blood will color a relatively large quantity of water and deceive the unaccustomed eye.
It would be beside our purpose to describe the capillary service in other great internal organs. The <;ntire interior of the body is traversed by Capillaries numerous enclosed channels through which elsewhere the blood courses to and from the heart, and all the interspaces arc filled with a vast network of micro- scopical vessels. From all of these capillaries fluid is constantly oozing, not as blood but as its constituent
36 Personal Hygiene
parts; and into them waste material is entering, not as organized waste but as worn matter for later dis- position. That one can scarcely intrude the point of a needle into the flesh without drawing blood, means that a needle's point is too coarse to pass between the meshes.
The Nervous System
A S Watson long ago remarked, the nervous system ^ is the third leg of the tripod upon which animal life rests. The other two are respiration and the cir- culation. Through the nervous system man himself, not merely his physical envelope, is -brought into rela- tion with the outer world and the conditions of time and space. The nerve-cell, which corresponds physio- logically to the molecule of the chemist, is the elementary unit and, in its various combinations, Brain, makes up the brain, spinal cord, nerves, and Nerves*^** ganglia, which are the working apparatus Ganglia of the nervous system. The nerve-cell originates and conveys nervous impulses. It responds, without recog- nizable change, to stimulation. Muscle changes form when it displays energy; bone does not respond to stimulus; but a nerve receives, originates, or transmits a stimulus without appreciable alteration of form. A nervous impulse once started may arouse a similar impulse over considerable distances, and a nervous current is particularly prone to sweep repeatedly over the same course and thus affect our daily life.
37
38 Personal Hygiene
Nervous matter is gray or white. Nervous force
appears to originate in the gray and to be transmitted
along the white matter. The brain is an ovoid white
„ , mass lying within the skull, in which are
Brain ,
embedded numerous gray foci or islands,
and over it is a convoluted (folded) gray surface. All the gray parts are connected by white fibres, and the gray brain is also thus connected with the gray of the spinal cord. The brain consists of two lateral halves united near the centre and subdivided into lobes, of which an English walnut with the shell removed is a rough model. (O. W. Holmes.) The interesting, but probably erroneous, doctrine of the Duality of the Mind rests upon this duplication. Nervous manifestations really arise from distinct gray centres. Every brain has a general resemblande to every other brain, but may differ from it in the number and depth of the gray folds. Upon this difference and probably upon the inherent quality of the gray matter depends the capacity of the mind, which is physically dependent upon the brain for its operation. In infants and idiots these folds are meagre and shallow, in intellectual men they are con- spicuous and deep. But as their number and quality cannot be determined, mere inspection fails to show natural capacity. Nevertheless in general terms the size of the skull implies the weight of the brain, and in dealing with considerable numbers we find the large- brained men to be the superior as a class, although the factor of quality may disturb the finding in any particu- lar case. At all events narrow foreheads and narrow
The Nervous System 39
minds seem closely associated. The pseudo-science of phrenology appears to have no scientific basis, but there is a higher phrenological doctrine * which is plausible. This associates the pre-frontal lobes with intellection, those just below and behind them (tempero- sphenoidal) as connected with the propensities com- mon to man and the lower animals, the emotions with the parietal and the hinder parts of the frontal lobes, and places the domestic and social affections in the occiput. Although not demonstrated, this is at least credible. The standard weight of the adult white male brain is 49.5-50 ounces; the female brain about 44 ounces. The brain increases rapidly in weight until the seventh year, more slowly until between 16 and 20, still more slowly until its maximum at 40, and after 50 it slowly loses about one ounce in every ten years. The spinal cord, enclosed and protected
by the spinal canal, is continuous with the „ . .
, . . . , , . . Spinal cord
bram, but m it the white matter is super- ficial and the gray is central. Death promptly follows whenever the cord is severed high up, whether pierced by the garrote, torn on the gallows, or crushed by breaking the neck in shallow water or elsewhere. Interrupted lower down, by disease or by violence, sensation and voluntary motion are abolished below that point. This continuous nervous mass communi- cates with the organism at large by the nerves which escape through openings between the vertebne.
* Mental Functions of the Brain. (B. Hollander.)
40 Personal Hygiene
The brain as the seat of the mind induces the voluntary movements of the body. Automatic action inspired by portions of the cord may be modified by the brain, but when not thus controlled the co^d itself superintends complicated movements, as walk- ing or dancing, without the intervention of thought. The lower cord contains centres that respond equally to emotion and sensation, and, when stimulated act reciprocally; but these may also be controlled in their operations by the active brain.
Nerves are slender whitish cords running from the nervous centres to all parts of the body. Alike in
structure, those from the brain and the Nerves
cord are sensory (afferent) or motor (effer- ent). Both lie indistinguishably together, the sen- sory being those which convey impressions from with- out to the nervous centres, whence the outward im- pulses are borne by the motor nerves. Some of the cranial nerves are those of special sense. There is
Sympa= q\^q ^ system chiefly within the trunk, the
thetic / . . . .
nerve sympathetic (or organic) nerves, arising
from ganglia and distributed to the viscera and the blood-vessels and connected with the brain and the cord. Ganglia are enlargements of nerve sub- stances, spinal (general) and sympathetic (organic) connected with other ganglia and with the centra system. The sympathetic nerves chiefly go to organs involuntary in action and obtuse in sensibility whose functions are subconscious and automatic. These nerves are affected not merely by drugs such
The Nervous System 41
as may act on the other nerves as well, but by bad habits and indeed by emotions which may induce bad habits as well as by those springing from them.
In health we have no direct knowledge of possessing a liver, kidneys, intestines, or other internal organs. When subjectively conscious of any organ or append- age of the body, something is wrong. The heart and the lungs, for instance, do their daily work under control of the sympathetic without supervision and without discomfort. But the sympathetic system is also associated with other nerves. Thus through this medium the pupil responds to emotion as Well as it does to light. A part of the service of the sympathetic is to regulate the tension of the arteries and the capil- laries, by distributing to them the filaments there known as the vaso-motor nerves. This control of the calibre of capillaries (alcohol dilating, nicotine contracting, for example), is particularly important in affecting the local supply of blood. The pallor or flush of the countenance is a visible example of its operation under emotion.
Reflex action is the simplest form of nervous activity. This may or may not involve the sympathetic. An appropriate stimulus applied to a sensory Reflex nerve excites a motor response without the action
intervention of consciousness. Thus when light falls upon the open eye the muscle regulating the pupil contracts. The will has nothing to do with it. Under a bright hght the pui)il contracts, we say spontaneously. A sleeper will involuntarily with-
42 Personal Hygiene
draw his foot when it is tickled, owing to the play of a reflex centre in the spinal cord. If the cord should be severed above that centre, the legs will move in response to the tickling without the knowledge of the subject except as he may see their motion. So food entering the upper intestine induces an un- conscious flow of bile. Other elements may add to the complexity of the operation, when the gray mat- ter of the brain becomes involved and action is delayed or uncertain. For instance, in the East a suspected thief may be detected through his inability to moisten with saliva raw rice held in his mouth, when accused with the offence and this impotence predicted. The emotion of guilt inhibits the salivary flow through reflex force. Much reflex action is too common to attract attention until we stop and an- alyze it. We more easily observe examples in disease, because they are less familiar and are apt to be marked by suffering; as headache from a disordered stomach, or pain in the knee when the hip is affected. However, not all pathological reflexes are painful. Frequently a sensory impulse occasions a dream whose numerous incidents depend, in a not necessarily logical sequence, upon the first nervous irritation. Thus, a man aroused by the slamming of a door from a short sleep dreamed that he had enlisted in the army, had joined a distant regiment, deserted, was captured, had been tried by court martial, was sentenced to be shot, was led out to execution and awoke at the sound of the volley. Here the whole
The Nervous System 43
chain of events, involving an imaginary enlistment and the violation of his oath, was called before his mind by his ear being startled at a sharp and sudden noise. Not all dreams are reflex, but some, like that, clearly illustrate that phenomenon.
Reflex action has a practical relation for students in its connection with eye-strain. The unconscious effort of an astigmatic eye to neutralize Astigma- its defects sets up disturbance, elsewhere. ing*l-e«ex*" Astigmatism is rarely appreciated as early action as simple near-sightedness, and when not corrected by glasses it occasions pain, not necessarily in the eyes, generally somewhere in the head or the back of the neck, frowning, nausea, dizziness, or even dys- pepsia. Sleeplessness and vertigo, sometimes night' mare, may be attributable to the forced use of astigmatic eyes. Deep perpendicular lines in the forehead of the young usually have eye-strain behind them. The habit of leaning the head toward one shoulder in reading or writing pretty surely indicates mechanical trouble in the eye, with the risk of some reflex being established. Pain, at intervals which usually grow shorter, after reading or writing is a sign of sucli disability; and in some the strain of gazing in a bril- liant theatre, or that of looking up at a high pulpit, renders this defect active. It has been plausibly maintained * that the notorious intermittent ill-
* Biographic ClinicS; by George M, Gould.
44 . Personal Hygiene
health of such well-known men as Carlyle and Darwin
was determined by unrecognized astigmatism.
The cardiac and solar plexuses are large sympathetic
networks which are also connected with the spinal
^ J. nerves and lie behind the heart and the
Cardiac
and solar stomach respectively. The solar plexus is p exuses distributed to the stomach and the adja- cent organs, as the cardiac plexus is to the heart; and our daily life is maintained in great part by the nervous force they furnish. Severe blows over the heart may be followed by faintness, sometimes unconsciousness, occasionally death, from the shock of the impact to the nervous system. The ribs protect the heart and the nerves from direct injury, but the jar is trans- mitted to the plexus. A blow over the stomach is even more dangerous than one over the heart, because the solar plexus is larger and is less protected from vio- lence. The padded guards of the base-ball catcher are a tribute to the vulnerability of these localities. The mental lassitude that follows a heavy meal depends upon the draft of nervous force, as well as the diversion of the blood-supply required by digestion. Too vigorous ex- ercise of the brain while the stomach is active is liable to interfere with the efficiency of one or the other.
The heart's action is best revived in a person Revival unconscious or prostrated from violence, by after pros- dry heat over the heart through hot- water from vio- bags or bottles, hot sand-bags, cloths, or a lence heated plate. If able to swallow, strong
coffee, diluted aromatic ammonia, or a very little spirits,
The Nervous System 45
preferably in hot water, may be given. Alcohol in excess depresses.
Depressing as well as exciting emotions act on the sympathetic, and death has followed threatened be- heading after a mock trial. Hence the danger as well as the folly in frightening children and others of nervous susceptibility, who sometimes lose health and occasionally reason by severe nervous shocks.
The complicated act of walking excellently illus- trates correlated and partly automatic nervous action. The brain wills walking to begin and the Automatic cord maintains it without conscious effort, spinal The brain may at any time interfere and regulate the pace or change the direction, but until that interference occurs the unconscious spinal cord con- trols the exercise. Skilful dancing still better illus- trates such automatic service.
Different nervous manifestations have distinct sources; that is, localized brain-centres control par- ticular actions. The whole brain does not Centres of conduct the act of writing or of speaking, action certainly not the movement of an arm, probably not the play of an emotion. Within narrower limits this is true of the spinal cord where reflex centres may come into independent operation without reference to the conscious mind, as illustrated by the feet that move when tickled although communication with the brain may be entirely cut off. Sensation resides in the brain, but motion may originate automatically en route.
46 Personal Hygiene
Usually reflex centres coordinate and rearrange re- ceived impulses, producing an advantageous result. Thus the presence of food, rather than the mere motion of the jaws, excites the flow of saliva. Some centres Automatic are distinctly automatic, as that which con- centres ^j-Q^g respiration. Breathing may be af- fected by the will only within very narrow limits. So with the heart, whose perpetual pumping exertion or emotion may modify but the will cannot control. A nervous impulse is transmitted in cold-blooded animals about 92 feet a second; in the warm-blooded Rate of a trifle more rapi ly. The natural differ- impulsc Q^^Q between each other in ability to per- ceive and to act upon our percepts is the personal Personal equation. Tl is 13 best observed in a pri- equation jnary function, as making and recording a simple observation. Originally connected with noting the passage of a star across the meridian, it now has a much wider application. Within certain limits the speed and accuracy of both observation and action may be increased. Much of the advantage of out-door games is the training of "the eye," which besides speed of vision means rapidity of judgment and the swiftness and precision with which motor impulses call suc- cessive muscles into action, and the close adaptation of mind and body alike to the situation. Such bene- Acquired fits extend beyond the game to the gen- skill, gj-g^j advantage of the individual. Acquired skill means judgment, promptness and agility, and depends primarily upon a cultivated nervous system
The Nervous System 47
which also promotes efficiency in the classroom, the laboratory, and over the drawing-board. But field achievements should be tributary to intellectual prog- ress, not in place of it. The Gymkharna should be an ally, not a rival, of the College.
Two practical lessons should be learned about the nervous system: (i) nerve-cells undergo constant change; (2) nervous action tends to repeat itself.
We may infer constant change in the nerve- cells from the abundant blood-supply of their vicinity. More- over, the microscope demonstrates that Change In nerve material is expended and renewed nerve=cells during respective periods of activity and rest. During prolonged exertion the essential centres (nuclei) of nerve-cells shrivel and the whole cells diminish com- pared with those at rest. In old age they are habit- ually small and distorted, hence nervous exhibitions of high grade and especially of prolonged energy are rare in the aged. These changes are most conspicu- ous, and probably most common, in the gray matter. The gray cells break down and must be renewed. The white matter, whose function is limited to trans- mitting a form of molecular motion, shows no such palpable changes. We are not to conclude that nervous waste does not occur because it is not as apparent as that of muscle or fat; nor may a stimulant be substituted for nourishment and rest. As well overcome fatigue in a tired horse by whip and spur, rather than by oats and repose,. Nervous tissue expended by work, study^ or worry must
48 Personal Hygiene
be restored by rest and nourishment and by these alone.
The second lesson to remember is the inherent tendency of nervous action to repeat itself. We are j^ liable to overlook habit as an essential at-
action_re= tribute of all phases of the nervous system. The facility v^ith which complicated mus- cular movements, as swimming or the use of musical instruments, are resumed after years of inaction illustrates one aspect. Excepting as barred by the weakness or stiffness inciJental to disease or age, the muscles respond, perhaps not as vigorously but, as perfectly as formerly; for the nervous messages flow as readily as in boyhood. So there are tricks of physical expression, peculiarities of gait or of speech that we truly say have grown upon one. They begi in early life, continue as a habit, develop into a characteristic. Among these may be eccentricities or provincialisms of language which, carefully guarded against ordinarily, reappear under excitement in the grammatical errors or local idioms of an illiterate youth. That is, the old nervous paths once worn are not barred, much less destroyed. New ones may have been laid out, but the old ones remain ready for the nervous flow to follow the familiar channels. Paths of conduction become, through frequent use, particularly adapted for the passage of emotions and thoughts as well as of mechanical and simpler habits. It is especially to be remembered that there is not merely a facility but a tendency for individual thoughts and for groups and
The Nervous System 49
classes of thoughts to repeat themselves and to generate others like them. "As a man thinketh, so he is," is a solid and fundamental fact, and Personal Hygiene, while chiefly concerned with the body, also touches the mind whose servant the body is. The late Professor Martin, of Johns Hopkins, felicitously said:* "The higher nerve-centres are eminently plastic; it is that which marks them out for a far higher utility and gieater adaptation to the varying experiences of indi- vidual life than the more fixed and mechanical lower centres." But he adds: "Every thought leaves in [those centres of intellection and emotion] its trace for good or ill; and the moral truism that . . . the more often an evil solicitation ... has resulted in a wrorg act . . . has its parallel (and we can hardly doubt its physical antecedent) in the marking out of a path of easier conduction from perception to volitional emotion in the brain." "On the other hand every right action helps to establish ' a path of least resistance ' and makes its subsequent performance easier.'* Thoughts, whether high intellectual concepts or based on appeals of passion, follow each other over the old paths with increasing facility. That is true of morals and mind alike. Perhaps not literally, but certainly in effect, "runways" are easily established in the brain, over which our mental processes race along in preference to breaking out untrodden routes. New paths arc formed under compulsion; old ones invite by their familiarity.
* The Human Body, by 11. N. Martin, p. 631, et. seq.
'50 Personal Hygiene
Cerebral action is accompanied by cerebral change, for nerve-cells break down in operation. Without doubt intellectual and emotional operations follow laws like those that govern motor functions. As the practised nerves of an acrobat convey at once the necessary directions to his muscles, which execute with comparative ease a new feat in which a novice would fail disastrously, so the skilled mathematician solves an unfamiliar problem more readily than a man of equal but untrained mind. Equally a roue commits without self-reproach sins from which a neophyte would shrink in dismay. Obsta frincipiis applies as well to ethics as to mechanics, to modes of living as to a leak in a dike. To quote Martin again: "Association of movements ... finds an interesting parallel in . . . the association of ideas; and all edu- cation is largely based on the fact that the more often the brain regions have acted together the more readily, until finally almost indissollibly, do they so act." The plasticity of the brain, like the flexi- bility of the muscles, inay be preserved by practice, but disused thought- centres lose both pliancy and force. Nevertheless, whatever exercise may be given the brain, the time will come when habitual thoughts of former years will recur and the brain be haunted by the echoes, if not by the renewed calls, of those earlier familiar ideas. If they are exalted, the later years will be, if not exhilarated, at least serene. If they are narrow or unhallowed, the prospect will be one of limitation and regret. The importance of
The Nervous System ^t
cultivating clear strains and broad views in mental operations cannot be exaggerated. However attrac- tive football may be, it is not the summum bonum; and the men who achieve success in logical debate are at least as likely to be eminent in the world as those who acquire their numerals on the track. To quote finally from Martin: "The brain like the muscles is improved and strengthened by exercise and injured by overwork and idleness ; and just as a man may specially develop one set of muscles and neglect the rest until they degenerate, so he may do with his brain, develop- ing one set of intellectual faculties and leaving the rest lie fallow until, at last, he almost loses the power of using them at all." It is a part of merely honest mental hygiene to cultivate the mind and accumulate mental resources outside of a selected career. The narrowest specialty, the most technical study, rests best upon a broad base ; nor should the habit of looking at a subject from every angle be neglected. Neither should one wander so far into so-called general reading that nothing is thoroughly learned and the end is illogical thinking and mental slovenliness.
VI
The Contents of the Abdomen
'TpHE organs below the diaphragm are those engaged
in digestion, the transformation of food into the
living body or assimilation, and the elimination of
waste. This general region is the abdomen or belly.
Its best recognized content is the stomach, Abdomen , . , . ...
which m common speech gives its name to
the whole. This is illustrated in the popular sacrifice of accuracy to imaginary elegance of expression in such a phrase as "stomach-ache," for an entirely dif- ferent condition. The stomach proper is a hollow, extensible, muscular organ lying directly under and touching the diaphragm. Its fibres run in various
directions, assuring a complicated motion Stomach , , . . . » ^ ,
by their successive contraction. As food,
the stomach of the lower aniinals is known as tripe. When moderately full the adult human stomach has a capacity of about three pints, but under gorman- dizing or disease it may be much dilated. Digestion is the process of preparing food for assimilation, and the digestive apparatus begins with the mouth. From the mouth the food passes down the gullet (oesophagus)
52
The Contents of the Abdomen 53
into this sack, the stomach. Beyond the stomach the
digestive tube is continued by the small intestine and
is completed in the large intestine. The , . ,.
^ . '^ . . Intestines
small intestine, so called from its calibre,
varies from twenty to twenty-five feet in length and lies coiled in the middle of the abdomen. The large intes- tine, also named from its calibre, is several times the diameter of the former but is only about five feet long. It lies in a single large coil on the outer border of the assembled small intestine. Its greater length is the colon, along the upper and left border, the seat of the colic. The last eight or ten inches, comparatively straight, is the rectum, which terminates at the anus. The two extremities of the digestive canal, the mouth and the anus, are sphincters — ^purse-like muscles not directly attached to bone. At the junction of the \arge and small intestines is a bulge or enlargement, the coecum, about three inches in length. Vermiform from which the well-named vermiform ^PP^n^ix appendix proceeds. The appendix, closed at the lower end, is from three to five inches in length and about as large around as the stem of a clay pipe. Its wall, like that of the rest of the intestine, is not much thicker than fairly stout paper. The appendix is conspicuously known from its condition in disease rather than in health, due to accuracy in diagnosis and the wonderful possibilities of aseptic surgery. Appendicitis was formerly lost in the general designa- tion of inflammation of the bowels, a condition that almost invariably proceeded unchecked to a fatal endj
54 Personal Hygiene
for operations which now are done successfully every day, not many years ago would have been homicidal. The appendix * is not a catch-all for the collection of grape-seeds, cherry-stones and the like, with consequent inflammation. Although it occasionally occurs, the detention of foreign bodies there is so rare as to be negligible. It is not yet practicable to assign a general cause for appendicitis, but although not demonstrable at this time, it seems probable that habitual constipa- tion with bacterial action depending thereupon may induce the condition. Practically if the bowels are kept fairly regular, it is not worth while to anticipate the introduction of a foreign body or the spontaneous development of inflammation.
Directly below the diaphragm on the right side and in front, extending from the fifth to the tenth rib, is the liver, the largest single organ in the body. Its weight is a trifle over three pounds. It consists of innumerable lobules the size of a pin's head (one- twelfth inch), themselves composed of cells completely enveloped in capillaries. This organ has a special and important circulation of its own, not necessary to be described here ; but any organ so large and so full of blood, whether, as formerly supposed, the seat of sentiment or not, is necessarily of conse-
* Some authorities regard the appendix as a purely superfluous relic, an evolutionary sign-post of the past. Others look upon it as a lymphoid organ, of positive although secondary importance. It is found only in the higher apes, the curious marsupial the wombat, a few rodents, and man, and its genealogy is not well made out.
The Contents of the Abdomen 55
quence, and whatever may disturb its work must damage the system at large. All the blood in the body passes through the hepatic (liver) circulation and is modified thereby just as certainly, although not with the same immediate influence upon life, as in the pulmonary (lung) circulation. Various secre- tions that affect the digestion of food, of which the best known is the bile, form in the liver. In the intervals of digestion the newly-formed bile collects in the gall-bladder, a small reservoir that peeps out under the front edge of the liver.
To the left of the middle line and below the stomach
is the pancreas, which in food- animals
1 1 rx^i • T • Pancreas
IS sweetbread. This secretes . a digestive
fluid.
Farther to the left is the spleen, connected with the disintegration of the blood -corpuscles and not at all with digestion. The residents of mala- rious districts know it, when enlarged and hardened in such disease, as ague-cake. An earlier generation seated here a form of ill temper.
On each side of the spine, near the level of the
last rib, is a reddish-brown, "kidney-shaped," body.
Each of these is about 4I X 2I X li inches in ...
, , 1 . . 1 Kidneys
Size and about 4 or 4J ounces m weight.
These are the kidneys, and in their small compass are
packed half a million capsules and fifteen miles of
delicate tubing, All the blood passes through the
kidneys sooner or later, and from it they excrete from
two and a half to five pints of urine daily.
56 Personal Hygiene
Within the pelvis and well to the front in the middle line is the bladder, capable normally of holding rather Urinary more than a pint, although in disease it is bladder sometimes distended much more. The urine, constantly formed but irregular in amount, reaches the bladder through a tube from each kidney called the ureter.
In the male attached to the lower part of the bladder are two small very irregularly- shaped reservoirs, the seminal vesicles, which receive the semen secreted b}' the testicles, and hold it preparatory to evacuation. Like the urine, the semen is constantly forming (during the virile period) and, also like the urine, at very irregular rates. In the female the uterus, or womb, lies behind the bladder, and after conception the child developed therein passes out at the proper time between the bones of the floor of the pelvis. Because of its relation to that phenomenon the normal female pelvis is broad and roomy.
All the organs of the abdomen have now been roughly accounted for.
VII
Digestion and the Care of the Digestive Apparatus
T^IGESTION, the preparation of food for assimi- lation, like all vital acts requires blood and nervous force. Consequently neither severe physical
labor nor marked mental activity should be
1 1 . , , ,. Digestion
attempted simultaneously with the diges- tion of a heavy meal. But in a vigorous person ■ neither mental nor bodily activity should interfere with the digestion of a temperate meal. It is in part because of its demand for blood and nervous force that modern life has unconsciously placed the heaviest meal at the close of the day, when serious drafts upon the system are not likely to be made. But where^ the early night is devoted to study, care should be taken that the last meal is not unduly heavy. Enough food should be eaten, but it should be digestible in quality and not excessive in amount.
Digestion begins in the mouth, and the mechanical subdivision of the food by the teeth is always service- able. With some classes of food this subdi- Mastica- vision determines between the fact and the *^'®" failure of digestion. Cheese is a conspicuous illustra-
57
58 Personal Hygiene
tion of this. Some persons to whom cheese carelessly- eaten is entirely indigestible, assimilate it perfectly when it has been finely subdivided by the teeth. As digestion depends upon the action of fluids upon solids, it follows that the more extensive the surface of any particular quantity of food with which the digestive fluids come in contact, the more readily is it accom- plished; and obviously the superficial area increases rapidly as the fragment is divided. A reasonable rec- ommendation has been made (Dewey) to chew solid food while any taste can be recognized. Ordinarily this requires each portion to be acted upon from twenty to forty times. Besides prolonging the gustatory pleasure and bringing the food into the best possible condition for digestion, such careful treatment satisfies the appetite more readily and diminishes the amount consumed. When food is abundant we all are apt habitually to eat too much. Three consequences follow compete mastication. Sapidity, or at least the recognition of sapidity, is increased; swallowing is facilitated; and one variety of food is partly digested.
Flavor is recognized only when the part of the food next to the nerves of taste is moist. A little sugar or salt laid upon the tongue when wiped per- fectly dry will yield no taste. As embarrass- ment in speaking, to use a minor illustration, may inhibit oral moisture and render the mouth dry and stiff, so the act of swallowing is aided by a copious flow of fluid. But saliva, besides having these
Digestion and the Digestive Apparatus 59
mechanical advantages, is a digestive fluid which turns starch into a form of sugar as a prerequisite to further digestion. Starch is a considerable com- ponent of flour, potatoes, and many other vege- tables, but is digested with difliculty, if at all, in that form. To use a borrowed illustration: Starch mixed with cold water will not dissolve, but ulti- mately settles as wet starch. Starch boiled in water will partly dissolve, but when such a mixture is placed in a bag of several thicknesses of fine mus- lin, the water will leak out and the most of the starch will remain. But sugar (or salt) will thoroughly dissolve in hot or cold water and the sugar (or salt) in solution will pass through the muslin walls as freely as the water itself. Now some- thing very like this occurs in the alimentary canal, the wafls of whose capillaries will not absorb starch suspended in water but will readily take up sugar in solution.
It is insufficient, therefore, for the starch merely to pass through the mouth; it must be thoroughly mixed with the saliva in order that advantage may be taken of its sugar- making quality. When starchy food is bolted, as with iU-bred or over-driven people, nature happily provides a supplementary agent in the upper part of the small intestine to complete, or to replace, the service begun, or indeed omitted, in the mouth. But it puts a strain on those glands when they are called upon to transform the starches that have passed through the stomach practically as so much
6o Personal Hygiene
foreign matter. There is intestinal indigestion quite as truly as gastric indigestion, and one form of it is where too much starchy food for the small intes- tine to treat has reached the bowel unacted upon. Malted Various malted and otherwise predigested food foods are advertised to assist nature pre-
sumed to be delicate. Malted foods have had at least a part of their starch artificially transformed into sugar. Their design is to lighten the work of the digestive fluids, because these are either inefficient in character or inadequate in amount from sickness or undevelopment. Or else they are open aids to laziness in eating, artificial props, proxies, or substitutes, that enable a man to slight his physiological work. They may remind students of contraband ponies on which to trot swiftly over classical highways, instead of depending upon honest toil on foot with the pilgrim's sandals and staff of grammar and lexicon, make- shifts to shame vigorous men — although both may lift invalids over serious difficulties. The repulsive habit of chewing tobacco, fortunately rapidly waning, wasted large amounts of saliva, besides having other disadvantages. Its inane successor, the chewing of gum, observable in a certain class, is also happily going out of vogue. These people are not apt to be aggressively offensive, like the dischargers of tobacco- juice, but besides the repulsive working of their jaws they waste saliva; for saliva is wasted when swallowed without food, and taken in excess on an empty stomach it is supposed to cause irritation.
Digestion and the Digestive Apparatus 6i
The ordinary moisture of the mouth depends less
upon the saliva than on the watery secretion from the
numerous glands which stud its surface, _. , ^
. . , . Thirst
saliva flowing in addition when food is pres- ent. The sensation ordinarily confused with thirst is a superficial dryness of the fauces. This false thirst, the dryness of the throat, is best relieved by holding in the mouth a bit of wood, a pebble, or other inedible substance. On the track gum is commonly used to induce moisture, but gum is undesirable for prolonged work. In a long excursion, a march, or even an extended walk, all the advantage of drinking water will be secured by keeping the mouth moist in just that way. An experienced soldier on the march will keep a pebble in his mouth, but will drink nothing after the morning meal until he approaches camp. As soon as one begins to drink on a long walk, the tempta- tion is almost irresistible to repeat the indulgence, often at great inconvenience. The exception is that of extreme exertion under tropical conditions, when there is risk that excessive perspiration may danger- ously increase the density of the blood. For of course the perspiration, like the choleraic discharges, is ulti- mately derived from the blood itself. Such loss of fluid causes true thirst, and when the loss is excessive it must be replaced. True thirst therefore depends upon the loss of the watery part of the blood, usually by perspiration, sometimes from intestinal discharge (from ordinary diarrhoea to cholera), occasionally by haemorrhage. This can only be relieved by drinking
62 Personal Hygiene
more water, and the overpowering thirst of a bleeding man depends upon that drain. To supply water to a man who has lost much blood not only relieves his most obvious symptom, the distressing thirst, but it partly qualifies the vital fluid to pursue its course more easily. It is always proper to give water to a man who has lost much blood. Alcohol may start the bleeding afresh, water ordinarily will not.
Water taken into an empty stomach is not absorbed directly through the walls, but is spirted in small successive jets into the upper part of the small intestine. Obviously it is unwise to flood the empty stomach with water, especially with ice-water, that escapes slowly. On the other hand when water is mixed with food, so that a nutritious solution is formed, it is absorbed directly and rapidly into the walls of the stomach, that is into the capillaries that throng them. As a rule, to which there may be exceptions, there is little risk of diluting the gastric juices, as is popularly taught, by drinking freely with meals when natural desire prompts. In this instance the natural impulse may safely be followed. Curiously, the various alcoholic beverages are absorbed directly and rapidly by the stomach itself.
Food enters the stomach from the mouth through the oesophagus (gullet), down which it is not shot as along SwalIow= a chute nor dropped as a pile-driver. It *"S is passed, in a small quantity and a little
way at a time, by the action of involuntary muscles. This is clearly seen in a horse drinking, where the
Digestion and the Digestive Apparatus 63
successive gulps may be observed moving along the ex- posed oesophagus, usually against the action of gravity. When one drinks directly from a spring he knows that position neither retards nor assists the process. The effort to transfer a morsel of food somewhat larger than the tube conveniently accommodates makes one .conscious of the muscular effort. Conversely, the real difficulty occasionally found in swallowing a pill is not that it is too large but that it is too small to be grasped readily by those muscles; and the remedy is, to increase its bulk either by a wrapper, or by as- sociating it with a swallow of water or a bolus of food. In the presence of food the inner surface of the stomach changes from a grayish tint to a bright red, because of the increased flow of blood in Gastric the capillaries; and a thin, colorless, acid digestion fluid, the gastric juice, begins to trickle from the glands with which the lining of the stomach is thickly studded. The function of the gastric juice is to act on the proteid parts of food, as represented by lean meat, white of egg, cheese, the gluten of bread, etc., and prepare them for absorption into the blood as nutriment. Obviously it is reasonable and desir- able to leave moderate, sometimes long, intervals be- tween meals so that the gastric glands may recover their activity before being again drawn upon. One of the evils of civilization and the abundant food that belongs with it is too frequent eating. Many indis- positions, some quite grave, are recovered from when the meals are limited to two a day, sometimes to one.
64 Personal Hygiene
with an occasional fast. Persons in good health are not rare who eat little or nothing between a noonday meal and breakfast the next day, or who omit breakfast entirely. But active children may properly enough eat small quantities of nutritious food between the arbitrary hours for stated meals, and youth still undergoing development should not starve themselves either in emulation of ascetic saints or from false notions of manly limitations.
Our knowledge of the physiology of gastric digestion dates from, and to a remarkable degree still rests upon, the observations and experiments between 1825 ^^^ 1833 of Dr. William Beaumont, of the United States 0 . Army, upon Alexis St. Martin, where
and ^ advantage was taken of an artificial opening in the stomach following gunshot. Too much credit cannot be awarded Beaumont for the intelligent use that he made of a unique situation in the isolation and dulness of a remote post. He is a great man who recognizes and utilizes an important opportunity, and this is Beaumont's warrant to scien- tific fame.
As the food gradually becomes digested, it passes as chyme into the intestines. The stomach is usually Intestinal emptied in from two and a half to three digestion ^^^ ^ Yyali hours. The small intestine is lined with innumerable small glands, devoted to the digestion of that part of the food not actea upon by the stomach. Immediately on its entermg the small intest".::3 the bile and the pancreatic juice
Digestion and the Digestive Apparatus 65
together act on the chyme. One of the services of the bile is to reduce the fats and oils, as country house- wives use ox-gall to remove grease-stains, and the pancreatic juice completes the action of the saliva in changing starch into sugar. It also supplements the gastric juice in dissolving albuminous material, and it acts even more powerfully than the bile itself in promoting the absorption of fats. Digestion is popularly regarded as a function of the stomach alone; but practically the action of the small intes- tine upon food is quite as valuable as that of the larger organ. The completion of the intestinal digestion leaves a highly nutritious creamy fluid, known as chyle. This is directly taken up by capillary vessels in the bowel and ultimately enters the main column of the blood.
So much of the transformed food as is not absorbed in its slow progress through the small intestine passes
on into the large intestine, where the ab- -.„. . ° ' Office of
sorption is completed and the refuse is the large brought together more compactly. This refuse consists of indigestible matter, as ligament from animal and cellulose from vegetable tissue; undigested material, as fragments of flesh, starch, and fat which have simply escaped digestion; products of bacterial decomposition; and various forms of body waste, whose names are not important here.
If for any reason the intestinal contents are swept too hastily through the body, proper absorption of nutritive matter cannot occur; if they are too much
66 Personal Hygiene
delayed, an absorption of undesirable products may
happen. In their fresh state the faeces are harmless,
_ however offensive to the sense of smell:
Faeces . i i
but when retamed they undergo gradual
change, a part of their offensiveness is absorbed, and their general repulsiveness increases. It has been explained how readily the capillaries absorb gases, as in the lungs, and liquids, as in the stomach and upper bowels. Now " when organic matter undergoes decomposition in immediate con- tact with the capillaries, the very law of their being requires them to take up some of the products. Faecal matter passed daily is not apt to be dry, but after several days' delay the evacuations are hard and compact. The normal moisture has been reabsorbed as a consequence of the constipation.
The longer such waste is retained within the body, the more easily this absorption occurs ; and auto-intoxi- Auto=in= cation or self-poisoning is the necessary toxication consequence of retaining in the blood mate- rial rejected by nature. One form of auto- intoxica- tion is where the excretory organs fail in their full work, and the other and more common is the re- absorption of that already prepared for expulsion. This is an ordinary consequence of packing the lower bowel with successive instalments of intestinal waste. Constipa- In this way constipation leads to greater or tipn jggg physical depression which sometimes
induces mild feverishness, dulness of thought, commonly headache, frequently loss of appetite and general
Digestion and the Digestive Apparatus 67
languor, and occasionally positive illness from the system becoming loaded with emanations that, worse than useless, are positively harmful. Well-defined differences in appetite, in clearness of thought, and in activity of body are easily recognized as coinciding with what is commonly called the state of the bowels. In extreme cases the absorption of these gases gives a perceptible odor both to the breath and the perspiration. Fortunately all foul breath is not due to this cause, although it is not unusual in the young. Sedentary people are apt to neglect these functions, and youth whose attention has not been directed to their importance often act as though regular habits were matters of no consequence com- pared with mere temporary inconvenience. They should reflect upon what such procrastination really implies.
The relatively straight lower- portion of the bowel, the rectum, is not designed as a carrier, although fre- quently transformed into such, but merely „ ^
• 1 T 11 1 Rectum
as a discharger of waste. Normally the
rectum is empty until just before evacuation. Prop- erly the waste gradually passes along the large intes- tine to a curved portion within the pelvis. In health this is passed at stated intervals into the rectum, where desire for relief immediately occurs and, unless it is antagonized by the will, this will be effected by reflex action. When the desire is effectually resisted, the contents lie there packed more and more tightly with every accession, so that in extreme cases the damming
68 Personal Hygiene
leads to an accumulation far up within the colon. Under such conditions the rectum becomes diverted from its function as a temporary reservoir into that of one of more or less permanence, a condition for which there is no excuse. Although with the body as with the mind bad habits form more readily than good ones, care easily determines our physical usages, especially in youth. To visit the closet at a fixed hour regardless of immediate inclination soon leads to periodical desire. To press or knead the abdomen along the line of the colon, from right to left, aids. Corn bread, chocolate, dates, prunes, figs, and, gener-, ally speaking, fresh fruit, assist in overcoming the habit of costiveness. Medicine should be reserved until advised professionally, and reliance upon physi- ology is better than upon pills. Indeed the use of proprietary preparations is a prolific ultimate cause of the evil they are taken to avoid. However, a few leaves of senna chewed thoroughly from time to time are frequently useful. Morning is better than night as the season to attend to this function, but whenever felt the reflex impulse should not be restrained, although the habit may be gradually regulated. For physiolog- ical reasons a loaded rectum should be evacuated at night in preference to further delay.
Besides leading to general depression, habitual con- stipation is the efficient cause of the distressing local complaint of piles, or haemorrhoids, whose essence is the engorgement and partial rupture of rectal veins. These veins have no valves
Digestion and the Digestive Apparatus 69
to check the tendency of the blood to stagnate near the bottom, so that when the flow toward the body is impeded it is Hable to congest near the anus. As the venous flow is progressively interfered with one or more small veins are choked, the inner coat tears, the outer coat stretches, and a grape-like enlarge- ment, the pile, occurs. Piles give rise to a sense of weight and heat, they are prone to protrude, and usually they are very sensitive. , Sometimes by fur- ther rupture they bleed freely When inflamed they are exquisitely tender and quite disqualify for active work, and even when not inflamed they cause con- stant discomfort. Contributing causes in youth are a sedentary life, the use of soft cushions, highly spiced food, which has a peculiar tendency to lead these veins to fulness, and in later years congestion of the liver affects the rectum through a peculiarity of the local circulation. Life in the saddle, the very oppo- site of the sedentary life, especially when combined with constipation, also tends to piles; but, although ever threatening the cavalryman, it is essentially a disease of the careless student.
Fissure is a very painful crack or tearing in one of the many folds of the anus. It is usually traceable
to the expulsion of large hard masses „
, , ... . , , Fissure
created by constipation, is particularly
sensitive, and is very difficult to heal. As with piles, it is much more easily avoided than cured, and the old injunction Ohsta principiis applies to no physical error more directly than to these.
70 Personal Hygiene
As previously suggested, it seems probable, although not proven, that habitual constipation predisposes to Appendix appendicitis. Not that the large intestine citis jg gQ loaded with unexpelled waste that it
finally directly excites inflammation there; but it seems probable that the retention of refuse so congests the capillary and other circulation of the bowel as by degrees to cause a puffiness or engorgement of the small-calibre appendix, and so open the way for the local attack. The general lesson certainly is, by attention to this function of relief to keep both the brain and the lower viscera free from fulness of sen- sation and sluggishness of action.
The teeth, at the actual beginning of the alimen- tary canal, are the only parts of the human organism
^ . which, when broken, nature makes no
Teeth , , , .
attempt to restore and whose decay is
always progressive. When damaged, they must be repaired or replaced by art. But decay, practically always due to bacteria, is preventable. Bacteria are microscopical vegetable organisms upon whose action many vital processes depend and against which anti- septics are directed. They are always present in the mouth and thrive particularly in that ropy saliva which clings tenaciously to the teeth, especially in those who sleep with the mouth open. They are more abundant when the brush is neglected. They abound where the remains of food, especially starchy food, stick to the teeth. Their mischief is done by the formation of an acid which eats away the enamel and
Digestion and the Digestive Apparatus 71
then leads to interior decay. Careful brushing and wash- ing the mouth with plain water will rid it of 92 % of the bacteria, which will then increase very slowly until food is taken again. But two hours after eating a piece of fresh bread or a cracker ,the mouth will swarm with them, and in four hours the normally alkaline reac- tion of the saliva will be acid from their multiplication where food has lodged. Cracking the enamel in the abuse of the teeth by biting hard substances opens the way for bacteria, and wounds of the gum by tooth- picks and bristles sometimes give them access. When they are in undisturbed possession, the teeth are pretty sure to decay. It is probably true that the local use of tobacco by chewing sterilizes the mouth and thus conserves the teeth, but the abuse of tobacco is believed to harm the teeth. It is not probable that gases from the fermentation of imperfectly digested food have any material direct action upon the teeth, for there is no constantly open channel from the stomach to the mouth. It is doubtful whether eating a reasonable amount of sugar tends to decay the teeth, as vulgarly believed. Sugar in excess diminishes the appetite for the time, but certainly in cake, so far as the teeth are concerned, the flour is much worse than the sugar, and candy cannot be compared for mischief to the remains of bread in an uncleansed mouth. Those who eat food difficult of mastication, as most savage nations, usually have sound teeth from the inevitable polishing they undergo. The advance in modern dentistry is doubtless due to the necessity
72 Personal Hygiene
imposed by dental deterioration. The interdependence of the entire organism upon the normal condition of all its parts is illustrated by the fact that children with sound well-cared-for teeth are not only heavier than children of the same age whose teeth are dis- eased, but mentally they are at least half a year in advance of them. However, this may merely mean that the care of the teeth is an index of geni.ine cultiva- tion. With those who have reached years of discretion uncleansed teeth are a fair sign of a polluted person, of one unacceptable socially or physically.
To maintain the teeth in good condition requires the careful use of a soft pick, if they are irregular; Care of passing floss-silk between them so as not the teeth ^^ ^.^^ ^]^g gum, several times a week ; the careful use of a soft brush, which should be discarded when the bristles loosen, after each meal and on rising and retiring. The most useful powder is probably prepared chalk or simply baking-soda (sodium bicar- bonate). Teeth are best, but not most easily, brushed toward the crown, not transversely. When not readily kept in good condition they should be polished, not filed nor scraped, by a competent dentist every two or three months.*
The care of the teeth has more than an aesthetic, or indeed a simply digestive, value. Through reflex action decayed teeth sometimes disastrously affect or-
* For much of the section on the teeth credit is due to Dr. S. A. Hopkins's very excellent essay on The Care of the Teeth.
Digestion and the Digestive Apparatus 73
gans of special sense. Deafness has been traced to disturbance of the auditory nerve through Reflex other nerves connected with damaged dec'aye/^'" teeth, and complete loss of vision has fol- teeth lowed the unsuspected and painless reflex action from decayed roots, sight returning on their removal. Such conditions are very infrequent, but they war- rant careful search for this possible disturbing ele- ment when all the usual causes of functional dis- ability have been rejected.
VIII
The Development and Care of the Body
'nr^HE preservation and development of the normal physical vigor which in varying degrees is the heritage of youth, and not the athletic distinction that in the nature of the case can be attained by few, should be the chief object of physical culture by those in pursuit of intellectual superiority. The
„ . primary object of all exercise is to secure Exercise ...
vs. or maintain physical and mental health;
s reng ^^^ ^^ acquire strength, which in a reason- able degree follows incidentally. Excessive strength is undesirable, except as means to some special end; and such end is not among those which an institution ot learning has in view or which its graduates will require in their vocations. Abnormal strength is frequently accompanied by physical limitations, for masses of muscle impede freedom of movement. There is liability for over-developed muscle to take on partial fatty degeneration when allowed to return to the normal too suddenly, on which account even
74
Development and Care of the Body 75
legitimate training, if severe, should not be abruptly "broken." Universal experience confirms the adage that a healthy mind depends on a healthy body, and to maintain the health of the body requires the free and frequent exertion of all its parts. Vigor cannot be secured merely by systematic exercise to the neg- lect of other physical duties, but neither object of may exercise be neglected by those who exercise w^ould reach reasonable development and maintain fair health. An admirable discussion of this special subject is contained in Benson and Miles's "Daily Training," a little volume from which much of this section is adapted with frank acknowledgment. The training best adapted for students are exercises which lead to skill, to endurance, perhaps to speed, and only incidentally to strength. They most efficiently edu- cate the nerves and develop promptitude and quickness of apprehension as well as of motion. They are better practised in the form of games, or at least in company, and should call into play the whole body; for these encourage, along with the physical qualities, the moral ones of courage and perseverance which come from confidence, and of self-control and courtesy, the attributes of a gentleman. Such ends are quite worthy of steadfast effort, independently of the pleasure of the games themselves. Exercises of quickness, or even of endurance, do not necessarily add to the bulk of a muscle. Each effort may re- quire only very slight exertion of the individual muscle, but the sum of the whole may exceed the force involved
76 Personal Hygiene
in great feats of strength. Besides, it is quite possi- ble that a muscle of fine quality may excel a coarse one of greater bulk. Doubtless the essential power of a muscle is improved by training, but we also find that a trained man can use all the appropriate muscles, when the untrained man depends upon a few. Thus a powerful man without skill, will go down before a trained lightweight. The light but agile man strikes with all his disposable force at the exact point required. It is neither expedient nor possible to attempt training all the muscles equally, and if it were possible endurance would suffer. The most Methods practical rule is to select a game for which of exercise lY^^^e is aptitude, or at least predilection, and steadily practise it and supplementary exercises. To maintain efficient health under the conditions of col- lege life requires about two hours' active exercise daily. This is represented by a brisk walk of six or seven miles, or by its physical equivalent. Such exercises are much better taken in company, for ignoring that it is exercise adds to the efficacy. That is a reason why games are more effective for health than solitary walks or than merely routine work, as with dumb- bells or clubs — although these are much better than none.
Games in this sense are not those great contests that degenerate into a spectacle, participated in only by small select teams. Football, for example, is only of service for the elect, the qualified few whose growth, weight, and force fit them for the arena.
Development and Care of the Body jj
There is no saving grace in assisting at football, or
baseball, by holding down the bleachers, _ _ .. rx., 1 1 .1, Football
The lungs may be occasionally ex- panded, but one should not be deluded into fancy- ing that to be exercise. The older and better foot- ball, for the greater good of the greater number, as played before the Rugby importation, involves the lining up on opposing sides, with a captain for each, of an indefinite number of players who run and kick the ball as opportunity permits, but who are penalized for touching it otherwise than by the foot.* Oppor- tunity is given to the many. The guarantee against contingent roughness lies in the breeding and self- control of the players. It is not a game for roughs, but it is fit for students — and other gentlemen. Even under the temptations of the Rugby game, no college with traditions of manly honor can afford to violate with intention the Golden Rule, one of the bases of good breeding, or to condone errors invited by the im- petuosity of the contest.
An admirable game, better known under its modi- fication into the team-game of hockey, is shinny. It may be played on any moderately level, unobstructed, field by a few men or a hundred. It gives full play to arms and legs, lungs and back. Like other games of multitude it may be made rough and dangerous, but it is not essen- tially such.
* Association Ball is a modification of this.
78 Personal Hygiene
Except that it consumes more time with less projBt than the average student can spare, and incidentally it may be costly, golf is a wholesome game that must be played out of doors. The essential advantage of golf is that the skill required tempts to gentle and prolonged exercise in the open air persons, usually not well adapted to strenuous contests, who might otherwise be indisposed to leave their studies — or their clubs. It gives to a long walk an immediate interest, with occasional exercise of the upper extremities and some cultivation of the eye and control of audible emotion. But, like whist, it is best suited for men to whom excitement and acute energy are past pleasures. Women who will not walk for the sake of walking may better substitute the tee of the links for that of the drawing-room, but in the hands of vigorous young men the golf- club is no equivalent for the saddle, the racket, the bat, or a dozen other agents for the exhibition of vital activity and strength.
Cricket, an exotic that has never taken wide root
on our soil, lacks many of the qualities of a good
game, chiefly because of the long waits
before going to the bat and the limited
number actively engaged.
Fencing, single-stick, the broadsword, and sparring, when the latter is not carried to extremes, are ad- Fencing, mirable. For many reasons every man ^^^' should be qualified to defend himself with
the equipment of nature, wherein skill in boxing
Development and Care of the Body 79
transcends the mere question of exercise. Active
practice with a punching-bag beautifully develops
agility and, within limits, chest expansion and the
general strength.
La Crosse, although limited to teams and liable to
abuse, does not require weight and is free from the
roughness so nearly associated with the Eng-
,. . . ^ La Crosse
lish football. It is graceful and vigorous,
deserving much greater vogue as a game for the open
than it has acquired south of the Canadian border.
Basket-ball, played by gentlemen, is a fine gym- nasium game, again with the disadvantage Basket^ of drifting into one only for expert teams. ''^"
Tennis is the queen of games. It may be played gently or vigorously, it exercises all the muscles ex- cept possibly those of the left upper ex- tremity, it cultivates the group of quali- ties known as "eye" — that is, accuracy, promptness, and agility — and it should encourage good temper and courtesy.
Boating not carried to an extreme is valuable exer- cise for the arms, the legs, the back, the lungs, and
the heart. But that means neither racing
, . T^ . Boating
nor any approach to it. Racing or severe
training may hurt the lungs and is almost sure to damage the immature heart. Physiologically it is more than unwise; it is wrong. A college crew is an expensive luxury
Swimming has a double value, and every man owes it to himself to learn to swim and to keep in practice,
8o Personal Hygiene
although fortunately once acquired swimming never
^ . . becomes a lost art. Occasional practice Swimming . '■
when completely dressed is valuable, less
for hygienic purposes than to qualify for rescue.
Exercise may be defined as movements of the muscles sufficient to contract them energetically. Its usual
_ . effects are increase in the size and power Exercise ^
of the voluntary muscles and of the func- tional capacity of the involuntary muscles involved, and health and general vigor are promoted by its increasing respiration and quickening the circulation. After attaining their full size muscles cease to grow, but exercise cultivates their higher functions. It should never be forgotten that walking for exercise, as an example, to be effectual must be brisk, not mere saunteringw For instance, in walking four miles an hour the lungs inhale five times as much air and of course five times as much oxgyen as in repose. That oxygen taken up in the blood goes to the removal of tissues and compels the carbon dioxide, formed by their disintegration, to make way for it. Thus following the quickened circulation exercise hastens repair by the more rapid interchange of the primary cells through waste and assimilation.
The physiological advantages of exercise as ob- served and summed up by Dr. Beyer, U. S, Navy, are Advantages these: An immediate subjective feeling of of exercise general well-being. While the supply of those substances in which energy is stored equals the demand and before breathlessness limits it, there is
Development and Care of the Body 8 1
exhilaration. We sleep better and think more clearly and move quickly; our senses are more acute; the skin and the kidneys, the special excretory agents, act better; digestion and assimilation are improved; the lungs expand better, and the heart contracts more strongly from the increase of blood pressure, and all the muscles contract more quickly and effectively. The "warming up" of animals and men on the race- track and in the athletic field is taking practical, although possibly empirical, advantage of this better state. The common condition and the primary cause of all this is the increased supply of oxygen in the capil- laries, and a more abundant outflow of the products of wear and tear than when at rest. The importance of the capillaries appears in this. From two to seven times as much oxygen unites with the cells as in re- pose, and the products of its consumption leave them as rapidly. To attain the best results of exercise the work must be systematic and, if in the gymnasium, it should be in classes or groups carefully arranged with reference to the individual requirements. Ir^ regular and desultory exercise is rarely helpful, and where regular exercise is not obligatory a large pro- portion of those who require it the most use it the least.
Besides leading to desirable control of the body and to reasonable health, systematic exercise „ .. within the growing age increases the length affected by of the bones as well as the bulk and ser- viceability of the muscles. Even where growth ap-
82 Personal Hygiene
pears attained, the shoulders may be broadened and while still within the period of development the chest may be expanded. This is shown by observations covering two considerable terms of years upon cadets of the Naval Academy, who were lads of similar age, similar original selection, and were living under other- wise identical conditions. The groups were large enough for minor errors to be disregarded. During both periods their compulsory drills and general duties gave them more exercise and more time in the open air than other students as a class enjoy. The only difference between the groups was that one underwent systematic bodily training in addition to the drills and the other did not. Comparison with the stature of the untrained men, which might be taken as a standard, showed that between the ages of i6 and 21 there was a gain in height of rather more than one inch (26.6 mm.), that is, the men of the trained battalion averaged a full inch taller than the others. In individuals this increase may have been considerably more. Weight increases with height, and while the normal increase between 16 and 21 was about 21 lbs. (10 kilos), that actually attained was 77 lbs. (35 kilos). However, weight depends upon too many conditions for it to be a constant quantity. But the most important gain was that in lung capacity, which is reported as increasing five pints as against one and four-tenths pints. Such increase of lung capacity implies a greatly enlarged chest and presumably a stronger heart. There can be no better demonstration of the advantage of sys-
Development and Care of the Body 83
tematic exercise than the results thus acquired by picked youth, results that are open to others who will make the effort. But no serious exercise should be undertaken inconsiderately. It should be selected for appropriateness, be approached gradually, and be increased only with increasing strength. Irregular and excessive exertion yields ill effects. On the other hand the neglect of exercise leads to want of appetite, to loss of vigor and of animal warmth, and to imper- fect sleep.
Good breathing-capacity implies endurance, the key to success; and it is more important than mere mus- cular strength. Regulated, deep-breathing Effect of exercises strengthen and normally develop ^q^^^uq the breathing apparatus. But shallow and lungs careless breathing may lay a foundation for disease. Therefore the chest should be free from the restraint of either tight clothing or position, and formal exer- cise should be carried on out of doors or in a room free from dust and overcrowding. Dust and re- breathed air are obviously harmful, and a dusty, ill- ventilated gymnasium may more than neutralize the advantages its facilities present. On the other hand over-exertion causes pulmonary congestion; the blood cannot pass rapidly enough through the lungs. Hurried and rougher breathing indicates this. Suddenly to "break training," especially that for running or boat- ing, invites, or runs a risk of inviting, tuberculous disease, as explained elsewhere. In such prolonged exertion as serious training implies, the extreme upper
§4 Personal Hygiene
part of the lung is unusually expanded. Sudden suspension of the exertion leads those margins partly to collapse, and, no longer washed out by the re- current aerial tides, they afford a nidus, a nest, for the omnipresent bacillus or germ of tuberculosis. It constantly happens that athletes and prize-winners fall early victims to consumption. It is to be ex- pected that such men will die, but on the face of it one should suppose that consumption would spare them. It is not normal exercise, it is the excessive strain that leads to this mischief.
Exercise influences the heart, so that palpitation may follow when it is either excessive or insufficient. Over- Effect of work may lead to overgrowth (hypertrophy) ; upon^tlfe strain, that is some unusual effort, espe- heart cially in the young, leads to dilatation.
A dilated heart is a stretched heart. There is serious risk of this accident where great volumes of blood are forced through the heart, especially the growing heart, within a narrow limit of time, as in some of the great contests. Following convalescence from a prolonged fever, as typhoid, the heart usually remains particu- larly weak very much longer than the rest of the system; so that there is great danger from strain then, even after the other muscles have fairly recovered their tone. Racing on the wheel or on foot, or heavy lifting and other great effort, may lead first to strain, then to dilatation. A dilated heart is not one stretched like a balloon, for a very small change disturbs the relative state of the parts. Too much blood forced
Development and Care of the Body §^
into any of the four chambers is liable to distort the flexible doors, the valves, so that they will leak back- ward. Happily a single such strain properly managed is usually recovered from in the young, if recognized and cared for in time. But it is better not to incur the risk. Excessive or badly regulated exercise leads first to dilatation and then, usually, to overgrowth; although hypertrophy (overgrowth) may be, and often is, induced by continuous overworking of the heart without intermediate dilatation. All the conditions leading up to these disabilities are beyond the legiti- mate field of general exercise.
Sighing generally means insufficient oxygen. Either the blood passes so rapidly through the lungs that it cannot take up an adequate supply, or an insufiicient amount of blood goes through them, or the air itself is limited in amount or quality. In either case the cells of the body are sending an in- articulate message for more oxygen. Under great exertion there is gasping, a modification of sighing; and when the chest is mechanically constrained (as with corsets), or there is great loss of blood (as in haemor- rhage), true sighing occurs. The involuntary sighing sometimes noticed is a modification of one or the other of these conditions. In later life involuntary sigh- ing may mean a leaking valve.
The foundation of all physical vigor lies in the proper development of the chest, which implies habit- ually full inspiration through the proper channels. The mouth, frequently used for breathing, is not a.
S6 Personal Hygiene
proper channel. The offices of the mouth are the Normal mastication and transmission of food and breathing articulation. We eat and talk by means of the mouth, but we should not breathe through it. The air should pass, in both directions, through the nose, the multiple folds of whose lining membrane are lubricated by its own secretion. In health there should be no discharge from that organ, and the handkerchief in its common application should be a sheer superfluity. The lining membrane, rich in blood, warms and moistens the incoming air, and minute hair-like attachments (cilia) waving to and fro inter- cept and gradually expel the suspended dust. This secretion is also supposed to neutralize at least some of the accompanying bacteria. The mouth that habit- ually hangs open means either a carelessness closely approaching inferior intelligence — idiots have that habit — or disease. Sometimes the minor morals of polite usage have been so neglected in childhood that an untrained youth may, from sheer indifference, sit with a dropped jaw and a vacant expression. But usually it means that the passages are clogged by a congested lining or by a painless and unrecognized growth (known as the third tonsil) at the rear opening of the nasal canal. Other possible states, to be noted presently, gradually assert themselves. Unconscious habits, or states, become so nearly second nature that frequently the victim is unaware that he differs from his fellows and fails to appreciate that such observa- tions as these have a personal application. If directly
Development and Care of the Body 87
asked, he may reply that he "has a little cold "; but should he reflect he may find that the little cold, inter- fering with his own comfort and with the pleasure of his associates, is a frequent if not a constant condi- tion, and that the accidental want of a handkerchief seriously embarrasses him. We can hardly be too. critical of ourselves, and when any defect is under discussion every one may properly ask himself. Is that mine? He may be surprised at the answer. In mouth-breathing children, not those who carelessly acquire the habit when older but in whom it is con- genital, notwithstanding the outer nostrils may be un- obstructed the inner passage is apt to be found clogged in some way, so that the true nose fails to develop as an organ for breathing. In such cases the infantile arch of the upper jaw persists, the upper teeth are apt to pro- trude, and the voice is liable to be modified. (Another cause of the contracted arch arid protruding teeth is supposed to be the infantile habit of thumb-sucking, which modifies the soft upper jaw by mere pressure.) Where the air is cut off from its proper course, the condition inconsistently known as speaking through the nose results. Rather curiously, members of one's own family are not apt to recognize these defects, probably because of the familiarity which breeds in- difference. Or, if recognized, they are liable to be regarded as incurable infirmities to be patiently en- dured. It is never too late to remove the third tonsil and thus open a freer route, although should this be deferred until the bones of the face are set the appear-
88 Personal Hygiene
ance will not be changed. Adults and children alike have numerous other painless but remediable condi- tions, including innocent but space-filling growths within the nose. A common obstacle is a deviation of the median partition, which is not so easily rectified. Whenever one channel is blocked, wherever in its course, a greater liability to catarrh seems to depend upon the effort to force a larger volume of air through the remaining channel. As already intimated, it is probable that some disease-bearing germs enter the lungs much more freely when the mouth is the main air-channel.
The misnamed nasal twang with which some Amer- icans are justly charged is due, partly to chronic Nasal catarrh blocking the nasal passages, and
twang partly to that curious and unconscious imi- tation by which in youth we acquire the tones most commonly heard. Unfortunately as a people all our voices are too sharp and lasping, chiefly from the want of a fair standard for comparison and imita- tion. We are so accustomed to strident voices that we fail to recognize their inherent infirmity. The one defect of our charming women is that their edged words are apt to cut the air too keenly, and, except that they are somewhat less shrill, the tones of our men offend in much the same way. One advantage of university residence should be serious and system.atic effort to acquire a tone more serene and persuasive^ even if less penetrating and far-reaching.
When runners get their " second wind " it means
Development and Care of the Body 89
that under the stronger action of the heart the elastic blood-vessels gradually dilate so that the Second circulation becomes freer and the blood wind flows more easily. Normal children when unre- strained run freely and easily, in preference to walking sedately. This is because their vessels, besides being equally elastic, are of greater relative calibre" to the size of the heart and the quantity of blood than are those of adults. The heart has so much less resistance to overcome that children are not restrained by its oppression. With youth, and with some others before old age sets in, the blood-vessels gradually expand under exercise and thus relieve the tension in the lungs that would follow from forcing too much blood through them hastily. Horsemen recognize as a fact, although per- haps not always understanding the reason, that a pre- requisite for fleetness in a horse, and especially in a long- distance horse, is large veins which under the require- ments of speed swell with blood and relieve the heart. The preparatory "warming up" of both animals and men is partly to supple the muscles and partly, unconsciously, to expand these channels. Another factor in acquiring second wind is the unconscious temporary increase of chest capacity by the expansion of the walls through the flexibility of the ribs, and the depression of the diaphragm in the very effort to introduce more air. Very soon, then, the respirations become longer and deeper and both blood and air arc pumped more freely. As long as this condition is maintained there is no trouble. It is when the further demand exceeds the
90 Personal Hygiene
supply that the respiration becomes quicker and more shallow and there is distress. With advancing years the arteries grow more rigid, and they fail to yield (except by breaking) either to the strong impulses of the heart under sudden strain or to the more gradual effort of the track.
Breathlessness in its last analysis is not absolute lack of air, but its relative insufhciency. So much blood Breath= is driven through the lungs in response to lessness ^Yie requirements of the system under mus- cular exertion that the carbon dioxide cannot be elimi- nated nor the oxygen be absorbed with sufficient rapidity to keep it pure. The same consequence from different conditions occurs in certain forms of heart- disease. The victim pants not because the air does not freely enter the lungs, but because of the difficulty in sufficiently aerating the blood.
A barrel- shaped chest is the most serviceable, and a broad chest is one of strength. As already pointed out, the essential factor is less the gross circumference than the difference between inspiration and expiration. The ribs, especially in youth, are very elastic, and much of the development of the lungs depends upon their flexibility. Practice increases this acquirement, and very happily will carry this qualification of youth into advanced years; but neglect will encumber its victim with rigid and unyielding walls. The professional strong men, the weight-lifters, are frequently inelastic in the chest and are valueless in daily life. Even although the chest
Development and Care of the Body 9 1
may be loaded down with muscle, this immobility re- mains. Still more objectionable, except that taken in time it may be modified, is the contracted chest which fails to expand properly. Here the muscles are weak, the back is rounded, usually the ribs may easily be counted, and frequently the subject is badly nourished. Defective chests, besides the two immobile classes just noted, are those marked by abnormalities unconsciously acquired and ignorantly maintained. The common errors, so common that in many they fail Defective even to attract the eye, much less to ojffend <^*^®sts the observer, are one shoulder lower than the other, a transverse (lateral) curvature of the spine, or a bending forward, particularly at the shoulders. The lowered shoulder, possibly concealed by a little padding, is usually accompanied by flattening of the upper chest on the same side. Some persons, not commonly reckoned as deformed, have the breast-bone thrust forward like the prow of a ship. They are pigeon-breasted. In all of the foregoing capacity, that is breathing space, is lessened. Usually these defects depend upon ig- norance or carelessness; a few are due to unwise handling in infancy; more to improper attitudes at the desk, especially in writing. To carry weights, whether school-books in a strap or the burdens of severer labor, over one shoulder or by one arm, tends to depress the opposite shoulder (in the effort to pre- serve the line of gravity) and to flatten that side. Where shoulders slope effeminately it is sometimes charged that the effort to keep suspenders from slipping off is respon-
92 Personal Hygiene
sible for a similar irregularity. A frequent occasion for such obliquity is the weakness of rapid growth, where mere erectness becomes a strain upon the supporting spinal muscles, and parents and guardians shirk their duty. But sheer carelessness is the chief cause for both Physical unequal shoulders and a flexed spine. The carriage average citizen upon the street, the frequent student on the campus, are daily illustrations. Un- fortunately the eye is so accustomed to the lounging gait and the distorted figure that, because they are not unusual, to most they do not seem unnatural. This carelessness is so great and anterior curvature of the upper spine, round shoulders, is so common as to be formally recognized in the great factories of ready- made clothing where the coats are habitually cut to accommodate the artificial hump which, more and more, is marking the untrained man. A man with the erect back that nature gives will find such a coat lie in folds across his shoulder-blades. This is not merely a question of looks, it is one of utility. Every devia- tion from nature is not merely an offence to the trained eye, but is a practical blemish in the physical life of the subject. It puts him to disadvantage as well as disfigures him. There is no physiological reason for a shambling gait more than for a trembling hand; nor should the rounded shoulder and the hanging head be glorified as the scholar's stoop, while a similar impress on the cobbler over his last, or the tailor at his board, is a trade-mark to be avoided. In each case it me^-ns diminished lung- capacity, lessened
Development and Care of the Body 93
physical vigor, weakened muscles, and an unnatural flexion passing into permanent deformity. All this is absolutely unnecessary. Young and healthy children are usually erect and graceful. Square shoulders, an erect head, and a natural spine, the perpetuation of what so many have lost, are perfectly available for every healthy young man. It should be a laudable ambition for every liberal student to bear himself so that his very carriage will make him an example in physical life, as his intellectual attainments should make him a leader in the civic world.
IX
Physical-culture Exercises
'T^HE following are rules * for maintaining a normal posture, as has been advised :
A line perpendicular to the floor should pass through the shoulder, hip, and ankle.
The neck is to be erect and the shoulders held up.
A perpendicular plane touching the buttocks passes just in rear of the shoulder-blades and about twice as far behind the heels.
A perpendicular plane in front should just touch the lips, chin, chest, and toes when the feet are at an angle of 60°.
The chest should be thrown forward by expansion, and the abdomen be moderately retracted.
These rules yield a correct standing position and hence a point of departure for walking and other exercises. This position is not to be maintained by contracting any muscle into stiffness, nor by holding the body rigid, but by encouraging the frame to sup- port itself naturally.
* These are abstracted bodily from a writer whose name has been mislaid.
9t
Physical-culture Exercises 95
The commoner incorrect positions are: The back held flat in constraint (normally the spine curves forward below the shoulder-blades); the incorrect forward stoop and rounded shoulders; the Pos't'ons narrow chest, intensified by lateral curvature. Such deformities, besides being offensive to the eye, diminish the breathing capacity and decrease the stature, the barrel-like contour of the chest is destroyed, and the height lessened from one-fourth to one and a half inches. When the pelvis is tilted or a shoulder drops, lateral curvature of the spine follows. The pelvis acquires an angle in standing carelessly, as is so com- mon, on one leg. To counteract this there is at once a compensating lateral curvature, which becomes fixed if the habit is maintained. Sitting with a tilted pelvis leads to the same results. When the head turns side- ways or the neck bends toward the shoulder (usually from defective vision), as in reading or writing, or from any cause the body inclines to one side, there is a compensating curve to the other side. Such deformi- ties may commonly be corrected before maturity sets in, or the body may be fortified against them. To cor- rect irregularities of carriage or to promote flexibihty, balance exercises are important. Keeping one's balance depends upon retaining with- ^^'^"^e in a certain base the centre of gravity, which necessarily shifts with the movement of the body or the imposition of burdens. A perpendicular passing through the centre of gravity must fall within the base upon which we rest. Standing on both feet,
96 Personal Hygiene
the perpendicular readily falls within the space in- closed by their outline. Standing on one foot, the base is by that much diminished. To stand on the toes diminishes it still more. Hence to stand on one foot, or on part of it, and to move the other through space increases both suppleness and agility. To walk a tight-rope only a few inches above the floor, which relieves the exercise of danger, is admirable balance practice; so is skating; so is bicycling, where the coun- teracting evil is cramping the chest in racing. An exercise, not practicable in ordinary clothing, to in- crease balance and flexibility is: Stand erect with the arms at the sides; draw the arms backward until the hands are about eighteen inches from the vertical; drop the body quickly by bending the knees until the thighs and the legs are in contact, the body itself re- maining upright; then at once spring up on the toes, swinging the arms forward. As the buttocks touch the heels there is a natural tendency to rebound, and this may be repeated from three or four to a dozen times. Another exercise, useful to the whole body as well, is that of skipping the rope without using a rope. Swing- ing the arms in circles adds to its value. The move- ment should be repeated indefinitely, stopping short of breathlessness. During this, and in all physical exercises, the breathing should be deep and slow with the mouth closed. However, as the exercise pro- ceeds, especially when it is unfamiliar, the heart moves faster and respiration is necessarily hastened. The a,rt of dancing, whigh adds to the general control
Physical-culture Exercises 97
of all the muscles, their agility, and their coordinate action, should be acquired by every young person; and the more difficult it is to learn, the more important is it that it should be learned. The very confidence in physical carriage and the unconscious grace that it bestows, in themselves approach very closely to in- herent hygienic value.
Certain general exercises may be practised in the privacy of an apartment quite as well as in a gym- nasium. To increase the power of the General shoulders: Stand in the correct position; exercises lift the shoulders as high as possible, and bring them forward and throw them backward as far as they will go. Such simple movements mobilize the collar-bones and shoulder-blades and at once strengthen and make more flexible the overlying muscles. To broaden the shoulders and to develop the muscles of the upper back: Stand erect at right angles to a vertical surface just far enough away for the tips of the extended fingers to touch it easily. Move away an inch and again touch the surface without changing the feet or bending. Move another inch and it is not so easily done. Repeat, changing the position only a trifle each time, until the surface cannot be touched while the perpendicular is maintained, and then begin with the other side. Persisted in for a few months, broadened and symmetrical shoulders will be acquired.
To secure some flexibility of the pelvis: Stand erect and alternately drop the hips by bending the corre- sponding knee. This increases the flexibility and
98 Personal Hygiene
vigor of the muscles and ligaments involved, and it adds to elasticity and endurance in walking. Begin slowly, keep it up for a minute or two, and ultimately increase the rapidity of action and prolong the time. The common act of stooping to pick something from the floor may easily be made profitable. Do not squat, but first bend the knee, then the hip-joint, then move the shoulder forward and extend the arm so as to bring the hand to the ground without twisting the spine. It is a fundamental rule in stooping to contract, not to relax, the abdomen. At table throw forward the shoulders and if necessary bend at the hips, but do not twist the spine if it can be avoided.
But although it is undesirable to bend the spine in stooping, its flexibility should be maintained. ' An effective exercise is: Stand correctly, extend the arms in line with each other at the level of the shoulders, and then swing the arms and shoulders together in the same horizontal plane until they are as nearly as possible at right angles to their original position, the hips not moving, and then back again through 180°. To support the arms with a light rod makes it easier. Do this twenty times a minute until the shoulders tire. Each vertebra turns a little and after some practice the aggregate is considerable. This is as useful in developing the muscles of the back and the sides of the chest as in promoting flexibility. An excellent variation is to turn slightly the hips and pelvis, bend one knee a little, and with the extended arms cirectly opposed to each other turn the body
Physical-culture Exercises 99
on its axis and bring first one and then the other hand between the feet. Properly these movements should be at the rate of fifteen a minute. At their best the face should always be directed toward the front so as to strengthen the neck, but the double twist is difficult. Persevered in, such movements will strengthen the back and will relieve the painful weakness of those who grow rapidly. They are much better done in undress. To develop the neck-muscles and prevent headaches from muscular weakness, stand against a wall and move the head from side to side, keeping the face vertical. This is very difficult to do without rolling the head, but the ultimate result justifies the effort.
The act of breathing is either costal or abdominal in preponderance, not exclusively. The lungs expand laterally through the elasticity of the ribs, Exercises or perpendicularly by depressing the dia- breathing phragm and raising the apex of the chest. The essen- tial feature in all breathing exercises is to inflate the lungs upward instead of downward, as though trying to lift the body off the ground by the inspired air. As a preliminary exercise, the chest being uncon- stricted, first fill the lungs with a deep breath with- out straining, hold the breath a few seconds, allow it to escape slowly. This strengthens and makes elastic the chest- walls and increases the lung capacity, and it should be done whenever it is remembered; at first once or twice a day, afterward once or twice an hour, finally habitually. Once acquired, this habit
lOO Personal Hygiene
betokens dignity and repose of manner and, more important, enduring strength. Shallow-breathing and quick-breathing persons are necessarily devoid of en- durance.
The principle just described is at the foundation of competent breathing, but there are valuable special exercises w^hich combine respiratory and muscular exertion and are particularly adapted to enlarge and strengthen small-chested men, those deficient in measurement and mobility. The simplest, of which all the others are variants, is to stand erect, lock the thumbs in front of the body, draw in a long breath, and at the same time slowly raise the hands above the head, keeping the arms straight and the hands extended. Then slowly lower the arms, keeping the head erect, and exhale as they descend. Such move- ments are exhilarating by introducing more fresh air, and they tend to develop both the lungs and the chest- walls. They should be practised night and morning, not oftener than ten times a minute. Another is to raise the elbows to the level of the shoulders, the hands to- gether and on the same plane, extend the arms as in swimming, and simultaneously fill the lungs with air. Then bring the arms around on the outer circle to points on a level with the shoulders, and slowly empty the lungs as the hands fall to the side. An excellent way to attain the same result is to face the angle of a room with both hands extended against the walls. Lean forward on the toes until the head enters the angle, and support the body by allowing the extended
Physical-culture Exercises loi
arms to glide along the walls so as to stretch the chest mechanically. Resume the upright position by draw- ing the body back with the arms. Careful practice with any of these movements should develop strong chests.
The heart, the other chief occupant of the chest, is closely associated with the lungs in complementary
function as well as in position. A sedentary _
ir • r • , . r 1, • i The heart
me mterferes with its full action because
the blood fails to circulate with normal force and frequency, so that in enforced general inactivity there should be co responding exercises to maintain the balance. The poverty of the blood known as anaemia (literally bloodlessness) is generally due to insuffi- cient diet, but may depend upon the sluggishness of the circulation — the blood failing to move rapidly enough to undergo proper nutritive change. This is particularly true of children within the school age, and some who do not suffer from insufficiency of food may long feel the effects of inadequate exercise. For the very young, exercise of the heart is of prime importance, and it is better attained by natural unrestrained run- ning and out-door play than by the artificial methods of the gymnasium. With every one, but especially with young children, the object should be to avoid heart-strain, and to encourage exercises which do not require a maximum effort within a limited time. That is because in the very young the heart is small and is limited in strength, but die arteries are rela- tively large and the circulation goes on readily. This
I02 Personal Hygiene
is the natural reason why children, if not too hard pressed at any one time, can run in the course of a day for periods that would completely exhaust an adult. With children waste and repair go on very rapidly, and their ultimate reason for moderation and rest is that prolonged exercise uses up tissue and fills the blood with disintegration-products. Along with the heavy demands for repair are the requirements of new growth, so that a growing child often requires for its daily wants as much food as an adult — certainly as an adult not carrying on severe labor. But about puberty the heart suddenly enlarges out of all pro- portion to the calibre of the arteries, and it pumps then with more force. The relatively smaller arteries therefore afford more friction and mo e resistance, so that to accomplish equal results the heart drives the blood under greater pressure. That difference in relation persists, and after the age of twenty-five exercises of speed affect a person much more than during the period of development. The foundation for the mechanical straining of the valves is laid about the age of twenty and subsequently, when the blood cannot get away fast enough from the heart. With advancing years the arteries lose much of their remaining elasticity and grow more and more brittle, with in- creasing risk of that snapping of their coats which causes apoplexy.
Note. — The most of the exercises described in this section are from text -books whose references unfortunately have been lost.
X
Fatigue
'nr^HE condition of fatigue and recovery therefrom is common experience. We all know experi- mentally what it is to be tired, and when, no longer tired, we say we have rested we express one of the agencies in the recovery of strength. The human organism is in perpetual unrest and it is the wearing away of its particles that causes weariness, and their renewal is the revival of vigor. Every physical move- ment, exercise of the will, stirring of emotion, causes the disintegration and death of animal substance. The various parts wear away under labor, and in health they are renewed in the manner about to be outlined.
The blood-bearing capillaries interlace everywhere through microscopic areas so close together that the prick of the finest needle draws blood. Lymph- But between the cells which make up, each spaces group after its kind, the various structures there are also innumerable chinks and crannies called lymph- spaces, into which oozes from the capillary blood
nutrient material and from the tissues themselves
103
104 Personal Hygiene
waste in solution. Thus the cells are constantly bathed in a mixture of their peculiar food and of their own worn-out matter. If it were possible to make a section of flesh from which no blood would escape, nevertheless to the hand it would feel soft and damp, as the moist and pliable fresh meat at the butcher's imperfectly illustrates. If it were devoid of all liquid except the blood itself, it wouU be stiff and relatively hard. Much of the flexibility of the soft parts during life depends upon their saturation with the animal fluids. The condition is substantially this : Osmosis is con- stantly occurring through the simple walls of the blood -bearing capillaries. Blood is a watery fluid, or plasma, holding in solution or suspension nutritive materials derived from the food, and also heavily charged with floating particles. These particles are the red and white corpuscles, in the proportion of 300 red to one white, and in every j\ cubic inch of blood there are about 5,000,000 red corpuscles which give it its color. These "are so many little packages in which oxygen is stored away.'* The chief province of these corpuscles is to absorb oxgyen from the air, which they readily do as they pass along the capillaries in the lungs, and to carry it to the inmost recesses of the body where on demand it is relinquished to the primary cell-combinations that make up the ultimate structures. In health the red corpuscles themselves do not escape through the capillary walls, but under varying degrees of pressure
Fatigue 105
they yield a part of the oxygen they are carrying to the liquid itself, the plasma, where it is held in solu- tion and from which it escapes to build up cells when the plasma passes by osmosis out of the vessels.
The nutritive part of the plasma that thus reaches the spaces outside of the capillaries is called lymph,
and the spaces into which it thus leaks are , ,
. . Lymph
the lymph-spaces. By further osmosis into
the cells tlie lymph gives up to them a part of its con- structive material, and it receives from them broken- down material of which a part thus gathered returns by a further osmotic process to the capillaries, whence it flows on as a part of the blood into the veins. Hence by means of these minute vessels the moving column of blood constantly loses nutritive material and as constantly takes up that which has been worn out in the service of the body. Moreover, the capillaries near the digestive apparatus directly absorb the nutri- tive material as it becomes fit. Then, as the blood passes through the kidneys and the sweat-glands, it parts with a great deal of water, much of which, espe- cially that going out by the kidneys, is charged with waste. As explained elsewhere, the whole character of the blood changes in the lungs by the elimination of carbon dioxide into, and the absorption of oxygen from, the air, both through the agency of the capil- laries. Hence at varying ])oints in its progress the blood differs from the theoretical standard. Upon the whole, because of the greater pressure within the vessels, the j)lasma loses more liquid to the lymph than
lo6 Personal Hygiene
it receives from the lymph-spaces. The excess uid- mately rejoins the column of blood in ways of no prac- tical importance for consideration here.
When there is much exertion, physical or mental, and in some forms of illness, breaking-down goes on faster than building-up, so that there is in the blood an excess of disintegrated mate- rial. When that occurs we say we are fatigued. Now fatigue is both a condition and a sensation. It is a condition, in that it represents loss of strength due to exertion. It is a sensation, in that it expresses in terms of nervous action the consequences of that loss. The normal sensation (not the condition) of an excess of body waste in the blood may be masked by certain drugs, notably alcohol, so as to disguise the fact and make a false record upon the nervous system, and the subject may temporarily fail to recognize that he is fatigued. Pure emotional excitement may lead to extra exertion. In the lower animals, and indeed in man, the stimulus of the whip may induce fresh exer- tion when genuine fatigue demands rest. All of these, corporal punishment, high emotion, or alcohol, are false helps in that they do not remove the fatigue itself. Either they apply for the time a stronger stim- ulus, or, as is notably true of alcohol, they derange the nervous conducting power, so that false messages are transmitted. Alcohol, moreover, does other mis- chief, to be noted elsewhere.
An interesting demonstration of the nature of fatigue is this: A certain quantity of blood was taken
Fatigue 107
from the veins of a dog that had undergone no exertion, and an equal quantity drawn from another ^ dog of the same breed, age, weight, and stration general style that also had been at rest ** * *^"^ was substituted. There was no change in the be- havior of the dog thus operated upon, which showed that the substitution of normal blood was a perfectly regular procedure so far as consequences were con- cerned. In connection with the experiment that fol- lowed this was what is technically known ., ^
•^ Nature of
as a control experiment. That is, the con- control ditions were identical excepting as to the ^^''^"'"^" special feature under investigation. Then on another day the experiment was varied by substituting in a dog that had undergone no exertion p. blood taken from one completely tired out. stration The dog that had taken no exercise and ^^" *""^ that should not have been tired, but which received blood from the overworked dog, immediately showed all the signs of fatigue and crept away into a place of repose and slept. The fair inference is that muscular work creates fatigue-products which enter the blood. These probably represent an excess of broken-down muscle- and nervc-cclls and perhaps their more than usual disintegration, so that the lymph and hence the blood is temporarily poisoned by these products of exertion and the nervous system in contact therewith carries that message to the brain. One's working power is diminished when he is tired, because a part of his working apparatus, of his capital, has been ex-
Io8 Personal Hygiene
pended. More than that, he feels less inclined to work because his brain thus interprets the sensation con-, veyed to it by the nerves in contact with the disinte- gration-products. He is also less capable of working for the same reason, because voluntary labor requires adequate nervous stimulus. The warnings of fatigue' should therefore be respected. But it is not necessary to be too cautious in this matter of work. All work' need not cease at the first suggestion of fatigue, for. strength and especially endurance (a different quality from strength) maybe acquired by practice which passes. the limits of ease. That is, a distinction should be. drawn between disability and disinclination. It is profitable to remember that " what man calls lassitude the fox calls laziness," and not to confuse languor and laziness with the premonitions of fatigue and incapacity. We may fairly infer from the foregoing that" severe intellectual labor, leading to the expendi- ture of nerve-cells, acts in the same way. It is not so easily proved, but doubtless all such effort throws into the lymph-spaces, and so into the blood, broken^ down nerve-cells in excess of the ordinary wear and tear. But after all worry is more re-
orostration ^P°^^^^^^ ^^^^ work for nervous break- down, and the abuse of tobacco and other nervous depressants is a close second in the causa- tion of neurasthenia or nervous prostration, so called. It follows, and it is confirmed by common expe- rience, that vigor returns after rest and food. This is because during simple rest not only the special draft
Fatigue 109;
ceases, but the blood, unless impoverished by star- vation or disease, sends into the lymph- „ spaces more lymph than that neutralized from by the current vitiation. Moreover, the Waste matter already in the blood is constantly being lessenedo It is not the elimination of waste from the blood, it is its passing into the blood, that makes trouble; just as, for example, it is not the sewage filtered out of a water-supply, but that which is dis- charged into it, which damages the public health. Mere rest, the negative factor of simple abstention from exertion, thus helps to equalize outgo and in- come. When we add to the foregoing the positive
element of new material derived from nu-
Food tntious food, we see how fatigue is over- come. Both are necessary. Food is essential, but we know very well that we cannot continue working indefinitely as a consequence of merely eating. Rest must help to restore the equilibrium. Nor is simple rest, abstinence from labor, alone sufficient. Sleep, sleep at night in a thoroughly ventilated apartment is of prime importance. Breath- ing, which is a modified form of nutrition, constantly carries oxygen to the blood, and it is as important that it should be pure at night as that it should be uncontaminatcd by day. Every man should sleep consecutively for eight hours, and for many ten is not too much if appropriate work has been carried on in the day. The younger and the more industrious over books and field sports are the subjects, the more
no Personal Hygiene
imperative is the need for sleep. And as the sleep
before midnight is the beauty sleep for those to whom
beauty is an attribute, - so is one hour's sleep before
midnight worth two after it for growing youths engaged
in mental work. It must never be forgotten that a
. ^ stimulant, whether coffee (or its analogue, Stimulants ^ °.
tea), tobacco, alcohol, or any of the myriad nerve excitants, is not a substitute for food and repose. Sometimes these temporarily suppress or modify the message sent to the brain so as to falsify the actual condition, but they add no strength, restore no waste, and in the end the most of them create a special mis- chief of their own. •
The Elimination of Waste
'THHE perpetual renewal of the human frame is necessarily accompanied by the elimination of worn-out material. A small quantity of such tissue- waste escapes with the solid discharge of the bowels, but that discharge is chiefly the direct remains of food, and its consideration need not detain us. But
much of the fluid sometimes passed from ^. 1111 r ^ Diarrhoeas
the bowels does come from the person,
not from the drink. As such diarrhoeas represent departures from health, they concern us here only as something to be avoided. It is sufficient that many diarrhoeas are due to antecedent irritation and repre- sent nature's effort to expel unassimilable material, some are symptoms of constitutional disease, some follow a disturbance of local temperature. These last, with which alone hygiene is properly occupied, occur when the surface of the abdomen, sometimes the surface of the entire body, becomes chilled, so that blood driven from that surface is thrown in excess into the intestinal capillary circulation, from which much of the watery part QXUdcs into the course of the bowel.
XIX
1 1 2 Personal Hygiene
This is nature's method to relieve a local surplus. It is always good policy, not only negatively, to avoid chilhng the abdomen, which is most likely to occur at night, but positively, to keep it warm. There may also be a diarrhoea of constipation, where retained fasces sometimes act as an irritant, leading to watery flow in the effort to get rid of them. The general lesson is to avoid unduly cooling the surface, and to take competent advice as to persistent diarrhoea. Un-^ instructed persons sometimes say dysentery for c iarrhoea, as more elegant. The conditions are entirely distinct, and it is as absurd to say dysentery when diarrhoea is meant, as it is to speak of a common cold as an in- fluenza.
From half a pint to a pint (330-526 gms.) of carbon escapes invisibly from the lungs daily in the form of
carbon dioxide. This is easily demon- Lungs .
strated by passing the breath through lime- water, when a white cloud appears. Watery vapor' also escapes freely from the lungs. On a frosty day much of this is visible in the exhaled breath, but there is none the less when it is not sufficiently condensed to be observed.
The kidneys separate from the blood waste held in watery solution. The half-million capsules and fifteen
miles of tubing there assembled assert the Kidneys . ° 1 • 1
importance of these organs, through which
sooner or later all the blood in the body passes, and fronl which the perpetual current of urine is ex- creted. The amount of urine formed in any par-
The Elimination of Waste 113
ticular period varies with that of the perspiration! to' which it is complementary, and the rate may be in^: fluenced by nervous conditions. As rapidly as it is formed it passes through one long slender tube from each kidney to the bladder, which easily holds from one-half to three-fourths of a pint or more. The total amount made by the adult in the twenty- four hours varies between two and a half and five pints. About, forty parts in one thousand of average urine are solid,: chiefly representing broken-down flesh. It is this which must be expelled, not the water, which is merely the vehicle. This waste is formed in the liver and- there is thrown into the blood to be eliminated by the kidneys. When they are damaged so that a part of this waste is retained, the body suffers in proportion;, and when they entirely cease to act death quickly; follows. An excess of flesh food, that is more than the system requires to repair waste and in the young to form new tissue, puts a serious strain on both the, kidney and the liver, requiring of them extra work. When the bladder is irritable, so that "water is passed: more frequently than usual, it is often supposed that an unnatural amount is actually excreted; and when there is pain or stiffness in the loins many think the kidneys are diseased. These are two popular errors that often occasion much unnecessary anxiety. Im- portant as they are, the kidneys are rarely attacked' acutely and more rarely with direct and severe pain.' The constant, even if not excessive, drinking of alcoholi is p-pt finally to disorganize them, but local _ disease
Ii4 Personal Hygiene
is usually a complication of other diseases. Thus it is a frequent and dangerous consequence of scarlet fever, and the lighter the attack appears to be, espe- cially in a cold climate, the more liable are the kidneys to be involved. In convalescence from scarlet fever, preeminently a disease of youth, extra work is thrown upon the kidneys owing to the inactivity of the skin, and the subsequent dropsy that frequently happens is due to the inability of the kidneys to dispose of all the water. The most scrupulous heed should be paid lest the imperfectly-working skin and the overworking kidneys are chilled, or are clogged by unwise diet. Acute inflammation of the kidneys (not incidental to other disease), a very serious state, most commonly depends upon exposure to wet cold, either directly over the loins or general and prolonged. It is neither a sign nor a test of manhood to submit to avoidable trials of that kind, and forewarned should be fore- armed by the operation of intelligent prudence.
The skin is a general envelope of two strata. The outer one (epidermis) is insensitive and consists of flattened cells whose dead superficial layers are constantly pushed off by those under them, as illustrated by the rolls peeled off after a warm bath. It is without blood-vessels and is nourished by simple absorption from beneath. The lower layer or true skin (dermis) is extremely sensitive through the terminal filaments of its multitude of nerves, by pressure upon which, through the loose upper stra- tum; we literally keep in touch with the outer world.
The Elimination of Waste 11^
Complexion depends upon the color of the deeper cells, blonds having little and the dark races much pigment. Blushing follows an increase of Com- blood in the superficial capillaries, and its plexion occurrence upon slight provocation indicates extreme, sometimes abnormal, nervous sensibility. The pallor of some disease, as well as that of persons not other- wise appreciably ill, shows an insufficient amount, or an impaired quality, of blood. Continuous ex- posure to the sun and wind coarsens the skin as well as darkens it, as seen in the face and neck of farm- laborers and sailors. A sun-and- wind-roughened skin probably never recovers its pristine delicacy. Freckles are changes induced by the sun in the pigment of deli- cate skins. A yellow veil should protect against them.
This lower stratum, the dermis, is closely-woven fibrous tissue which becomes areolar toward the body. In the young of both sexes and in Areolar \7omen these meshes hold numerous fat- tissue cells, which round the contour and are non-conductors of heat.
Under the epidermis are minute elevations of the
dermis called papillae, some of which contain an artery
and two small veins, and others tactile ^ ,„
Papillae
nerves. On the palm these lie m rows which form delicate ridges as the epidermis dips between. On the finger-tips they run in whorls which are never duplicated, and the impress of the thumb, the oldest of all seals of authentication, is the best possible identification.
1 1 6 Personal Hygiene
Hairs arise from follicles, or special papillae, at the bottom of depressions, and slender unstriped
. muscular fibres run, usually obliquely,
from the true skin to the side of the follicles. When these fibres shorten under the reflex action of anger or fear the hair becomes relatively erect. Hair does not grow in the ordinary way, that is at the outer extremity. It is protruded, pushed out from beneath. Its color depends upon the pigment in the cortex, and it becomes gray as the central air- cells increase and better reflect the incident light. But it is not clear why they increase. Probably air replaces the shrunken cells. It certainly indicates either gen- eral or local physical deterioration, and the influence of the nervous system is constant and well marked. There are historical instances of the hair turning gray in one night, and premature grayness from sorrow or anxiety is not very uncommon. The falling of the hair depends on many causes, not all of which are recognized. Heredity and certain diseases play a part, the essence being degradation of the follicle. Baldness is also one of the signs of the atrophy, the general wasting, of advancing age; although the hirsuteness of other parts, as the chin, the breast, the axillae, the pubes, is not diminished. Probably the most general condition leading to premature baldness is confinement of the hair by a close-fitting, ill- ventilated covering, or by constriction of the blood-supply by a tight circumscribing ring. Certainly savages and women, who are least troubled with tight hats, preserve
The Elimination of Waste 1 1 7
their hair much longer than the average white man. Notwithstanding a substantial head- covering may in- terfere with the quantity of hair, the greater should not be mistaken for the less and the head be allowed to suffer for the sake of its appendage.
In the connective tissue just beneath the true skin lie an enormous number of minute glands, each with a spiral duct that opens upon the Sweat:* surface. These microscopical mouths are ^ ^" * popularly known as the pores of the skin, and the common impression seems to be that they play the part of a colander whose orifices open and close automati- cally. As a matter of fact around each of these little glands is entwined a very close capillary network^ which always implies an active function. They are about 2,500,000 in number, and they extract from that capillary blood the colorless fluid we call perspiration or sweat. The quantity made every twenty-four hours varies from one and a half to nearly four and a half pints. When, as is generally the case, this evaporates as rapidly as it reaches the surface it is known as insensible perspiration. Visible perspiration forms only when the secretion is so very profuse, or the air is so charged with moisture, that more mois- ture is taken up with difficulty or not at all. The combination of heat and atmospheric humidity is sultriness, and on a sultry day perspiration chngs to the skin. Humidity is an element of climate, and its oppressiveness is directly proportioned to the atmospheric moisture which interferes with cvapo-
1 1 8 Personal Hygiene
ration from the body and it marks one of the differences between Philadelphia and Denver, for example, in the summer. The odor of perspiration, lying in the excreted solids, varies with the race and with the individual, and in different parts of the same person. It is probable that by such variation, un- recognized by our duller sense of smell, the lower animals, especially dogs, differentiate the trails of individual men; and that by the general residuum of the perspiration the scent of game is formed. The insensible perspiration goes on by night as well as by day, and of course is absorbed by the bedclothes as well as the underclothing. When for any reason the body appreciably perspires, there is so much the more to be taken up. Underclothing that is to be worn the next day should therefore be freely exposed to the air when it is taken off; and the proper course on aris- ing is distinctly not to draw the bedding back in place for the sake of appearance, but carefully to expose it to the light and air over the foot of the bedstead or on chairs. Bedclothing hung out of a window is not attractive to the passer-by, but it is a sign of hygienic housekeeping. The more frequently under- clothing can be changed, the more comfortable and the healthier will be the wearer.
Perspiration disposes of water next after urine, and sometimes it discharges much more. Its chief function, however, is not to establish an equilibrium of fluids, but to regulate animal temperature. The action of the sweat-glands depends entirely upon the nervous
The Elimination of Waste 1 1 9
system, and neither directly upon the heat of the body nor upon the quantity of blood near the surface. A profuse perspiration may break out on a cold pallid skin, and in a fever with the superficial vessels full of blood the skin itself may be parched and dry. Ordi- narily we perspire more when the weather is warm because external heat increases the nervous irritability of the sweat-glands. We perspire after labor because the heat generated by muscular work acts as an irritant, and the swifter circulation sends more blood through those capillaries in a given time. But pain or fear by reflex action may cover the body with moisture, and the drenching collic|uative sweats of wasting diseases follow relaxation of nervous tension.
The philosophy of cooling by perspiration is simple. Evaporation, the changing of a fluid to a more rarefied state, reduces the temperature of the surface acted upon, as illustrated by the sensation that follows the volatilization of a little ether or alcohol from the palm. So bathing the body with water, whether poured on from without or exuded from within, cools it. Although the perspiration is of the body- tempera- ture, its evaporation holds that temperature in check. Normally the skin discharges a trifling amount of solids in solution, as recognizable in the saltiness of perspiration. But when the kidneys are inactive through disease this special excretion, urea, of which ordinarily there is but a trace in the sweat, is greatly increased therein. The impression that water may be absorbed as well as given out by the skin seems to
I20 Personal Hygiene
depend on the popular and erroneous colander doctrine. The orifices of the sweat-ducts are outlets, not intakes.
Besides the sweat-glands are oil-glands (sebaceous glands) yielding a greasy semi-fluid secretion which Oil'Slands becomes cheesy after exposure to the air. sebaceous These are generally associated with the hair-follicles, but they are also found in hairless regions. When near a hair-follicle the dis- charge escapes upon the hair as it passes through the skin. This physiological protection to the skin should not be removed too completely. Cleanliness is desir- able, but not too much daily scrubbing. It is not always necessary to be scraped in order to be clean. The oily film on the surface should be removed occa- sionally, not continually. This does not militate against a daily bath; it is merely a caution against too much subsequent friction.
An obvious illustration of sebaceous secretion in excess is the so-called flesh-worm or blackhead of the Blacks face and back, especially in dark- and coarse- heads skinned adolescents. A blackhead is the secretion of an enlarged and stimulated sebaceous gland whose canal has been partly blocked. The black points are not dust as commonly supposed (except occasionally with the very careless), but are pigment granules. Annoying as they are to the eye, they are painless and perfectly harmless, and usually disappear at maturity. The secretion is most easily emptied by pressing the barrel of a watch-key over the canal.
The Elimination of Waste I2I
Frequently mingled with the blackheads in the adolescent age are the pimples known as acne. To squeeze or handle these irritates them. Pressing out the contents is not curative. The bowels, apt to be sluggish, should be attended to, and frequent gentle bathing with hot water and good soap is helpful. Permanent relief is found through patience and the lapse of time.
■ Warts are simply overgrown papillae whose density depends upon the amount of the epidermal layer. Their cause is not clear, but usually they may be removed by a mild caustic system- atically and not too vigorously applied. They often disappear spontaneously and there is no ground for the superstition that they are communicable.
Corns begin with an overgrowth of the papillae, but when the corneous layer becomes predominant the papilla is forced down, the true skin wastes, the fat is absorbed, and sometimes a pouch is formed below. Corns are entirely due to pressure and friction, generally from tight shoes, although occasionally from chafing by those too large. Long- continued pressure may set up an inflammation, some- times leading to suppuration. They are ordinarily on the more prominent parts of the foot, but the so- called soft corn occurs on the inner side of the toes where there is free perspiration. The prevention of corns is in the avoidance of pressure. They fre- quently arise in childhood before it can be intelligently explained where the shoe pinches, but quite as often
122 Personal Hygiene
they are created or intensified by vanity and ignorance forcing a growing or full-grown foot into an insufficient shoe. Their treatment does not belong to this sub- ject, but where there has been no pressure there will
_ .. . be none to treat. A callosity or modified Callosity ■'
corn develops on various parts of the per- son from mechanical occupations, and it sometimes points out the trade of a suspect.
A bunion, much more formidable than a corn, is a change in the joint of the great toe next the foot.
„ . The toe having been turned inward by a
Bunions ° • , ,
shoe too short or too tight, the end of the
bone enlarges from the irritation, the face of the joint
turns outward from pressure, and a sac (bursa) forms on
the joint surface. When inflamed this is very painful.
The efficient use of the foot requires the weight in
walking to be thrown on the ball rather than on the
heel, which cannot be done if this important joint is
crippled. The least deviation from the line of nature
tends to increase, and the changes range from a slight
enlargement at the joint to a complete change of cirec-
tion carrying the toe across the others. Pressure always
aggravates it, and freedom from compression keeps it
at the minimum. Corns and bunions, especially if
liable to inflammation, should be protected within a
roomy shoe by a ring of soft felt to take up the pressure.
Blisters of the foot, usually at the heel, are due to
^,. \ friction by a rough shoe or a wrinkled stock-
Blisters . ■' °
ing. The fluid should be allowed to escape
through a minute hole, made by the point of a needle,
The Elimination of Waste 123
at the most dependent point and the skin be left in place. To avoid blisters on a long tramp, the shoes should be well-fitting and not too coarse, and the stockings quite smooth. Sprinkling the inside of the stocking with a foot-powder whose base is French chalk and salicylic acid is a good preventive. At the end of the walk the feet should not be soaked in water, but be wiped carefully with a damp towel. To grease tender feet overnight is a relief.
XII
Catching Cold, Swimming, Bathing
TN common speech we catch cold when the open "^ pores are exposed to a draught, or to general low temperature. These "open pores" are the active Catching perspiratory glands which popular opinion *^^^^ seems to regard as apertures in the skin
having varying degrees of patulousness. Catching cold is in effect a disturbance of capillary equilibrium, so that the blood passes in excess from the capillaries of the skin to those of the lining membranes, some- times of the intestines but usually of the respiratory organs. Popularly that disturbance means the sub- stitution of cold for heat; either general, as when exertion is suspended in the presence of cold or one passes from a warm room into cold air, or local, when by a current of air or otherwise a part of the body is cooled more than the remainder. That is frequently the case, but quite as many common colds are contracted by entering an overheated apartment
from biting out-door air. The ordinary condition
124
Catching Cold, Swimming, Bathing 125
seems to be that a disturbance of the capillary circu- lation of the skin sets up a counter-disturbance in the lining membrane of the nose or throat. In substituting general cold for heat the capillaries about the sweat- glands are suddenly contracted by the reflex action of the cold and perspiration is checked, but the capil- laries of the membranes remain, or become, engorged, and leakage of serum soon ensues because the other capillaries are not prepared to maintain their share of the work. Where the cold is locally applied, as to the feet or the back of the neck, there appears to be a reflex disturbance of some regulating centre so that the membrane of the nose, for instance, receives more blood than usual. When one comes from the outer cold, with all the superficial capillaries con- tracted, into an overheated apartment, it is generally after out-door exercise has rendered the circulation specially active. There is prompt removal of the capillary tension, but the capillaries of the skin do not respond to the change as quickly as those of the membranes, which thus become engorged and "a cold " results. The explanation of the cause, how- ever, is of less importance here than a recognition of the condition and its avoidance. Entering a hot room one should accommodate himself to the situation by taking off his wraps slowly and by degrees. Submis- sion to such temporary inconvenience will usually re- sult in escaping a probable cold.
The most usual illustration of unequal bodily tem- perature leading to colds is wet feet. The mistake
I 26 Personal Hygiene
there is in confusing conditions. Wlien any part of Wet the body at rest becomes wet and there is
clothing ^ local reduction of temperature in conse- quence, harm is apt to follow. But exercise usually counteracts the mischief, as common observation of hunters, fishermen, and all kinds of day-laborers shows. The real danger from wet clothing in general is that the evaporation from large surfaces materially lowers the bodily temperature, so that reaction from the depression is difficult. This is less a question of catching cold than of serious illness. A cold wind in- creases the danger from wet clothing. Experienced frontiersmen accidentally immersed in severe weather will strip and dry themselves and their garments by an extemporized fire, regardless of the temperature of the air, in preference to wearing wet clothes. If the temperature is not very low one may trust to exercise; but when it is really cold, strip and dry.
Adaptability, however, is such that men gradually in- ured may march all day in the wet and sleep under Sleeping the stars in moderate weather, merely being outdoors uncomfortable. But the sensible rule for ordinary life is to substitute dry clothes for wet ones when exertion ceases. That those whose general health is reduced do not suffer from living constantly in the outer air regardless of the weather, is shown in the very successful treatment of those consumptives who are kept, warmly clad, always out-of-doors. It is a singular and not entirely explicable fact that well per- gons who spend night and day out of doors not only
Catching Cold, Swimming, Bathing 127
are much less liable to colds while thus exposed, but the first night spent in a house is almost certainly fol- lowed by a cold.
The liability to these disagreeable ailments seems to be proportionate to the sensitiveness (not the deli- cacy) of the skin, and every cold makes the Avoidance way easier for its successor. They are best **^ colds avoided, not by senseless effort at "hardening " through insufficient clothing, but by keeping the body com- fortably, not excessively, warm, by living at night as well as by day in well- ventilated, not draughty, apart- ments, and by gradually diminishing the sensibiHty of the skin through the systematic use of cool baths. It is imperative that the bowels should not become constipated.
There is another class of colds, not distinguishable in symptoms, clearly communicable by infection. That is, it is liable to be contracted through infectious mere association with a person already ^^^^^ affected. Such a cold is liable to run through a family or an associated group, independently of exposure to wet or draughts. It probably depends on a yet un- identified bacillus.
Connected herewith is the mischievous every-day advice not to go in swimming while warm or per- spiring. Under its influence boys rush to 1 '111 , . Swimming
the waterside and, dressed or undressed, sit
still, hot and perspiring, to cool as rapidly as pos- sible, a course naturally productive of colds or worse. The proper course is to strip quickly, plunge in,
128 Personal Hygiene
and swim. To swim is necessary. Merely to bathe or to paddle in the shallows when hot is hazardous. Swimming is good active exercise well calculated to keep the blood moving rapidly and to counteract the chill of any water at all fit to swim in. It is of no consequence whether one is perspiring or not on going into deep water, provided one swims vigorously at once. But it is a very different and it may be a very serious affair to remove one's clothes when hot and passively stand or sit in the water. No one when cold should go into water for swimming or bathing — unless it be hot water — nor remain in the water after the faintest sign of chilliness. There is frequent temptation to do so, but always at serious risk. To remain in the water, whether in a tub or in the sea, long enough to feel cold is wrong. Blue lips and chattering teeth are a challenge to congestion and a defiance of Providence. Powers of resistance differ so much that it is impossible to lay down rules as to the time of immersion. The limit of endurance in this respect for a dozen men is no more identical than would be their strength for lifting weights, or their speed upon the track, and in rivalry there may be danger. Women, especially young women, who swim frequently can remain in the water longer than men because of their non-conducting fat; and it is folly for a man to risk illness through false pride in com- petition with them. A man of any age who begins to feel cold should leave the water without delay, and if it is desirable should frankly give the reason.
Catching Cold, Swimming, Bathing 1 29
Younger persons whenever in the water should be carefully watched by those responsible for them, and be sent out promptly on the slightest sign of chilliness.
Surf-bathing, being knocked about by the breakers, is much more exhausting than it seems to those ex- hilarated by its novelty, and novices should 1 1 11. , rx., , ,. . Sea-bathing
husband their endurance. The chief sani- tary advantage of sea-bathing is this concussion by the surf, being smitten and showered upon by a hundred points of spray with the body wrought up physically in withstanding the waves. The salt is a stimulant chiefly in increasing the density of the water driven against one, and the hygienic value of "sea-salt," advertised for the tub, is nothing.
Delightful as swimming is as an accomplishment and valuable as it is as an art, the ears may be readily damaged by deep diving, by swimming too care of far under water, or by exposing them to ^^^ ^^''^ the force of the surf. The delicacy of hearing is very readily disturbed and the organ itself may easily be hurt. Whoever is much under water should carefully guard his cars by using unwashed wool. Wool from which the oil has not been removed retains its elasticity and is much better, under all circumstances, for use in the car than cotton, which packs whenever it is damp. Those conscious that their ears are delicate or unsound should take this precaution before entering the water at all.
Swimming is not undertaken primarily for the sake
130 Personal Hygiene
of cleanliness. That is one of the functions of the
bath. Cold water alone is not particularly Baths , . T^ 1 M 1 • •
cleansing. Poured over an oily skin it
flows off uncontaminated. But to most persons cold water, especially in the form of a shower when the atmosphere is temperate, is a delightful stimulant. But neither the very young, the aged, nor the truly delicate can endure the shock of immersion in cold water. Such persons can secure the most of the benefit of a cold bath by standing with the feet in tepid water and pouring cold water from a large sponge over the body. The extremities remain warm while the stimu- lant effect of the cold is obtained. The interior tem- perature of the human body is 100° F., and the conven- tional temperatures of the various baths are as follows : cold, below 65°; cool, 65°-8o°; tepid, 8o°-9o°; warm, 90^-99°; hot, above 99° F. The immediate effect of a
_ . . cold bath is to contract the superficial capil- Cold bath . . ^
laries and to drive the blood inward. Breath- ing is deepened, at first quickened and then slowed; the circulation is slightly retarded; the temperature very slightly lowered. The nervous system and espe- cially the mental faculties are immediately and power- fully stimulated, probably by the influx of blood un- accompanied by any morbid condition. Reaction should occur immediately upon leaving the bath, when the capillaries and the small arteries dilate, the skin flushes, and there is a general sense of warmth and well- being. Such reaction is the test of whether the bath is well borne. It may be aided by brisk rubbing down
Catching Cold, Swimming, Bathing 131
with a coarse towel. Apart from this agreeable reac- tion, there is almost complete immunity against catch- ing cold in those who take such a bath daily.
The hot bath also is stimulating at first. The super- ficial capillaries dilate promptly. The circulation is
quickened: perspiration is excited : the skin „ ,. . ,, . 1 . Hot bath
easily parts with its worn-out layers; the
stiffened and wearied muscles are relaxed; the joints become more flexible; the sense of fatigue yields to one of satisfaction; and for the time the brain is more alert. This is soon followed by a happy sense of languor and drowsiness, and if maintained longer sleep is apt to follow. There is no single agent that gives such complete relief after fatigue, or that me- chanically removes so well the effects of labor. It does not take the place of food or sleep in overcoming fatigue, but it is an admirable prelude to each. When followed by a cold bath there is a marked revival of energy. The hot bath is often used for its secondary relaxing effect in some forms of sickness, especially with children. This is referred to here only to impress the caution that the cold faucet should always be; opened first, and that in testing the temperature, in the absence of a thermometer, the elbow and not the hand should be used. The hand is too insensitive to judge for the more delicate skin of the body. To wash properly, in distinction from bathing, tepid
or warm water and soap, but not too much .,, . ,
. , o , . . . , Washing
soap, are required. Soap by uniting with
the natural or acquired grease on the skin makes it
132 Pergonal Hygiene
soluble. When in excess it removes too much, for unless it is replaced very rapidly a little of the pro- tecting oil should remain. Good soap, soft water, and a fairly coarse towel carry off the worn-out surface-skin in rolls.
The simpler soaps are the best, the type being castile. Highly scented cheap soaps are always to be avoided,
for the perfume is liable to conceal rancid Soap ^
fats. This does not apply to the delicately
perfumed high-grade soaps, which on the other hand are too costly for common bathroom use. For irri- table skins much pains should be taken to select a soap with no free alkali, usually best determined by experiment. The so-called medicated soaps are of little value, for the soap does not remain long enough in contact with the skin for any remedy to be effective.
For purposes of cleansing a quart of water properly applied is as useful, although not as convenient, as a tubful; and a hot bath is a luxury rather than a necessity. If an entire bath cannot be taken, the feet should be carefully washed daily, preferably before retiring, and prodigality would better expend itself in stockings than in neckties.
When the bath is neglected the body slowly ac- quires a musty odor and the clothes become offensive. This proceeds so gradually that the subject himself is not always aware of it, and his own senses may be quite unconscious of his offensiveness to his neighbor. Such a caution can be required by only one, if any, of a multitude newly gathered from heterogeneous
Catching Cold, Swimming, Bathing 133
homes with scholarship as the only common standard. To avoid being that one too much care cannot be taken to not transgress against the straitest rule of bodily purity. It is a physical quite as much as a moral rule that it is the first deviation from the right v^ay which opens the undesirable course.
Reference has previously been made to the occa- sional afifliction of foetid feet. There the sweat-glands
are abnormal and secrete a horribly off en- „. . . .
■' nidriosis
sive perspiration. Those people are not unclean. Usually they are scrupulously stainless in their persons, but the secretion is tainted at the foun- tain. They change their stockings with great fre- quency and also change and ventilate their shoes; but they suffer from a disease, not a condition to be remedied at will, and it may be alleviated, if at all, only by medical advice of the first quality.
xin
Clothing
/''^LOTHING is primari'y designed to promote
^"^ health and comfort by protection against wet,
by conserving bodily heat in low temperatures, and
^. . ^ by shielding against solar heat. As worn
Object -^ . . . ...
during exercise, it should mmimize the heat
thus generated. Its secondary objects are decency and attractiveness. Warmth is not an intrinsic qual- ity of clothing. If two blocks of inanimate matter
are dressed, under the same atmospheric Warmth . . ^
conditions and out of the sun's rays, one in woolen or fur and the other in muslin or paper, and their sensible temperature is measured after a definite period, there will be found no change in it due to the clothing. The temperature of both ob- jects will closely correspond to that of the surrounding air. When clothing adds to the heat of the body, it is by absorption directly from the sun's rays. But Tempera= although neither warm nor cool intrinsi-
tion as cally, clothing conserves animal heat or
depending .
upon allows it to escape freely by radiation.
c o ing Clothing is only warm in the sense that it
retains, not creates, caloric. That is a quality of the
134
Clothing i^g
material and is not influenced by the solar rays. But independently of material, when in those rays color causes a marked difference in their absorption. Thus, in the sun black takes up the most, blue the next, and so down the scale to white, which absorbs the least. The difference between white and black in the sun may be ten degrees. A thin white cotton tissue over a black coat has reduced the temperature in fierce rays of the sun, as compared with a coat not thus covered, by i2°.6 F. This may be demonstrated by exposing to the sun upon a bank of snow equal sur- faces of identical cloth colored differently (Franklin). The relative sinking of these in the snow shows their comparative absorption of the solar heat. It is felt, if not seen, by those who wear black instead of white hats or coats in the sun. White clothes are therefore worn 'ogically in the tropics or during our own summers. Color also determines the conspicuousness of clothing, background being a contributing factor. The order in which colors are observed over a neutral Conspicu=. ground is red, white, black or dark blue, o"sness butternut, dust-gray, olive-drab. Surveyors' flags and railroal signals are chosen on this principle. Cloth- ing absorbs odors partly on account of its color and partly from its hygroscopic quality. Black takes up the most, blue the next, and white the least. A material is hygroscopic as it ab- sorbs moisture within its fibre. Exact experiments to show the relative absorption of odors by different materials of the same color arc wanting. Where
136 Personal Hygiene
texture is identical the absorption-order is black, blue, red, green, yellow, white. Hence black is the worst and white is the best color to be worn where odors abound. Probably morbific emanations are taken up more readily by the black and moisture-absorbing dresses of amateurs, and least by the light- colored and non- absorbent gowns of professional nurses.
The ordinary materials for clothing are cotton, linen, woolen, silk, leather, and, for occasion, india- rubber. The ultimate fibres of cotton and linen are Cotton and very hard and durable, very slightly hy- linen groscopic, and are very good conductors
of heat. Hygienically they are of equal quality. The body generates heat in proportion to its exertion; but in health the temperature to be maintained should not exceed 98°.4 F. near the surface, or 100° F. within. Hence the warmer the external temperature the less of this self-generated heat should be retained; but the cooler the air, the less rapidly it should be dissipated. Nature's cooling process is by the evap- oration of perspiration, which continues after the exercise which induced it has ceased. Both cotton and linen easily become wet, but they are only slightly hygroscopic, and so do not well take up the water. That is, it passes through them and evaporates. This evaporation would readily chill a person at rest. Be- sides, both cotton and linen, even when dry, allow the heat of the body to radiate rapidly; that is, they are good conductors. Consequently they are not suited as the only clothing, either when there may
Clothing 137
be perspiration or when mere exposure to dry cold is probable. The wearers of mere cotton or linen risk their health according to the degree of perspiration, to the temperature of the air, and to their personal power of resistance. This power of physical re- sistance represents the distinction between individuals. Usually it is overestimated, which leads to serious risk; and inappropriate clothing should not add to the chance of harm.
Wool conducts heat badly and absorbs water freely: (i) by absorption within its fibres (hygroscopic water);
and (2) as it lies between them (water of „, .
^ ^ ^ Wool
interposition). The water between the
fibres gives the sense of dampness, and the most of this can be removed by pressure. But the water that enters the fibres themselves (hygroscopic water) gives no sense of dampness, and little of it can be expelled by wringing. Wool absorbs water twice in propor- tion to its weight and four times in proportion to its surface, as compared with cotton or linen. By taking up its moisture it counteracts the evaporation from consecutive perspiration. As the vapor from the body is condensed by dry woolen clothing, the heat that would become latent when the perspiration passes off insensibly is released. This creates the sense of comfort felt when a woolen garment is put on while the body is cooling rapidly after sharp exercise, be- cause the further evaporation from the cloth proceeds slowly and there is not the chilling effect of the cling- ing vegetable tissues. This is the philosophy of the
138 Personal Hygiene
sweater. That all laborers, even enginemen, Wear flannel shirts shows that experience and theory agree. Wool is neither easily penetrated by cold winds nor readily conducts heat from the body; so that while it is comfortable in cold, it is oppressive in warm, climates. When, as rarely happens, woolen clothing becomes saturated with perspiration, the water of interposition may be wrung out, so that it will serve anew for condensation and absorption. A full suit of woolen underwear, neither too closely clinging nor too coarse, is the most comfortable and safest dress in the so-called temperate zone for nine months in the year, and light wool is better worn over the chest and abdomen the whole year round and the wide world over. The shrinkage of vi^ool in washing is best avoided by mixing with it about thirty per cent, cotton. The trade name of this is merino. Flannel Flannel, is a loosely woven woolen, chiefly used for ®**^* undergarments. "Flannelette" and "sani-
tary flannel" are practically cotton. "Canton" flan- nel ("cotton flannel") is cotton, not woolen, with a long soft nap on one or both sides. Serge and worsted are light woolens easily permeable by air, and have the good qualities of the lesser woolens. Any closely woven cloth takes up dust less readily and parts with it more easily than that of loose structure. Shoddy is old, used and worked-over wool and cloth. Blankets and garments made from it tear easily and wear badly. Mixed with fresh wool it is a common fraudulent ingredient in contract goods and low-grade ready-
Clothing 139
made clothes. Silk, of animal origin, sometimes used
for shirts and pajamas, is not common for
Silk
men's wear because of its cost. It is
highly hygroscopic and a poor conductor of heat.
Rather curiously it is subject to complete substitution,
as well as to adulteration. Pure silk is practically
noiseless, and when it rustles, as often represented in
fiction, cotton has been added. Leather, besides
being a good covering for the feet, is an
Leather
admirable emergency dress in dry, cold,
and windy climates. Tanned with the fur or wool on, which assists in turning water, no material can com- pare with it in resisting cold. Leather is not air-tight and it permits the insensible perspiration to trans- pire, but as a bad conductor it retains the heat of the body. Patent leather is so varnished as to be air- tight and water-tight, and hence is inappropriate for prolonged wearing. India-rubber has a temporary but invaluable use against rain, but it re- India- tains the heat and perspiration of the body rubber so effectually that it should not be worn persistently. Neither should any water-proof clothing be worn con- stantly. In outdoor life india-rubber has very great value as a protective against ground-moisture.
Poisonous dyes are occasionally absorbed with serious results from wet clothes, when these come in
contact with the skin. Aniline dyes, black _
^ Dyes
as well as bright, may be absorbed from
both shoes and stockings when worn on hot and moist
feet. Aniline black destroys the oxygen- carrying
140 Personal Hygiene
capacity of the red corpuscles, an evil that requires no commentary. The brilliant colors, fixed by irri- tant minerals, as arsenic, may disturb the skin, and deaths from their absorption through abrasions are not unknown. Low-grade white collars and some hat sweat-bands occasionally irritate from a contained chemical, in which case they should be discarded. Paper collars may contain arsenic. Celluloid, as used
^ .. . .. in collars and cuffs, is highly inflammable Celluloid , , , 1 /
and also may explode under great heat.
Red flannel acts on some skins as a mild irritant, and hence has acquired a reputation against the stiffness and pain commonly called muscular rheumatism. Paper conserves heat so excellently that it is valuable as an extra sole within the shoe, as an additional blanket stitched to ordinary ones, or as a cuirass outside the undershirt.
In moderate climates to dispense with a covering for the head probably conduces to the vigorous growth of the hair and to general health. But extremes of heat and cold must be protected against. All ex- posure, even when not extreme, coarsens the skin and hair; and a certificate of tan as to summer absence from town ultimately reduces a delicate complexion to a rough brown coat. To go hatless in a sunny
„ ^ climate further disfigures either sex by a
Hats , . , . . , /
scowl acquired m protectmg the eye from
glare. No hat should be tight enough to interfere
with the full supply of blood to the scalp. The head
ghould not remain covered within doors, because it
Clothing 141
would be kept too warm and the hair be ill-ventilated. Appropriately made and used, the silk hat has the advantage of being light, of having abundant air-space, and in this country of being worn only by those not much exposed. Its usual color and the possible danger of constricting the scalp are its chief disadvantages, and it should not be worn under our midsummer sun. The derby is so full of sanitary defects as to be properly tolerable only for those whose hair is beyond redemption and their skulls resistant to ill usage. Every stiff hat should be moulded to the head before it is worn, and under hot sun it should not be black. A soft hat of light color, to be in summer of light flexible straw, in cold weather of wool or fur, is more comfortable and more sanitary.
Collars are comfortable agents of cleanliness, which should never be tight nor interfere with the downward
flow of blood through the veins. The heavy ^, ,
° . . -^ Neck-wear
woolen mufHer bathes the neck in perspira- tion and makes it sensitive, so that after irregular and partial contact with the air, colds follow. There is no ob- jection to a light temporary wrap across the chest when an open coat replaces a close one in severe weather, nor to a heavy kerchief for strictly temporary use, but habitually to swathe the neck in wool is pernicious.
A chamois or buckskin chest-protector, perforated, may be worn by the delicate in severe protection weather, and the back of the chest should *o«" the not be neglected as it frequently is. All clothing over the body should be so loose as not to
142 Personal Hygiene
present to the chest-walls the least constriction. Even
the light pressure of suspenders tends to make the
shoulders round and the chest contracted, and for the
Suspenders young they are undesirable. In a normal
and belts youth with normal hips the trousers should
be sustained by a broad, moderately tight belt above
those bones. But it is better to depend on suspenders
than to wear a really tight belt, for the abdomen should
not be constricted. Trousers, and particularly draw-
^ ers, should not bind across the seat nor in
Trousers
the joints. Socks or stockings should be
suited to the season, and if not sufficiently elastic to re- main in place should be suspended. There should
^^ , . be no excuse to tie anything around the Stockings . .
leg, for fear of interference with the cir- culation. Woolen stockings are not suited for those who perspire freely. In such cases the feet become damp and grow chilly when exercise ceases. Although
,,, ^ ^ X uncomfortable, wet feet are rarely hurtful Wet feet . ...
to a man in good health who is taking active
exercise, excepting under excessive cold. In extreme
low temperature, for the body to be wet at all is hurt-,
ful; and the greater the surface that is wetted the
more serious the risk. A poor shoe inevitably cripples
the foot, either for the time or permanently. Every
^. shoe should be large enough for the foot
Shoes . . o &
m walking to expand one-tenth in length and more in breadth. But when too large, bhsters and chafes follow; and corns, bunions, and serious displacements of the toes are due to ill-fitting shoes.
Clothing 143
To have room over the toes for expansion in both directions is particularly important. High heels dis- turb the level and may distort the symmetry of the pelvis, and are specially harmful to the young. To go barefoot in a suitable climate assures normal feet for children.
The abdominal protector is a valuable addition to ordinary clothing, not only for torrid climates but under either extreme of heat or cold in the Abdominal temperate zones. It is an apron of two P^'otector thicknesses of soft flannel, worn next the skin, sus- pended from a tape tied around the waist. In that form it lies smooth and is comfortable. As a belt, as frequently supplied, it rolls up and is uncomfort- able. Its purpose is to equalize the intestinal circu- lation, which is liable to derangement with consequent sickness, in either very hot or very cold weather. The protector should be worn by night and by day, and its constant use shields against that form of diarrhoea which follows exposure to prolonged heat, especially when the nights are relatively cool.
XIV
Food
"C^OOD repairs the body's ordinary wear and tear and supplies material for tissue in those still growing. "Force manifested in the living body must be the correlative expression of force previously latent in the food eaten or in the tissue formed." That is, food provides for growth and repair and enables work to be accomplished and heat to be generated. Normal appetite and hunger are to be gratified and allayed in the interest of health. There should be an interval of four or, better, six hours between meals, for the recuperation of energy expended in digestion. The better practice is three meals in the twenty-four hours, although for a few mature* persons two seem siifhcient. Exhaustion from over- Fatigue or work or prolonged fasting manifests itself fasting jjj ^]^g digestive apparatus, so that indi- gestion follows the failure of the proper fluids to be secreted. Food taken by force of will when one is "too tired to eat" generally leads to nausea or dys- pepsia, and a necessary caution in those reduced by
starvation is to supply the most digestible food in
144
Food 145
the smallest quantities. The use of alcohol, whether
disguised as vegetable bitters or taken
more openly, before meals by men whose
stomachs are jaded by overwork or who are run down
by daily nervous strain, to stir the enervated stomach
into action, induces an ultimate condition worse than
that for which its aid was invoked. A hearty meal
should not be eaten within two hours ^,
Sleep
before bedtime; but this does not forbid a glass of milk and a few biscuits, or even a little well- masticated cheese. A little digestible food may be taken by light sleepers with advantage in an interval of wakefulness.
Food supplies material, energy, and animal heat, partly directly and partly by restoring expended material. It is divided roughly into pro- classes of teids and albuminoids, grouped as nitroge- ^^^^^ nous; the carbohydrates and fats, non-nitrogenous; the inorganic mineral salts, and water. Practically nearly every food contains more or less of various classes, whose preponderance alone places it in one group or the other. The construction of tissue is carried on by the proteids, the mineral substances, and water alone; all the organic constituents (that is, the non- mineral) evolve energy; and cell life pro- duces heat. The proteid foods are casein _, ^ .. ^ Proteids
of milk, myosin of muscle, gluten of flour,
legumin of beans, peas, and other pulses. In other words, flesh, milk, bread, and leguminous plants are chiefly, but not wholly, proteids. Albuminoid food,
146 Personal Hygiene
as a descriptive class, is limited to the non- nutritious Albumin gelatines, although retained by some writers "®'"^ as a synonym of proteid. Besides the pro-
teids, the energy- makers (the heat and work producers) are the albuminoids, sugars and starches (carbo- hydrates), and fats. Of these the proteids alone supply both tissue and energy and, witness the South Amer- ican Indians, lean meat and water are adequate for the support of an active life. The various proteids are similar, not identical, and have in common nitrogen and a little sulphur as their characteristics. When the nitrogen is cut off, the various functions gradually languish as the reserve in store becomes exhausted.
Energy and strength are not identical. Energy belongs to the nervous system, strength to the mus- cles (Hutchison). In that sense nitrogen is essential to energy, and intellectual ca- pacity and bodily vigor are only found among those using an essentially nitrogenous diet. Starches and Starch and sugars are found in varying proportions in sugar ^jj vegetables. Before transformation into
animal tissues the starch and cane-sugar are changed partly by cookery, partly by digestion, into grape-
^. sugar. A part of this is still further con-
Qlycogen ^ ^
verted mto animal starch (glycogen) and
stored as a reserve. The surplus of this sugar makes
fat, and that sweets in excess are fattening is
notorious.
The fats and oils of food are of both animal and
vegetable origin. As stored in the body, fat is de-
Food 147
rived chiefly from the starches and sugars; and, curi- ously, there is no positive evidence that fat Fats and eaten is stored as fat. It is absorbed after ®''^ disintegration in the intestines, but its uUimate desti- nation is obscure. As diet, fat is particularly neces- sary where growth is going on, although in the form of simple fat it often is objectionable to the healthy stomach. In cold climates much animal fat is con- sumed, and in the warmer regions the vegetable oils are drawn upon. Our ordinary diet supplies fat in butter, milk, and cheese, and fat is a part of the meat- supply. It is digested in the intestines and not in the stomach, and when in excess of the digestive powers it is prone to decomposition. The common inorganic salts are small in amount but inorganic important in character, and are furnished ®^"® integrally with the food. The lime salts enter bone, and those of potassium blood and muscle. Common salt, which is a part of nearly every tissue in the body, must be supphed artificially. Wild animals instinct- ively travel long distances to salt-licks, and the staring coats of domestic live-stock soon betray its need. It probably aids digestion, and also assists in the passage of fluids into the tissues by changing their specific gravity so as to facilitate osmosis. An ex- treme punishment formerly in vogue in Holland was to feed a condemned prisoner with only un- y^^^f ti salted bread. Besides the inorganic salts, acids and certain vegetable acids and their salts, insig- nificant in amount, are absolutely essential for health.
14B Personal Hygiene
When lacking, as formerly at sea, occasionally with
armies, and frequently with arctic explorers, the very
serious and distressing disease of scurvy is induced. Men
cannot live in health on salted food alone. Scurvy
Salted food is typically represented by
beef or pork preserved by common salt and similar agents.* The vegetable acids from which the organic salts are formed are the preventives of scurvy, and must be supplied to maintain health. These are best found as lemon or lime juice, raw potatoes, tomatoes, onions, cabbage, and vinegar, and it is imperative that some of them should be used where fresh vegetables are wanting.
All the general classes of food must be represented in a wholesome diet as necessary for substantial health, although so simple a combination as lean meat and water contains the requisites. The essential dietary problem is to secure the proper proportion of each class of food at a practicable cost, and to make use of it without undue strain upon the animal economy. Limited Thus one might live on bread alone and **'®*' secure enough nitrogen, but in doing that
he would overload himself with carbon. Or, con- fined to a meat diet he must digest four times as much nitrogen as necessary before getting enough carbon. That is, a man would require 6| lbs. of flesh, 4I lbs, of bread, or 15 lbs. of potatoes a day in the attempt
* Common salt has no connection with the organic salts of vege- table origin, and should not be confused with them, as is sometimes done by younger students.
Food 149
to live on any one of them, and even supposing that he could digest the whole he would run risk of dis- ease from the surplus. In starvation the non-nitroge- nous substances go first. Thus, 97 per cent. ExDendi= of fat disappears against 30 per cent, of tu^e of muscle and none of the brain and cord. For instance again, a bear in hibernation will lose all his fat, but his muscular system will be unimpaired. On the other hand, when a well-fed animal is given a very rich nitrogenous diet, all the nitrogen in the food re- appears in the urine; that is, it is excreted even while fat may be accumulating. As the elimination of nitrogen in excess means extra labor for piimina= the organs concerned, it is very unwise to tion of indulge in rich meat diets when the body is not using up its nitrogen by exercise. For the proteids sometimes go to waste easier than the fats. When built into the tissues they are much protected from oxida- tion, that is from being burned; but before being taken up, they are easily oxidized. They very readily go to waste, but only by the operation of some bodily organ. Should that organ be damaged by overwork, one or both of two results may follow. The organ — liver, kidneys, or what not — may be disabled; that is, we become ill with some disease of that organ. Or else the waste that should pass out of the body is retained and circulates within the system. For in- stance, much of the waste of the proteids, whether from the breaking down of our flesh in the ordinary course of life, or from the
15© Personal Hygiene
direct decomposition of their excess in food, takes the form of urea, which is discharged through the kidneys but is nearly all formed in the liver. But if the liver is so disordered that it cannot make the urea, or the kidney so disabled that it cannot rid the blood of it, we are poisoned, either rapidly or slowly, as the c'is- ability may chance to be. The lesson for us is that even in health the function of the liver has a limit beyond which we should not trespass. We do more than merely waste food when we eat in excess of our requirements. Intemperance in eating does not affect Food in= the nervous system, like alcoholic intem- temperance perance, but it is not the simple condition of mere overflow, as so often assumed. The liver may be and often is damaged in its attempt to dispose of the surplus. An extreme example of what a good diet improperly used may cause is the artificially diseased goose-liver which appears on the table as pate de }oie gras. In man an alcoholic debauch de- Alcoholic velops an acute fatty liver. The alcohol, excess more readily oxidized than the natural
fats, is burned in their place and a carbonaceous excess accumulates. All alcohol consumed in health beyond a very narrow limit has the same tendency; and when its consumption is habitual the internal organs suffer in increasing degrees.
The physiological value of food is measured in
_ , , calories. The calorie is the standard of
Calorie
heat-production, and, as heat and work are convertible terms, a calorie expresses the complete
Food 151
combustion of a given amount of food, which thus develops energy. It is the amount of heat lequired to raise the temperature of one gramme of water one degree centigrade. The great or kilo calorie is the heat required to raise one kilo, or litre, of water one degree centigrade, or practically one pound of water four degrees Fahrenheit.
Without attempting to describe in detail even the ordinary articles of diet, emphasis is laid on this generalization: Strength may be developed a a- * by the sugars, starches, and fats, and the proteids assist in maintaining the bulk of muscle (which is the agent for the development of work); nervous energy involves the assimilation of nitrogen, which is found in the proteids; and a reasonably mixed diet furnishes both forms of food. Thus bread has a value of 1 1 28 calories per pound, while beef has only 623, and eggs 739; so, weight for weight but not bulk for bulk, bread is a very valuable food. But the pro- portion of proteids to carbohydrates (starch and sugar) is too low to warrant relying on bread as a sole diet. Ideally the proportion should be i to 4.2; really it is I to 8.5, which, as already explained, would require four pounds of bread to be eaten daily, overloading the digestion with twice as much carbon and hydrogen as required.
Bread is so important as to be worth individual
discussion. It is the only article of diet
1-11 1 , . , Bread
m which there is no waste, and which
never palls upon the appetite when one is accustomed
152 Personal Hygiene
to its use. Its essential constituent is flour. Dough is flour mixed with salt and water, and bread is dough distended throughout its particles with carbon dioxide and cooked. Flour is the crushed kernel of wheat with the two outer husks, the bran, removed. Theo- retically bran is very nutritious, because it contains 15 per cent, nitrogen, 3.5 fat, and 5.7 salts. But practically bran is indigestible. Its valuable material is not in a form that can be absorbed, and moreover it mechanically irritates the intestines and induces diarrhoea. Consequently the "whole flour" recom- mended by theorists is an unfit food. As a matter of fact the whole flour sometimes advertised rarely con- tains more than a moderate portion of the outer part. On the other hand the highest commercial grade of flour, the very fine and white flour from which all the husk has been discarded, is not as valuable as the grade technically known as "straight flour," which is the entire product of the wheat, less the refuse. That is, one should habitually eat neither very fine nor very coarse flour.
Two practical questions immediately arise. What is heavy bread, and why is it indigestible? And is or is not hot, or fresh, bread, including rolls and break- Heavy and fast cakes, to be classed with it? First, hot bread ^^^^ jg bread ? As just stated, bread is dough distended with carbon dioxide and cooked. Careful kneading of the flour with water surrounds each particle with an aqueous film. If baked in that condition, these particles would be cemented into a
Food 153
hard and tough inedible mass. But when the dough is moderately heated, not only is the albumen in the gluten coagulated, but a part of the starch is trans- formed into dextrin, and carbon dioxide is generated from it and from the yeast or similar agent that has been added. This gas, the carbon dioxide, forces its way between the particles and separates them so that their digestibility is facilitated and the taste is im- proved. Bread is heavy vv'hen the gas does not suth- ciently permeate it and it is imperfectly aerated. It is then a sticky mass to whose surface alone the digestive fluids have access and within which they cannot act. From its density it is Hterally as well as figuratively heavy. Conversely, bulk for bulk, properly aerated bread is light. Fresh or hot bread is not necessarily, but it is apt to be, heavy. Its mere temperature is immaterial, the objection to it being that in that state imperfect baking may conceal its degree of aeration.
As already said, bread alone is not an ideal diet, but it is a good "proteid- carrier," as it has been expressed, and except by the very poor its deficiency may be remedied by adding meat, cheese, or milk. Bread and skim- milk is a very nutritious combination, espe- cially for growing youth. Stale bread is more nutri- tious, weight for weight, than fresh bread, because a part of the water has been evaporated. Toast is still more digestible; more water has been driven off and more of the starch has Ijccn converted into the soluble dextrin. Biscuit, from the pilot-l)read of the sea to the crackers of the shop, is unfermented dough thor-
154 Personal Hygiene
oughly kneaded, and baked completely but not burned. Bulk for bulk the hard bread of the camp, which is a variety of biscuit, is more nutritious than soft bread, but men do not thrive on it as well continuously. Corn-meal is, in this country, next most common to flour as a sort of bread. It contains as much nitrogen as flour and four times as much fat (6-7 per cent.) and is very nutritious. But it must be thoroughly cooked and cannot be forced upon persons unaccus- tomed to its use.
Potatoes are little but starch and water and con- sequently have narrow limitations. The starch is
„ ^ ^ nutritious, but where potatoes constitute the
Potatoes ,
sole food, as has been the case m Ireland,
the best that can be said of them is that they are better than nothing. That is, besides a little cellulose, in- digestible material which one might call vegetable gristle, in a thousand parts of potatoes 13 are proteids, 1 54 are starch, and the rest is water. The vigor of men fed on starchy food alone is trifling compared with those which absorb nitrogen abundantly, as is especially manifest in tropical countries where nature suppHes it in abundance with an equal indisposition to severe labor.
As has been suggested, the proteids are to be re- garded as nervous food. Exhibitions of energy de- pend upon the nitrogen, which is contained in them
_ . alone. Such diet "makes for intellectual
Oatmeal ....
capacity and bodfly energy" (Hutchison),
and is found most concentrated in the flesh foods,
Food 155
but not in them alone. Oatmeal is very nutritious when properly cooked. It develops, weight for weight, 130 foot-tons of potential energy against 87.5 for bread. This is due to the contained nitrogen, the same cle- ment that makes it stimulating for horses. Oatmeal gruel is extensively and profitably used by laborers on hard work, and should be serviceable for men under athletic training.
The value of beans and pease also lies in the con- tained nitrogen. Beans contain several times as much nitrogen as bread, but unless properly cooked they are indigestible and anything indigestible not only does no good but is harmful after it enters the stomach.
Eggs contain very little useless matter and are par- ticularly nutritious. Both the white and the yolk contain proteids of different quality, fats, ^ ^.^j^ and a considerable quantity of phosphorus, milk, which has a special relation to the nervous system. It is a delusion chat lish are peculiarly food for the brain. As others have pointed out: Fish con- tains phosphorus; the brain contains phosphorus; but no such syllogism can be constructed from those two premises. Milk contains nearly all the elements of food and is the one article of diet upon which alone life can be sustained. It is not a perfect food, and is better adapted for the very young than for adults, but skim- milk is a good source of proteids, and its deficiency in the carbohydrates is readily supphed by bread. It is a food quite as much as a beverage.
156 Personal Hygiene
A half-pound of cheese contains as much nitrogen as a pound of lean meat, and a third of a pound contains as much fat.
Sugar has long been known as fattening, but popu- larly it has been considered undesirable, especially for the young. However, its value as a pro- ducer of muscle and energy is practically recognized in the habitual supply of molasses to New England farm-hands, and molasses is a staple for lumbermen in the northern camps. In fact the desire for sugar by men doing very hard work and by those imperfectly nourished often amounts to a craving. This has been illustrated on a large scale in the pro- digious consumption of candy by armies in the field in South Africa and the Philippines, and on a small scale, but very effectively, by lads in training who were victors over non-consumers.* Herein practice has, until very recently, outrun theory. Now sugar is formally recognized as a source of energy, and this is confirmed by scientific experiment. An eminent student of the subject suggests that small cups of highly sweetened black coffee administered to the teams between the halves would probably be rewarded by greater endurance in the second half of match games. The writer has advocated considerable indulgence in sugar at the training-table, especially after weight begins to be lost. As a part of daily diet sugar is theoretically underrated. Children's instinctive desire
* In the Philippines the stout little native horses are regularly served with a ration of molasses.
Food 157
and young women's admitted fondness for it have stigmatized its use by grown or growing men as childish, or at least effeminate, whereas it is but the gratifica- tion of a natural appetite. Where the taste has not been vitiated, in a degree by tobacco but chiefly by alcohol, sugar is as acceptable to the normal civilized man as it is to savages, and his disposition toward candy is no bad test of one's drinking habits.
A secondary but important use of food is the genera- tion of heat from its oxidation within the body, and the changes in cell life which its presence facilitates. When more heat is required, more food must be eaten; and as the fats break down the easiest, we instinctively eat more of them when it is cold. The mere act of living creates bodily heat, and we adjust our personal temperature to the sur- rounding air by the amount of heat lost by radiation. Thus, in the tropics we not only spontaneously alter the character of our diet rather than its amount, but we reduce our temperature still further by providing for its more rapid radiation by wearing thinner clothes, or none at all.
It is impracticable in this connection to discuss all the details of diet; but its fluid elements should be considered. The so-called solid food carries with it much water in composition. This yields about one- third of what we actually require, so that
. J n. > Water
besides that which we neither see nor
think of as water we should take daily from three
to five pints of it either directly or in the ordi-
158 Personal Hygiene
nary table drinks of milk, tea, coffee, and the like. In scientific strictness water is not a food, in that "it undergoes no change, no chemical alteration in the body, and hence is not susceptible of liberating force. But it contributes to chemical changes by supplying a necessary condition for its occurrence in other bodies." It makes that solution of the food which is necessary for digestion; the tissues are bathed in fluid; and our secretions and excretions in great part escape in water. It carries the solid infinitesimal tissue-making particles all through the body, and it bears away much excrementitious matter. One dies of thirst much sooner than of hunger, and a bleeding man requires water more imperatively than any other non- surgical service. A man cannot live without water more than ten days, but he may go without food several weeks. As a rule we drink too little fluid, and many drink entirely too little at meals; but in this latter particular every one must develop his own equation. What is too much or too little for some is not enough for others. The limitation of water common at the training-table is designed to remove super- fluous water from the muscles and thus to increase energetic quality. Enough water should always be taken to satisfy actual, not factitious, thirst. The common fear that water taken at meal-times inter- feres with digestion by diluting the gastric juice is unfounded. Experiment has shown that the presence of a pint of water has no retarding influence; on the other hand it materially assists in softening or dis-
Food 159
solving some forms of food into a pulp for easier digestion. Simple water escapes from the stomach by gushes, at the rate of almost one pint every three- quarters of an hour; but hot water passes out more rapidly, and it also stimulates the movements of the walls of the stomach. Much of the water that holds food in solution, as soup, for example, is directly absorbed by the capillaries of the stomach. It is an error to take our drink too cold. The fashion of ice- water is purely a fashion, easily abandoned when ice is difficult to obtain. To flood the empty stomach with ice-water is not wise, for in real excess it may delay digestion a little. Distilled waters, which a priori would seem the very best, lie under the sus- picion of irritating the lining membrane of the stom- ach when drunk habitually (Hutchison). Usually the domestic water-supply of an intelligent family is better than that to be found in promiscuous wells.
Much of the fluid we drink is an infusion of tea, and more is a decoction of coffee. It is their con- tained active principles that make what we Tea and drink at table more important than the coffee question of their quantity. Both tea and coffee, besides their agreeable warmth and pleasant flavor, are gentle nervous stimulants with practically no reaction. The active principles of both are so nearly alike that caffeine may be taken as their representative; and this has been supposed to retard tissue-waste, but the latest experiments show that it tends to increase it. Tea and coffee are simple exciters of the nerve-centres,
i6o Personal Hygiene
accelerating, and at first strengthening, the heart's action and also the respiration, and increasing the secretion of the skin and the kidneys. In some per- sons coffee increases the action of the bowels, but in more strong tea, from its tannin, constipates. In excess both induce sleeplessness, headache, palpita- tion, tremor of the muscles, and impaired digestion. They are so active in their effects, and these are so mischievous, that they should not be taken on an empty stomach. Unless so weak as merely to flavor the water, it is impossible to drink enough of either beverage, day by day, to supply the requirement for fluid. When drunk at breakfast, coffee should be largely diluted, preferably with milk. For most, a small cup of black coffee after the evening meal assists digestion and also acts as a gentle nervous stimulant. But to drink, as sometimes undergraduates thought- lessly do, large quantities of strong coffee for the express purpose of impelling the brain to wakefulness and study, is harmful and therefore wrong. Coffee does not create organic tissue-changes, as alcohol does; nor, like alcohol, does it lead to reaction; but, abused, it jars the nervous system into profound irritability, and in a few persons it acts as a cumu- lative poison. That coffee is the strongest known antidote to the lethal effect of opium is the most conspicuous evidence of its action on the nerves. "Because caffeine increases the heart's action and has a distinct medical value for such use, is the very reason why it should be taken with caution and moder-
Food i6i
ation where the cardiac action is already too vigor- ous. "* Its great remedial value is the resistance it affords to the depressing effects of fatigue and of exposure to cold, where it is far and away in advance of any good that alcohol bestows. Water sipped as hot as it can be borne is effective to stimulate the brain for purposes of study. The local effect of the heat is to increase the cerebral circulation and hence the flow of thought.
To epitomize the subject of diet: An inteUigent dietary is a mixed one, and contains a due proportion
of nitrogen to furnish energy and of starch, „
1-1 -1 Summary
sugar, and oils to furnish muscle for work
and fat for protection, and, by its more rapid oxida- tion, to generate heat. Although meat is instinctively accepted as the typical nitrogenous food, there need be none if we are sure of plenty of beans, of fish, of cheese, of eggs, of bread from reasonably coarse flour, of nuts, — not all of these together, but some of them. Flesh is usually the most convenient form in which to secure the nitrogen, but it is by no means indis- pensable. A purely vegetable diet is more bulky, it tends to the increase of fat, and the energy it fur- nishes appears not to be as promptly available. The disadvantage of meat in excess is the heavy burden it throws upon the liver and the kidneys in disinte- grating and disposing of its waste. As a rule we all cat too much, especially when not exercising vigor-
* Hygiene and Sanitation, i>. 244. IJy S. Kgliert,
1 62 Personal Hygiene
ously. For those yet growing, milk most nearly ap- proaches an ideal single diet. Bread and milk, or milk and oatmeal, cannot be excelled, excepting that as maturity is reached milk disagrees with some persons. It is an error to suppose that skim milk is poor milk. It has lost much of its fat by the removal of the cream, but the other valuable qualities remain.
The table with congenial companions, sufficient time, and fair service should be one of the most attract- _ ive centres. It is a mistake from the point
of hygiene as well as of good manners to sacrifice any one of these features. There should be opportunity for conversation and to eat at leisure. As previously pointed out, prolonged mastication means better digestion, less risk of excess, less imme- diate demand upon the blood and nervous force, and pleasant social surroundings facilitate the flow of the digestive fluids. Food should not be stinted. To eat enough and to have it of good quality is most important, especially while growth is in progress. However plain, food should be abundant, wholesome,- and well cooked. The stomach is the last object on which to economize. Dollars saved at a table below the standard are dollars wasted. If retrenchment is necessary, it should take some other form of self- denial.
XV
Tobacco
nr^OBACCO has been so extravagantly praised and so fiercely denounced that prejudice for or against it is very common. This must be set aside, in what- ever direction it may run, if the subject is to be studied on its merits. The active principle of tobacco is the alkaloid nicotine. In its pure state this Nicotine and is an exceedingly poisonous, volatile liquid, Py"**>ne very soluble in water even as absorbed from the air, colorless, but rapidly turning brown on exposure, when a part is transformed into an allied substance, pyridine. Practically the effects of pyridine are identical with those of nicotine, so that the whole may be considered under the latter head. When nicotine is administered in increasing doses its more prominent symptoms are giddiness, nausea, vomiting, diarrhoea, prostration, trembling, convulsions, paraly- sis of the motor nerves, and death. Ordinarily, how- ever, nicotine is not administered as nicotine, and the body receives it as incidental to the use of tobacco, in which it exists in varying degrees according to the quality of the leaf. Its range runs from one to nine
163
164 Personal Hygiene
per cent. The physiological influence of tobacco upon
^, . man is that of the nicotine, a powerful
Physio= ' \
logical nervous depressant, usually taken in small ^ ^^ * individual doses. But it has occasionally been used by prisoners and others to induce vomiting, purging, and prostration, so as to feign serious illness and thus lead to transfer to a hospital and hence to escape from confinement after recovery from the acute poisoning. This is a hazardous ruse. Before anaes- thesia, tobacco was sometimes used, as it yet may be when ether is not available, to induce the relaxation of faintness as an aid in reducing a dislocation.
In other ways and in smaller amounts multitudes of people have used tobacco by smoking or chewing it,
or as snuff, and with some this consumption Toleration , , , ,
has extended over many years and to a great
extent without noticeable influence upon health. The establishment of toleration is one of the peculiarities of the nervous system, examples of which are found in the habitual use by some of enormous quantities of opium, of arsenic, and of alcohol, such as would overcome beginners. But freedom from observed results does not mean immunity from actual conse- quences. The nervous system is able gradually to resist increasing doses of many poisons, so that a particular effect only follows the use of multiple quan- tities. Usually this is at the expense of delicacy. Re- peated shocks, especially when pleasurable, or repe- titions of mere .exaltation or depression, decrease sus- ceptibility. More than that, habit creates a demand,
Tobacco 165
a positive want, and this craving often becomes im- perative and renders the victim miserable until it is gratified. Such gratification must be habitually re- newed. The use of tobacco is a typical illustration of toleration and of craving. In the beginning there is distress, then endurance, then desire. Further, it is a fact that, with many, when the habit has been ac- quired tobacco smoked in moderation after m:als stimulates secretion and aids digestion. Advan= Many also recognize that it soothes, pro- tages motes revery, favors mental and physical calm, and counteracts nervousness. In a limited degree it con- serves strength where food is scanty, by diminishing the retrograde metamorphosis of tissue. In the face of its w.'de-spread use, practically over the inhabited world, it is absurd to say that tobacco is only a poison or that it is always morally wrong or physically hurt- ful. Like certain medicines, it surely has a place when the physical system is not equal to the demands upon it; but, unlike ordinary medicines, it cannot be administered without preparatory adaptation of the system to its deranging action. We may go further and say that, unlike medicines which build up, it creates its own special demands and thus must have a classification of its own ; for even alcohol and opium may be taken in appropriate c|uantities without ex- citing repulsion at the very first. It has a tolerated, not a necessary, place among the auxiliary agents of daily life, over a very wide geographical range and among diverse multitudes.
1 66 Personal Hygiene
This is all that may legitimately be said in favor of
its ordinary consumption, excepting that tobacco has
^ ^. . a decided bactericidal action, so that when Toothache , . .
chewed it frequently stops the superficial
decay of teeth, a condition depending upon the action of bacteria. Between the occasional aching of a tooth and the habitual chewing of tobacco, it is a choice of evils. As just remarked, it has exerted a wide sway over many peoples since it was found in America about three hundred and fifty years ago; but it is equally true that "individuals and nations have attained the highest intellectual and physical development with- out its use in any form, and that it is in nowise essential to the progress of the race." "It is positively in- jurious to the young, to those with certain diseases, to those with a marked susceptibility against it or Av^ho are highly nervous by disposition, to those unable to restrict its use within proper hmits, to all who use it in great excess" (W. G. Thompson).
The ways in which tobacco is harmful are these: The lining of the mouth becomes congested and feels Modes of dry, notwithstanding the copious secretion harm q£ saliva. The tongue may be coated, or
be dry, red, and burning from the ammonia given off, not from the heat. In some cases the irritation goes on to actual ulceration. This ulceration, or any fissure, opens a way for the introduction of the virus of constitutional disease by any contaminated pipe or utensil. It is not alleged that smoking predisposes to such disease; that would be absurd. The asser-
Tobacco 167
tion is that the frequent sores among smokers are channels for possible infection from numerous sources. There is no scientific reason to suppose that the irritation of smoking produces cancer of the mouth. But when from causes not yet understood there is predisposition to this malignant disease, it does appear to be focussed at the seat of such irritation. The mouth and throat are injured by smoking far more than by chewing. The vola- tilized products of combustion are more acrid and penetrating than are the juices merely pressed out by the action of the jaws, although probably the long- continued presence of a quid may act as a local irri- tant. The upper part of the throat (the pharynx) is habitually congested in heavy smokers, catarrh and hoarseness characterize smokers' sore throat. Smokers' and a general disturbance of the upper air- throat passages is common and obstinate. Tobacco affects the action of the salivary glands, so that much water is lost, for many spit a great deal while smoking, and all do in chewing. Apparent, and sometimes real, thirst is increased, and what is more serious, the digestive quality of the saliva is impaired. It is easily under- stood how the excessive flow may weaken the quality. When smoke is inhaled, a part of it is absorbed by the lining membrane of the mouth and pharnyx, and also by that of the nose when passed through that organ, as well as by the lungs. The lungs inhaled themselves are not apt to be directly smoke affected by tobacco-smoke, but persons with liability
1 68 Personal Hygiene
to consumption have special need of pure air and normal heart action. Of course so far as the products of combustion displace the purer atmosphere they are negatively harmful, just as any other substitution of impure for pure air would be. As presently to be shown, the introduction of tobacco-^moke into the lungs favors its action upon the heart and nervous system.
In a sense the foregoing may I e regarded as the super- ficial or mechanical eflects of tobacco, the conse- quences of contact. But there are far more serious consequences, which depend upon the absorption of the hurtful principles, particularly of the nicotine. Osmosis leads not only substances in actual solution but also aerial mixtures, gases pure or combined, to pass through capillary membranes. If a part of the Nicotine nicotine is dissolved in the fluids of the absorbed mouth, we may expect a httle of it to be absorbed through that mucous membrane. It must be remembered that nicotine is exceedingly volatile as well as very poisonous, and that heat easily dis- engages it from the tobacco, so that along with other products of combustion it is a component of the smoke. Of its presence there the nausea of unaccustomed persons breathing an atmosphere clouded with tobacco- smoke is physiological evidence, for the fumes of ordinary burning vegetation have no such effect. Evidence Ocular evidence of the disengagement of of nicotine nicotine is to be had from the stem of any cigar-holder, the bowl of any meerschaum pipe, the fingers of any cigarette-smoker. The brown stain is cer-
Tobacco 169
tainly not that of simple smoke. It represents nicotine driven off by heat, condensed and made visible by the absorption of moisture from the air. If all the nicotine were expelled into the outer air, it would be of no conse- quence where it might be condensed later. But in too many instances when smoke laden with nicotine enters the mouth it is also drawn into the lungs. Some smokers regard it as an accomplishment "to swallow the smoke," as it is called. It is a dangerous feat. The smoke is not really swallowed, it is inhaled, drawn into the lungs v/here it replaces an equal quantity of pure air. In this way a good proportion of volatilized nicotine enters, or may enter, the lungs. Nicotine Were it not so, did all the nicotine remain inhaled outside the body, the visible stains would merely be an outward sign of one way of spending money. But while it is thus volatilized within the lungs a part of the alkaloid is taken up by osmosis into the blood through the delicate walls of the capillaries with which it comes in contact. For "the blood always absorbs such ingredients with great rapidity, and distributes them so as to produce their effects speedily." The nicotine as a vapor enters the blood through the capillary walls with perfect facility. Besides, a cer- tain proportion of carljon monoxide, very different and far more poisonous than carbon dioxide. Carbon which acts directly and actively upon the monoxide blood as a disintegrator — it is the dcatliprocUicing agent in [)oisoning from ilhiminating-gas — is also dis- engaged fn;m tlie tobacco and aljsorbed. The special
170 Personal Hygiene
action of the carbon monoxide is to destroy the oxygen- carrying capacity of the red corpuscles of the blood. But although this gas is dangerous, the quantity of it disengaged is small. Much more important as an active disturbing agent is the nicotine itself. One of its
... . . effects is upon the vaso-motor nerves which
Nicotine ^
and vaso= control the calibre of the blood-vessels. The tendency of alcohol is to cause the capillaries to dilate, that of tobacco is to cause them to contract. "When a smoker drinks wine or spirits, he has been described as inducing a balance in the tension of his arterial circuit" (Richardson). That is, the effect of tobacco is to contract and of alcohol to expand the fine elastic blood-vessels, so that when nicely adjusted one would counterbalance the other. Such a balance is impracticable, and "in the end the nutrition of the organic parts, which are under the influence of the same nervous regulation, is sure to suffer and in many organizations rapidly and fatally" (Richardson). Besides this specific action of contract- ing the calibre of the blood-vessels, there are well- established general physiological functions attributable to tobacco, all operating through the nervous system, to be carefully remembered.
Tobacco does not directly affect the brain, but its active principle does impair first the conductivity of Motor the motor nerves and then that of the motor
nerves paths in the spinal cord. When under the influence of the alkaloid the nerves fail to excite mus- cular contraction, there follow weakness, inability to
Tobacco 171
stand, depression of the respiratory movements, and finally death from failure of the respiratory muscles. Breathing ceases because the chest-walls no longer respond to the vital requirements. A person who smoked in one day fourteen cigars and forty cigarettes had paralysis of both legs and a copious discharge, probably from sheer want of tone, from the larger bronchial tubes (Axon). By causing irregularity of the nerve-supply it degrades the tissues irregu- generally, and it predisposes to neuralgia, larity vertigo, indigestion, and other disturbances of the nerv- ous, circulatory, and digestive systems. That tobacco causes wasting of the great nerve that pre- Optic
sides over sight is not true; or if at any nerve
time it might seem so, the condition is so infrequent as to be negligible. But very frequently its working power is interfered with, for tobacco is liable to render vision weak and uncertain, causing objects to appear nebulous, or it creates the sensation of floating spots and of similar subjective phenomena (Stille).
In numerous instances amaurosis — a defect
.... ^ . Amaurosis
m vision without change of structure — is
induced, and sometimes buzzing, ringing in the ears
and hallucinations occur. One distinguished oculist
reported thirty-five cases of amaurosis due to the
continued irritation of the optic nerve by tobacco;
and another asserts that when the sight fails with
smokers and no appreciable change of structure can
be found, tobacco-poisoning may be assumed. This
reaches certainty when approprig,te remedies fail
172 Personal Hygiene
during continuance of the habit, and recovery follows
the abandonment of tobacco (McSherry). Candidates
for the Naval Aacdemy rejected for defective vision
have admitted the premature use of tobacco, and the
Professor of Drawing at that institution has found that
the smokers have an impaired muscular control which
retards progress and efficiency, and he believes that
he can invariably recognize the use of tobacco in a
naval cadet by his tremulous hand in ma- Drawing
nipulating the pencil, and by his" absolute
inability to draw a clean straight line" (Gihon), Decaigne asserts that it often induces an intermittent pulse, and that 21 out of 81 smokers showed such a pulse without there being any change in the structure of the heart to account for it. With the abandon- ment of the habit the intermittence disappeared.
Annually candidates for the Naval Academy
Heart ^ . . . ■'
have been rejected for cardiac disturbance,
who afterward admitted using tobacco. When its use was allowed there, the annual physical examina- tions showed tobacco-hearts among those previously free. Stille and Maisch, eminent American students^ of the general action of drugs, discussing the subject General scientifically and without prejudice, wrote, action j^j^g g^g^. "Often there is a feeling of rush
of blood to the head with vertigo and impairment of attention, so as to prevent continuous mental effort; the mind is also apt to be filled with crude and ground- less fancies, leading to distrust and melancholy. The 3leep is frequently restless and disturbed by dis-
Tobacco 1/3
tressing dreams. It impairs muscular power and co- ordination by interfering with nutrition and by ex- hausting nervous force, and it usually keeps down the growth of muscle and the deposit of fat. . . . To the greater number the habitual use is more injurious than useful, and it acts upon a certain number in almost all doses as a poison." The abuse of tobacco does not cause all these disabihties in every case. But in a tobacco-consuming group every subject may have one or another of them.
Tobacco probably assists in arresting molecular waste of tissue, and on that account may be used by many adults, not only with apparent im- Tissue= punity but, under certain circumstances, waste with positive benefit — as, for instance, by soldiers on hard marches with limited food, and by underfed laborers generally. But that very action, the arrest of waste and the failure to utilize fresh material, is detrimental to the young by retarding the progressive changes upon which the advanced development of the body depends.
So far as the tobacco itself is concerned, a mild light cigar is the least likely to produce ill effects, but many smokers find that they can use clean Mode of pipes with less injury than any cigar. "*® When pipes are used the stem should be long, to cool the smoke and condense the volatile products, and the bowl should be porous to absorb the noxious constituents — the coloring of pipes depends on such absorption. The better pipes have a small res-
174 Personal Hygiene
ervoir which collects an oily distillate, and when
a drop or two of that is sucked in from a dirty
pipe it gives violently poisonous effects. A little of
it may be confidently relied upon to kill a young
child. In smoking either a cigar or a pipe, the last
portion of the tobacco is the most active, because it
has taken up in addition to its normal constituents
part of the products of the earlier consumption.
The discussion of the use of cigarettes depends for
its force upon the innate constitution of tobacco itself.
Bearing that in mind, it will be unnecessary Cigarettes . '^ . . , , . . ,
to mterrupt the account by explammg how
the cigarette intensifies the ordinary effect of this drug. The habit of cigarette-smoking is chiefly mis- chievous from what may be called its conditions, but these are important and pernicious. The mere act of smoking a cigarette need not in itself be more harmful than smoking as much tobacco of the same quality in the form of a cigar. But, generally speak- ing, it is more harmful. It is not probable that cigar- ette tobacco is commonly, or even frequently, adul- Adultera- terated (although the charge is sometimes tion definitely made that the cheaper grades are
filled with powdered stumps of smoked and discarded cigars), nor that the paper is soaked with narcotic drugs. Possibly certain grades may contain other narcotics somewhere about them, so that if sedulously searched for they may be found. But these, if they exist, are prepared for special customers well advanced in the drug habit and are not those ordinarily sold over the
Tobacco 175
counter. The possibility may be disregarded until established, for the nicotine itself is harmful enough to warrant every man, and especially every young man, abstaining from the practice when he under- stands the evil. The ill effects of tobacco pure and simple have been explained. It is recognized that the normal body is sufficiently elastic to react more or less completely from violence or prostration however induced, provided the attack is not distinctly over- powering and directly fatal. But the rebound is not
always complete, and the more frequent _
11111 • 111 Depression
and the deeper the depression the less and
less easily is the normal plane regained. It is there where the habit of smoking does harm, and espe- cially the habit of cigarette-smoking which is so easily acquired, and cigarettes are so rapidly, so completely, and so frequently smoked that they act by multiple continuous shocks. One may not recognize any indi- vidual blow, but inappreciably the body falls below the normal and only after a long time does the victim realize that he has lost ground. The custom of in- haling the fumes, although no necessary
r 1 . 11 , ,. 1 1 Inhalation
part of the process, is well established out
of proportion to the same practice in cigar-smoking, and seems to be so necessary a part of the "form," that the two are inseparably connected in thought and nearly so in fact. As already explained, such inhala- tion is particularly detrimental, for the nicotine at once enters the blood. Obviously the younger the subject the more injurious the habit.
176 Personal Hygiene
Tobacco in excess impairs digestion, it checks nu- trition, it diminishes growth, and frequently it induces serious nervous disorders, as illustrated. Careful Desire for observers believe that the tendency of alcohol tobacco is to encourage the desire for alcohol, and Decaigne, the French authority already quoted, speaking of young smokers whom he had examined, says "they furthermore became dull, lazy, and predisposed to alcoholic drinks." As Richard- son insists: "The young should especially avoid the habit. It gives a doubtful pleasure for a certain pen- alty. Less destructive than alcohol, it induces certain nervous changes, some of which pass into permanent modification of function." Without quoting authori- ties and accusations in more detail, Gihon's indict- ment against tobacco is cited and adopted: "An agent General that has mischievously been represented to indictment ^^ innocuous only because of the remark- able tolerance exhibited by a few individuals is actually capable of potent evil; through its sedative effect on the circulation it creates a thirst for alcoholic stimulation; by its depressing and disturbing effects on the nerve-centres it increases sexual propensities and leads to secret practices, while permanently im- . perilling virile powers; it determines functional dis- orders of the heart; and it impairs vision, blunts memory, and interferes with mental effort and appli- cation." In the great Polytechnic School of France, now more than forty years ago, "a comparison be- tween smokers and non-smokers showed that the non-.
Tobacco 177
smokers took the highest rank in every grade, and further that the smokers continually lost grade, so that in 1 86 1 the Minister of Public Instruction issued a cir- cular order forbidding the use of tobacco in the public schools of France." It may fairly be added that its tendency is to lessen physical growth as well, to deprive in every way the growing youth of his full Trammels. measure of development. That it trammels Physique the physique is notorious, so that all those in training for severe physical exercise are required to abstain from tobacco, and those engaged in very delicate manual work learn that they must refrain. But it does more than merely derange codrdinate action, it puts a limit to expansion. These figures, believed to be trustworthy, should appeal to undergraduates, representing as they do groups of similar character. At one of the large eastern institutions, taking the statistics for nine years during which time all the entering men were examined and measured, it was
found that the smokers averaged fifteen
,11 1 1 1 1 Stature
months older than the non-smokers but they
were less in stature. A reasonable inference would be that both their mental and their physical equipments were inferior to those of their abstinent comrades, or that, starting in childhood on a virtual equality, the use of tobacco had dwarfed them in both respects. During the four-years' course the non-users, notwith- standing they were taller on entering, p-ained^. . . . 1 . 1 Chest=girth in height 24 per cent, more and in chest- girth 26.7 per cent, more than the habitual users.
178 Personal Hygiene
Assuming that they lived under substantially similar conditions in other respects, it again shows the restraining influence of this narcotic. At a smaller New England college the differences were even greater and the inequality in lung capacity between the two sets of men was very striking. To interpret the statistics as to mental attainment, whether that means capacity or not, is more difficult; but it is reported that at one of the American universities Scholar- among the highest scholarship men only ship f^YQ pgj- cent, used tobacco, while sixty per
cent, of those who failed to secure appointments used it. There are too many other factors that should be considered to make this conclusive as to the mental state, but it certainly is suggestive and it establishes a strong presumption against the tobacco habit for undergraduates. To be possessed of such a habit is very serious. Like the user of any other narcotic, the habitual smoker finds, when deprived of his ac- customed drug, that there arises a consuming desire, a longing difficult to be translated into words, which sometimes is practically over- powering and unfits him for work or for enjoyment until it is gratified. The tobacco habit has not the moral nor the physical consequences of the alcohol or the opium habit, but that it is distinctly harmful must have been made clear, and is to be remembered that it is insidious in its approach and powerful in its hold. Smokers who pass beyond the border-line of modera- tion and realize that they must stop often find th§ni'
Tobacco 179
selves in a grip from which it is difficult to escape, or on an incline down which it is easier to proceed than to pause. Even youths and very young men once under its fascination who analyze their sensations and desires may find themselves very uncomfortable without cigarettes. When there is an apparent neces- sity, or at the least a desire, strong enough to interrupt, as is sometimes the case, the requirements of academic life and of social decorum, it is putting it mildly to say that the sufferer is not in good condition. De- pendence upon, or indeed aid received from, a nervous stimulant or sedative, the name is immaterial, implies deficient natural vigor; and the sooner the artificial support is rejected and that vigor is recovered the better. It is earnestly insisted that, in the opinion of all competent judges, for growing youth tobacco, especially in the form of cigarettes, quite apart from excess, is always deleterious.
It appears to be sometimes thought that the cigarette — the little cigar — is diminutive in its ill effects as well as in its name. Smoked like a cigar, an individual cigarette might be so. But in practice the action of the tobacco in the two forms is unequal because of the mode of use, and of the two the cigarette is the more pernicious. Physiologically either is bad, and no young man wants to dwarf himself, to diminish his possible physical or mental development, or to become entangled in the coils of a habit to secure release from which is practically to fight with disease. It is not asserted that, because
1^6 Personal Hygiene
the tendency is always to increased indulgence, the temperate use of tobacco is impossible; but it is iterated that any use of tobacco by the young does harm, although the signs may be delayed. The younger the use of tobacco is begun, the more hable is the habit of its use, a habit that nourishes itself, to be formed.
It is a characteristic of youth, which has its advan- tages as well as its disadvantages, to disregard consc- ■quences — but the consequences follow all the same, regardless of the state of mind. The recklessness of a life-saving crew and of a careless yachtsman or swimmer are very different in quahty. The "don't care" feeling of mere bravado is simply a sign of weakness or ignorance. Because of this disregard of what may happen in the future it is the more difficult for youth to reahze the danger or to appreciate the necessity for abandoning a practice which has its present fascina- tion. A good part of some lives is spent in repairing damages; in other lives the damage goes on without repair. There are quite enough evils that befall us through ignorance or by misfortune, without increasing the number with open eyes.: If it were a mere ques- tion of pleasure to be attained at some expense of standing, or if it were a temporary draft upon bodily power sure to be regained later, abstention might not be insisted upon. But neither is the case. The essential object of undergraduate life is to acquire an education as well as to absorb learning, and the two are not identical. For obvioris reasons all students cannot attain the highest grades, and it is very well that many
Tobacco 1 8 1
should broaden themselves by books plus other exer- cises. But it is not well, and it never will be well, deliberately to pursue practices which limit the ex- pansion and the acuteness of the growing mind and the full development of the physical frame. The less disposed one may be to accept these remarks, the more important it is that he should heed them.
Although most boys learn to smoke, and learn through much tribulation because they think it is manly, it is hardly necessary to argue seriously that smoking is in itself no evi- dence of manhood or of manliness. It is no more manly to ^moke than it is to swear; and both begin by imitation. The newsboys of large cities, the street arabs and wharf-rats in nearly every town, the un- trained boys of weak or ignorant parents puff ciga- rettes wherever they can fmd them. But they do not become manly thereby. It more clearly marks them as degenerate. It is a common belief that smoking is practically universal in what is ordinarily called Society, and that the young man who does not smoke
is peculiar — which with some is worse than
1 • • ^ T, , • • Custom
bemg immoral. But smokmg is not a
social necessity, and critical observation of the habitfe
of educated and gentle men may cause a revision of
that estimate.
It is by no means contended that tobacco in real
moderation is appreciably harmful to all solace in
whose physical develo[)ment, not merely "^^turity
Iheir stature, is attained. As already said, to the mature
182 Personal Hygiene
man a cigar after meals or before sleeping, a pipe after a tramp or in the intervals of work, may be a physical solace and relief. But that is entirely different from the burden of this discussion, and even with vigorous men the weight of testimony is against not only its excessive but its common and indiscriminate use. Many and many a man has had to give up smoking when he could, or to lessen his indulgence in the direct interest of his health. A fair proportion of the alleged nervous breakdown from overwork, the neurasthenia or nervous prostration of modern life, is a consequence of the abuse of tobacco.
This presentation of the subject is impelled by no sentimental motive, by no partiality for asceticism. The fellowship that is implied in the social feature of a good cigar is very attractive. What has been said is based on scientific observation supported by incontrovertible facts, which compels the teaching that to use tobacco before full maturity is attained, that is before the age of twenty-five, except in extremest moderation after complete growth, is harmful, and that even after that period its excessive use is apt to be mischievous. It is one of the signs of the liberty of an educated and expanding mind resolutely to forego such indulgence' during undergraduate years, when bodily vigor and mental force should be main- tained without risk of depression or harm to either. It will be quite time to consider the cultivation of tobacco among postgraduate accomplishments when that period is reached.
XVI
Alcohol
"PRECONCEPTIONS concerning the use of alco- hohc beverages are so tenaciously held by many, and half-truths have so wide an influence on this subject, that the utmost care is necessary to avoid error in one direction or the other. Some believe that it is immoral per se to drink a glass of wine; others think Popular that alcohol may properly be used to invoke views a hilarious delirium ai the cost of a succeeding tem- porary disturbance of the body, regardless of the accompanying danger and shame. Most non-experts, when unprejudiced, seem to regard its use short of in- toxication as negative, so far as any lasting mental or physical effect is concerned. Its primary . .. action on the nervous system tempts over lower barbarians, ignorant of its secondary consequences; and inferior races are speedily de- stroyed by its free use. With our own race "strong drink" is frequently regarded as analogous strong to strong meat, and to be deprived of beer <*""k or spirits is sometimes thought a positive injustice.
183
I 84 Personal Hygiene
But statistics are cumulative that the expectation of
life is greater amonff non-drinkiner people, Abstinence , ^^^ , ? , .. . , 1 f •
and Mussulman armies show that alcohol is
unnecessary for the greatest feats of courage and en- durance. Alcohol is a narcotic, " a medicine which
acts first to exalt the nervous system and Action , , -1,1
then to depress it, and to have a special
action on the intellectual part of the brain." Intoxi- cation, literally poisoning, is "a semi-narcotic condi- Intoxica=. tion with physical and mental want of tion co-ordination, and the exhilaration and
stimulation are stepping-off stones in the order of progress to narcotism." But, as with opium and Legitimate strychnine, alcohol may properly be admin- medicine istered, even in very large quantities, in some states of disease. Moderate amounts have c'.iffci- ent effects in health as taken before or after work, or with or not with food, and according to their degree
of dilution. In health moderate amounts Digestion . .,..,.
of wine appear to aid digestion of meat and
other proteid substances in the stomach. Larger quantities retard it. Malt hquors in excess retaid digestion, because of the vegetable extractives present. Intoxicating doses of spirits reduce digestion one- fourth or one-third. Alcoholic beverages stimulate the flow of sahva promptly but briefly. In small quantities alcohol does not interfere with intestinal digestion.
Taken moderately, latent energy is given off by alco- hol through oxidation, as with starches, sugars, and
Alcohol 185
fats, and it may afford energy for muscular work.
Four parts by weight yield as much energy as seven
of sugar, starch, or protein, or three of fat. Heat
is yielded in the same way, but whether it yields
muscular energy is still uncertain. It has ^
, . Energy
been supposed that all the energy furnished
is wasted by radiation, but the effect upon bodily heat developed by the maximum permissible quantity a healthy man may take is nothing either way. That maximum quantity within twenty- four hours is half a bottle of claret, four glasses of beer, or three ounces of whiskey well diluted and taken only at meals. Should it all be taken at once or ordinary intoxication be induced, there would be dilatation of the vessels of the skin, greater per- spiration, more radiation and consecutive fall of tem- perature. In dead-drunkenness the heat-controlling nervous centre is depressed and the pro- Resistance duction of bodily heat retarded; this, with *** *^<**** the increased radiation, lowers the temperature several degrees. Hence exposure to extreme cold easily destroys life, for the natural heat of the body is lowered while its power of resistance to cold is lessened. The subjective sense of warmth that follows drinking a little alcohol depends on the capillaries of the skin being dilated near the sensory nerves, so that as more blood is drawn to the surface from the interior the nerves recognize the additional superficial warmth — but it is a mere transference of internal warmth to the skin. As stated, alcohol has qualities under certain circum-
1 86 Personal Hygiene
stances that belong to food ; but it is not the best food, and beyond very narrow limits it creates per- nicious conditions. Still, when acting as food the various exhibitions of energy proceed in an orderly way and neither antagonize each other nor take on irreg- ular forms. The important difference between starch or sugar and alcohol as food is that the former may be taken up to the limits of digestion and assimilation, but the latter acts upon the nervous system in health so peculiarly that it is impossible to take enough to be of any nutritive value. But in certain conditions of disease large quantities of alcohol are not only tolerated but sus- tain life through a stimulating and a possibly nutritive effect. The foregoing states the whole case in favor of alcohol as nutriment. Its potential food-value lies within three or four glasses of highly -diluted whiskey or as many glasses of beer, taken with meals in the course of twenty-four hours by fully developed men, and it only considers its possible nutritive value under very
favorable conditions. Some authorities limit Limit . . 1 1 p .
the permissible amount to a glass of wme,
or a pint of beer, in twenty-four hours.
Alcohol, habitually or occasionally, is no more re- quired by the ordinary man of twenty-five than by ^ . the boy of fifteen. Its use in health only
morbific disturbs health, leading to numerous dis- eases some of which, of course, may also depend upon other causes, nor does any individual suffer from the entire catalogue. But so much ill health ultimately depends upon alcoholic indulgence
Alcohol 187
that the habitual drinker both lays the foundation for serious disturbance and steadily builds upon it.
Does its limited nutritive feature allow a man with insufficient food-supply to do more work, or a tired man to put forth renewed exertion? Small quanti- ties of spirits may act as supplementary ^, fuel-food, but it is more expensive than derfed or ordinary food and dangers accompany it. To incite to renewed exertion when fatigued, is another question. Fatigue involves both nerve- and muscle- cells; chiefly the former, which become exhausted first
and recover sooner. Thus, staleness from
... , . , . r ^ Fatigue
overtrammg is a relative exhaustion of the
central nervous system. The sense of fatigue, distinct from the cause of fatigue, depends upon the circulation in the blood of the debris of broken-down cells, and neither alcohol nor anything else can remove that debris from the blood. However, certain excitants call to renewed action moderately, or even greatly, ex- hausted nerve-cells, and that without reac-
TTT- , • 1 -1 Excitants
tion. vVithout reaction merely means with- out a subsequent depression due to the agent itself. It does not mean without adding to the sum total of fatigue on the completion of the work, for the wear of the vital machinery is one measure of the work done. Excitants do not re-create nerve-cells nor increase their number or their vital capacity, but some extract from them remnants of force without, by their own nature, pulling back again. Alcohol, on the other hand, which has reaction, is not one of these. Modcr-
1 88 Personal Hygiene
ate amounts of alcohol assist immediately and tcm- porarily in muscular work. This is promptly muscular and invariably followed by retrograde action, ^^*" so that the minimum is reached in about half
an hour, after which more alcohol shows again a slight temporary stimulation. This consecutive paralysis over- balances the primitive excitement, and the aggregate work done under alcohol is less than that done without it and would be represented by the minus sign. Not taking account of accuracy, work involving no severe muscular draft is less; but, in general, moderate indulgence in alcohol injures the quality as well as diminishes the amount, of which there is accumulated evidence ranging from the experience of typesetters and telegraphers to that of navvies and heavy diggers. This seems attributable to its action on the central nervous system. Alcoholic loquacity and display of emotion are not to be confounded with true stimula- tion. Foster and Shore, eminent physiologists, sum-
„ . „ . marize the effect of alcohol on nervous effi- Foster and
Shore on ciency thus : A small amount may promote the action of the central nervous system and appears to quicken thought and excite the imagination ; but usually, and always in excess of small quantities, it diminishes the power of concentrated thought and judgment. It diminishes susceptibility to sensory im- pressions, and blunts all the special senses. As it reduces the sensibility to cold and fatigue and allays mental stress and worry, it is often resorted to under such conditions and always with great danger.
Alcohol 189
When alcohol is said to affect the brain, we mean that it causes a more rapid flow of thought, then loquacity, unusual exhibition of emotion, 5uccessive suspended judgment and uncontrolled pas- effects of sion foUow, and finally there is no response to sensation and no motion but the automatic action of the lungs and heart. Occasionally these movements also cease; but even while life is technically present, the mind is overpowerec and the body paralyzed. The most immediate and striking action of Action on alcohol is on the brain. Even the moderate *^® brain use of wine induces psychological changes, although not noticeable by any except the closest observers of their own mental states. The essential motive for drinking alcohol is to affect appreciably the nervous system, not to quench thirst. " The reason for craving alcohol is that it is an anaesthetic, even in moderate quantities. It obliterates a part of the field of consciousness and abolishes collateral trains of thought" (W. James). Four tenths of one part per thousand (.0004) of body- weight noticeably affects the brain. That ^
. . . , Quantity
is, a trifle over half a pmt of wme contain- ing ten per cent, alcohol will induce in a person weigh- ing 150 lbs. sufflcient cerebral change to be studied. A much smaller quantity in one unaccustomed to its use occasions alteration appreciable to his own con- sciousness. Simple reaction-time is short- Psychical cncd by moderate quantities of alcohol, but ®*f^*^ts processes that involve working up concepts arc not facilitated. Ability in memorizing and adding figures
190 Personal Hygiene
decreases. Eye measurements are distinctly depressed by a bottle of wine. Large quantities diminish acute- ncss of smell and touch, "Alcohol tends to lessen the power of clear and consecutive reasoning, and its action on the higher centres resembles fatigue of the brain, although associated with greater motor energy and ease." Under the influence of good wine "re- straints are removed, too acute sensibilities are blunted, little acerbities are smoothed down, ideas and mental images follow each other with greater rapidity, there is a cerebral sense of richness, and lastly a condition of euphoria, a more serene state of consciousness, ensues." It is open to grave question whether such temporary serenity is worth certain accompanying risks, presently to be explained. But even this serenity is not attained by all. A man of the explosive type who drinks acquires motor energy and ease through Removes the absence of scruples, of consideration of restraint consequences, and in the extraordinary simplification of each moment's outlook. As James expresses it, the inhibitive type of mind is turned into the "hair-trigger" type. Larger quantities cause a lack of emotional control, affect the power of attention, clear judgment, and reason, lower the acuteness of the senses, and frequently anaesthetic action leads to all the phenomena of intoxication, ending in drunken sleep.
One school of psychologists regards the primary action of alcohol as depressant for certain higher and inore easily influenced brain-processes. In that view
Alcohol
191
alcohol paralyzes the central inhibitory mechanism. As Professor James expresses it, "inhibition Depressant is an essential and unremitting element of action our cerebral life." In more homely phrase, the brakes are always on. Now if some of these inhibitory func- tions are weakened or paralyzed before other r. , .
^ ■' Paralysis
qualities are enfeebled, a loss of the finer of inhibit
shades of restraint is an early consequence. The nominal excitement thus becomes merely incoordi- nation of the psychical activities. With the balance- wheel impaired the works run irregularly. As its anaesthetic quality removes the normal restraints of reason and the activities of speech and gesture are freer and less hampered, it is superficially assumed that the brain is "stimulated." The subject's own self- deception points to its paralyzing effect. That is, the stimulation is "fictitious and is in reality due to the removal of the barriers of self-restraint by the paralysis of the higher functions." It is of little consequence whether we call the route by which they are reached stimulation or depression, if wc keep in mind the actual results. Alcohol certainly removes the curb over certain propensities; we must hope that it excites others. If not, if the terrible examples of brutality, of heartless cruelty and ruffianly licentiousness, as well as the minor violations of social decorum that it leads to, are merely the escape of the natural man from his keeper, arc simply normal passions with relaxed restraint, we well may look upon ourselves with horror.
192 Personal Hygiene
Liqueurs and cordials, primarily after-dinner drinks
in certain circles and gradually coming into greater
vogue, are strong alcoholic preparations Liqueurs '=' ° ^ ^
flavored with vegetable extracts, some- times sweetened, and frequently colored. Of these absinthe and maraschino are typical illustrations. Absinthe is particularly perilous. It contains, accord-
. . . ing to its variety, from 47 to 80 per cent. Absinthe ^ , , , .... . . f ,
of alcohol, and it derives its special charac- ter from the oil of wormwood and other aromatics. The coloring matter also is occasionally hurtful. The great proportion of alcohol is necessarily deleterious, but the aromatics, especially the wormwood from which it derives its name, act directly upon the nervous system and wreck it in a distressing way. With all of these, hallucinations commence sooner than with the use of mere alcohol, but absinthe in particular dis- integrates the nerve-cells and predisposes to epilepti- form disorders. The mischief of an ordinary drink of brandy is so much intensified in absinthe that com- parison can scarcely be formulated. The absinthe habit, which seems to be peculiarly enticing, is recog- nized in France as so disastrous that to drink absinthe is absolutely prohibited in the army, and associations exist to discourage its use in civil life. Young men are liable to take the after-dinner cordial as a tribute to polite custom, ignorant of the extraordinary and increasing harm every such indulgence may inflict. We may hope that it is offered in equal ignorance.
The explanations presented for both the harmfulness
Alcohol 193
and the innocuoiisncss of alcohol are sometimes more
sentimental than scientific. One group de- p . .
nounces it as a constant and invariable poison, character , , 11 . ^ of alcohol
m any amount and under all circumstances.
Another maintains that a pure lic|uor may be taken habit- ually in considerable quantities, not only without harm but usually with advantage, and that the evil is entirely
due to adulterations. The quality of being ^ .
. . . Poison
poisonous is usually an accident of its condi- tions rather than an essential attribute of any substance. There are conditions under which every drug com- monly classed as poisonous may be used with bene- ficial, rather than injurious, results. An alcoholic beverage honestly made, sufficiently diluted, and taken at a seasonable occasion and in a proper amount can- not be regarded poisonous in the common use of the word. Further, adulterants, in the sense of deleterious substances intentionally added, are rare, even . , ,, in the low-grade lic|uors sold over the com- ants and monest bars. But impurities from irregular ""P"" '®* distillation are common and harmful. Thus toxic alco- hols, that is others than the ethyl alcohol which is the basis of the commoner beverages, from badly rectified spirits, collectively known as fusel-oil, may be danger- ously present, although less prevalent than generally supposed. vSpurious liquors, made outright from diluted alcohol, flavored with essences and colored with vegetable matter, usually contain nothing more injuri- ous than the alcohol itself; and ahhough the " essences" may som-jtim-js be hurtful, the liquors themselves
194 Personal Hygiene
arc generally freer than genuine brandy or whiskey
from the products of the higlier distillation. There
is a recent contention that, in its eagerness to get as
much spirit as possible, modern distilling
disintegrates the grain so completely that
under heat and acids furfural (from the husk of the
grain) and other aldehydes pass over. It is supposed
that the real advantage of the older over the newer
grades, of the output of the individual still as against
that of high-pressure money-making establishments
is that they contain less of the products of extreme
decomposition, and that alcohol from which furfural
is removed is free from the pernicious agents found in
that in which it remains. This view is not sustained
by all investigators, for some hold that, whatever its
character, the proportion of furfural, at least, is so
small as to be negligible. However if the furfural
hypothesis is correct it is possible that, notwithstanding
the low range of fusel-oil proper, the cheap genuine
whiskeys are intrinsically hurtful beyond the action cf
the alcohol itself.
But in its broad effects the drink evil, whether for
one man or a community, depends not upon possible
adulterations but upon the abuse of ethyl alcohol,
., . , the ordinary intoxicant of the common Alcohol a ...
cause of beverages. The objective evils of drunk- disease 1 1
enness are so patent that they require no re- hearsal nor explanation. But there is much ill health to which alcohol is a contributing or an active cause whose origin is not popularly appreciated. Thus Bright's dis-
Alcohol 195
ease, or congestion of the liver, or a variety of neuritis, may be reported as a cause of illness without distinguish- ing whether it has an alcoholic or a more innocent begin- ning. Practically alcohol is taken as a beverage simply to alter the range of emotional life. As already observed, "it is an anaesthetic. ... It obliterates a Action part of the field of consciousness," and mani- nervous festly this occurs by its direct action on the system nervous system. During acute intemperance it is prob- able that an actual change takes place in the nerve-cells themselves, although this has not been demonstrated. Fortunately they regain their normal state after re- covery from an occasional drunken attack; but it is easy to believe that with each renewal of the strain they become more and more unstable and less and less capable of fulfiHing the requirements of healthful exertion. This special affinity of alcohol for the nervous system is notorious, ranging from the flushed face of vaso-motor disturbance, through the loquacity of lost self-control, to the delirium and shameless stupor of the final stage. These aberrations increase in range with repetition, and the instabihty of the nervous centres becomes greater and greater. Such indulgences rarely induce insanity or even epilepsy in perfectly normal persons, as sometimes charged; but there "remain cases enough in which alcoholic poison- ing is the cause of serious disease of the brain, spinal cord, and nerves in persons of previously normal consti- tution." Besides the more conspicuous consequences, of which delirium tremens and inflammation of the
196 Personal Hygiene
nerve-trunks (neuritis) may be taken as illustrations, there are conditions depending upon closely allied nervous changes, among which, not to make an ex- haustive list, are thickening of the membranes enclos- ing the brain, v^asting of the folds of the brain itself, brittleness of the arteries, and increase of the neuroglia in the superficial layers v^^ith consequent compression of the brain-cells there. If the brain deteriorates, the mind whose agent it is suffers. But, besides, . closely dependent upon prolonged alcoholic indulgence is a toxaemia, or poisoning of the blood, due to that excess, so that the intervention of an acute disease like pneumonia, surgical shock or accidental injury, tuberculosis, privation, or some similar accessory cause, may disturb the balance and a crash follows. The character of the nervous change Nervous may be illustrated by the different conse- change quences to the vision that occasionally, by no means uniformly or even frequently, follow the abuse of tobacco and of alcohol. Tobacco may induce amaurosis, a loss of sight from functional causes, which passes off after cessation of the indulgence. The damage by alcohol is a positive change in the nerve itself, which abstinence does not relieve.
As just intimated, the habitual use of alcohol is responsible for much sickness as well as for many Patholo2i= deaths. For example, one of its effects is cal action to render the coats of an artery brittle. Now when a brittle artery in the brain snaps, apoplexy occurs. The cause is lost sight of in
Alcohol 197
the effect. Nor should we confuse minor with general conditions, for alcohol does not damage the arteries of all any more than all apoplexy is due to alcohol. For a recent period of twelve years, when recognized as a contributing cause of death alcohol has been thus noted on the mortality reports of Switzerland, which is classed as a country where its use is moderate. During this time the percentage of men Swiss over twenty years of age dying from its statistics direct or its indirect effects has been ten. One man in ten of those who died, died of drinking habits; and it is easily supposable that the natural disposition to conceal such a cause in certain social grades makes this a minimum report. It is not creditable to drink oneself to death, even indirectly. But "alcoholic diseases are not limited to persons recognized as drunkards." An increasing number of cases of dis- ease of the circulation, of the kidneys, and of the nervous system are being reasonably at- Moderate tributed to this cause in persons who never drinking became intoxicated and who have always been re- garded by themselves and by others as "moderate drinkers." There are no trustworthy figures of the frequency with such minor indulgence causes disease, but it is only natural to suppose that, if the direct mortality is so great, the incidental non-fatal mor- bidity must be very considerable. It is well established that those whose occupations tempt them to drink have a higher mortality, and we may believe a higher sick-rate, than others from diseases of the liver, kidneys,
%
198 Personal Hygiene
heart and blood-vessels, and the nervous system, and indeed a higher general mortality. The evidence that alcoholic excess injures the kidneys is very strong. This is true of beer as well as of spirits, and the beer- heart and the beer-kidneys are apt to go together. The arteries gradually harden, and fat forms in excess not only on the surface of the heart, but, which is more dangerous, between its fibres. Sometimes general Alcoholic alcoholic obesity interferes with the heart's obesity normal action. The disturbance of nutri- tion which leads to the obesity of alcoholism is most common in the drinkers of malt liquors, and some- times not only is the liver loaded with fat, but an excess of fat appears in the drunkard's blood. Fat beyond the need of the system is not a sign of health, and certainly fat in the blood is out of place. Un- reasonable beer-drinking gives one its signs in the full, rounded, frequently flushed, face, often with a peculiar Beer= glossiness, which represents precisely the
drinker's reverse of the robust health that generally face
it is supposed to mean. The plump, smooth
skin, like a child's, but without a cliild's delicacy, too full especially about the cheek-bone and the lower jaw, puffy as closely observed, means more than the begin- Beer= ning of a change. The inveterate beei-
drinker drinker, frequently gross and unwieldy in body and often dull and irresponsive in mind, is an unmitigated nuisance to others, and his more important internal organs gradually deteriorate. The wine- drinker, and often the beer-drinker, is in the end apt
Alcohol 199
to become the spirit-drinker also. The languid, im- perceptible, and progressive changes from Secondary the normal increase, while they mask, the ^**®cts evil. The best-knovv^n of the slowly arriving penalties is gout, usually laid upon the next generation as well; but gout is relatively harmless, as compared with the insidious undermining of the system at large.
The moral side of the question, whose deplorable evils deserve serious attention, is no part of this dis- cussion; but physically the periodical, not the habitual, drunkard is — excluding risks of violence — less liable to damage his health permanently than the Periodical regular moderate drinker. He who plunges *'*"*"'^®r into an occasional wild and senseless drinking-bout and is abstinent in the interval (always excepting the great risk from violence and the disgrace that he inflicts upon himself and his friends) has a better prospect of comparative health than the other whose daily dram, gradually increasing under whatever name or by whatever excuse, besides inaugurating physical degeneracy, handicaps his organs against those diseases which, at one time or another, arc the common heritage. Grave nervous complications sud- denly arise in alcoholics under the cooperative in- fluence of pneumonia, injury, surgical shock, priva- tion, and some other conditions. And by "alcoholics" is not meant merely obvious drunkards, but those who, day by day, under the pretence of fortifying themselves, are really weakening their powers of re- sistance by the ingestion of alcohol. The drinking
200 Personal Hygiene
habit distinctly lowers the power of withstanding many infectious diseases, as shown in both the increased liability to contract disease and the greater severity of the disease itself. Those attacked with pneumonia, Influence erysipelas, cholera, infectious dysentery, on disease ^.^^^^ other communicable affections, among which typhoid fever should probably be included, have a smaller chance of recovery. It was formerly supposed that the free use of alcoholic drinks afforded a degree of protection against contracting tuberculosis and substantially aided in its treatment. Alcohol not In tuber= only affords no protection against, but it culosis appears to increase the predisposition to, consumption. Not that it directly induces that dis- ease, but it so diminishes the resisting power of the body that the bacillus when introduced is less easily destroyed. Certainly in alcoholic patients its course is often more rapid than in others.
This chapter refers to the use of ethyl alcohol in its various forms as a beverage. It is important to Wood emphasize the fact that wood alcohol
alcohol (methyl alcohol), extensively used in the arts, is a deadly poison, immediate in its effect, so that in justice to the community, especially to those ignorant of the distinction, every container of it should be distinctly marked Poison. Frequent deaths occur from its being drunk by those who do not know its true character.
Ordinarily when the physical changes induced by an article of food or drink are discussed, the subject is
Alcohol Sol
ended. But in relation to alcohol the influence of habit, not only the ease with which nerv- The drink= ous action repeats itself but the tendency habit to such repetition, must always be remembered. This repetition is not hmitcd to thoughts or emotions, but it extends to conditions based upon the pleasurable excitation of certain nervous areas. Now the drink- habit, whether of beer or whiskey, is founded upon no natural impulse, no spontaneous desire. The craving that maintains it is purely artificial and rests upon no normal physical demand. As previously explained, alcohol is essentially a narcotic, and like all narcotic habits this constantly seeks further indulgence. No healthy person requires alcohol any more than he needs opium. The essential point is that the very narrow limit within which the body can legitimately use alcohol is soon passed, so that dependence upon it Proneness and craving for more constantly press *^ grow toward greater indulgence. This is particularly true in the plastic period of hfe, which for the nervous system extends beyond thai for the bones and the muscles. Very few understand their own limitations or can be sure not to exceed them, and no youth before he yields to temptation knows how easy it is to fall. "All men are mortal — except ourselves." Others may become drunkards, but we will not. Nevertheless every drunkard, and especially every man weakened by drink, becomes such only after he has begun to drink. The doctrine, sedulously maintained by a certain class seeking an excuse, that "abstinence from
ao2 Personal Mygiena
fear of excess argues a defective moral power and is a species of cowardice," is false. As a rule, less strength of mind is exhibited in drinking, that is in yielding to inclination or persuasion, than in refraining. There are innumerable illustrations of youths, so taught at home, doubtless in good faith, by parents possessed with an undue confidence of self-control, who con- stantly recruit those ranks of the ultimately infirm. Some, alas women as well as men, condone occasional alcohohc dissipation as evidence of animal vigor, as a sign of spirit, and look with forbearance, if not with pride, even upon their sons and their brothers who allow the demands of so-called good-fellowship and vital en- ergy to overpower the mind and sicken the body. No one v^hose years are many but may recite a long list of those who began to drink during the newly-acquired freedom of undergraduate days, possibly encouraged by moderate example at home, and afterward filled unhon- ored graves. Almost every one can call to remembrance families distressed in various ways by the consequences of alcoholic intemperance, always from inconsiderable beginnings, and to some that distress may be nearer at hand. It is sadly true that few escape such a blot, either upon their living or upon those not long dead. It becomes every young man, above all every educated young man upon whom the responsibility of exam.ple also rests, not to add to the num.ber.
Some offer for themselves, some present for others, as an excuse the plea that heredity has set its stamp so that the sins and weaknesses of the fathers rest with
Alcohol 203
the children. It is a false plea. If a young man
suspects that he has inherited an unstable ^
. . Heredity
nervous organization, one poisoned by this
subtle venom, it is by so much his graver duty to avoid the slightest risk, both for his own sake and for those who may come after him, as well as for those to whom he is bound by the ties of interest and affec- tion. If one has a friend with such an ancestral strain, he should not add temptation to that burden. Still less may those in positions where authority and example carry weight, by offering the example or pre- senting the invitation to youths whose bodily, mental, and moral habits are in the determining stage, risk setting in operation that singular nervous law of habit and desire. Beer and wine open the road to spirits and further peril. No one, comrade or Lost, can know the vital history of all his acquaintances, nor against what they have to contend; and he has no right to risk spreading a net, even without intent, before uncertain feet. We are our brothers' keepers.
Index
PAGE
Abdomen, the 52
protection for 143
Absinthe 192
Acids, vegetable 147
Acne 121
Ague-cake 55
Air, blood made by 34
complemental 22
contaminated 34
night 34
residual 22
tidal 22
Air-passages, collapse of 20
straining of 19
Albuminoids 146
Alcohol, adulterations of 193
as beverage, maximum amount 186
body-heat and 185
brain, action on, of 189
depressant action of 190
digestion and 184
disease due to 194
influence upon, of 200
drinking, reason for 189
energy supplied by 185
in fatigue 187
Foster and Shore on 188
205
2o6 Index
PAGE
Alcohol as fuel 187
heat-centre depressed by 185
as medicine 184
morbific effect of 186
muscular work and 188
a narcotic 184
nervous system, action upon, of 195
oxidation of 150
paralysis of inhibition by 191
pathological action of 196
popular views of 183, 193
psychical effects of 189
in tuberculosis 200
wood 200
Alcoholics, heredity of 203
AlveoH of the lungs 18
Amaurosis from tobacco 171
Anatomy 2
Aniline dye 139
Ankle, the 9
Antiscorbutics 148
Appendicitis 54, 70
Appendix vermiformis 53
Areolar tissue 115
Arm, the 6, 23
Astigmatism 43
Astragalus, the 9
Atlas, the 4
Atmosphere, the 3^
contaminating gases in 34
makes blood. " 34
Auricles, the 25
Auto-intoxication 66
Automatic centres in the spine 45
Axis, the 4
Balance exercises 95
Baldness 116
Basket-ball 79
Bath, cold 130
Index
207
PAGE
Bath, hot joi
neglect of 132
Beans ir,-
Beaumont, William 64
Beer-drinking jng
Beer-heart 108
Beer-kidneys jng
Belts, waist 242
Benson, E. F y^
Beyer, Henry G 80
Bile, the e i-
Biscuit 1^3
Bitters 14^
Blackheads j2o
Bladder, gall r e
urinary eg
Blisters of the foot 122
Blood, the 104
amount of.
35
changes during circulation of loir
course of 25, 20
loss of, non-fatal ^e
nature of ^2
Blood-corpuscles, red .33,104
white.
104
Blood-vessels 29
Blushing 32, 115
Boating yg
Bones, the 2
centres of growth in ■,
Bowels, care of the 68
Brain, the 5> 38
action of alcohol on 180
centres of action in 4=1, 46
growth of ■^6
weight of 3Q
Bran 152
Bread, constitution of 71^2
as
food.
^■^1
heavy , 1^2
2o8 Index
PAGB
Bread, hot - 152
a proteid-carrier 153
stale 153
toasted 153
Breathing is blood-making 21
mechanism of 19
normal 86
Breathing-exercises 99
Breathlessness. ... 90
Bronchi 17
Bunions 10, 122
Callosities 122
Callus 3, 5
Cancer and tobacco 167
Calorie 150
Capacity, vital 22
Capillaries, the 3i> 35
of the lungs 18, 20
osmotic action in. . 31
Carbon, escape from the lungs of 112
Carbon dioxide 20, 32, 112
Carbon monoxide 169
Carriage, physical 92
Cartilage, costal 24
spinal 4
Celluloid as clothing 140
Centres, reflex nervous 42
Cheese, digestibility of 58
as food 156
Chest, the 22
contents of 23
defective 21
girth dwarfed by tobacco 177
importance of 23
pigeon-breasted 91
shape of 90
Chest-measurement » . . . 22
Chest-mobility 22
Chest-protector • 141
Index 209
PAGE
Children, inactivity as affecting loi
play required by loi
Cigarettes. 174, 179
adulteration of 174
Clavicle, the 5
CUmate, humidity an element of 117
Clothing, conspicuousness of 135
materials for 136
object of 134
odors absorbed by - 135
temperature as depending upon 134
w^et 126
Coccyx, the 7
Coecum, the 53
Coffee 160
Cold, alcohol in relation to extreme 185
catching 124
Colds, avoidance of 127
infectious 127
"little" 87
Collar-bone, the • 5
Collars 141
Complexion, the i iS
Constipation. 66
Consumption 24
Contests, over-strain in athletic 24
Control experiment, nature of 107
Convolutions of the brain 38
Cord, spinal 39
Cordials - 192
Corn-meal ^54
Corns « 122
Corpuscles, red 33> i°4
white 104
Cotton as clothing 136
Cranium, the 4
Craving 178
Cricket 78
Custom and tobacco 181
2IO Index
PAGE
Decaigne 172, 176
Depression and reaction 175
Dermis, the 114
Dewey, Edward H 58
Diarrhoea, character of 112
Diet, single 148
mixed 151
summary as to 161
Digestion 57, 63, 64
effect of alcohol on 184
tobacco on 176
gastric 63
nervous draft in 44
oral 57
Dilatation of the heart 84
Disease due to alcohol 194
Dislocation 12
Drawing impaired by tobacco 172
Drink, strong 183
Drinker, habitual 201
periodical 199
Drinking, moderate 197
Drowning 17
Dyes, aniline 139
in clothing 139
Ears, care of, in the water 129
Egbert, S 161
Eggs as food 155
Emphysema. . 20
Energy an attribute of the nervous system 146
transformation of , 16
Epidermis, the 1 14
Essences for spirituous liquors, , 193
Excitants 187
Execution, legal, by hanging 4
Exercise, advantage of 80
amount of 76
effect upon the lungs of 83
methods of 76
Index ^ii
PAGE
fixercise required for children. loi
vs. strength 74
Exercises, balance g6
breathing qq
general. . , gy
physical-culture , 95
Extremities, the 2
"Eye" in games. 46
Eye-strain 4^
Faeces. 66
Fasting, food after 144
Fat as food 147
Fatigue 106
alcohol in 187
demonstration of 107
food after. 109, 144
recovery from. ,. 109
rest after, log
sleep after 109
stimulants useless in no
Fear, reflex action in 45
Feet, care of the. 10, 11, 12, 123, 132
wet 142
Femur, the 9
Fencing . 78
Fibula, the. 9
Fish as food 1^5
Fissure of the anus. . 69
Flannel 138
Canton 138
"sanitary" 138
Flavor, recognition of 1^8
Flesh, excess of, in food hurtful 113
Folds of the brain 38
Food 144
albuminoif! 146
alcohol as 181;
fuel T87
classes of 145
^12 Index
PAGE
Food after fatigue .,.,.. 109
fats and oils in 147
heat yielded by 157
intemperance in use of 150
proteid. 145
in relation to sleep 145
survival without 158
variety required in 148
Foot, arch of the 10
ball of the 10
Football, Association 77
Rugby 77
simple 77
Forearm, the 6
Foster and Shore '. 188
Fracture. 12 '
Freckles 115
Furfural 194
Fusel-oil 193
Gall-bladder 55
Ganglia 40
Games 76
Gastric juice, function of 63
Gihon, A. L 172
Golf 78
Gould, G. M 43
Gray nervous matter 38, 47
Gristle 14
Growth as affected by cigarettes 177
exercise 81
Gullet, the 17
Gum, chewing 60
Habit, demand created by. 165
Habits 48
Haemorrhage, water in 62
Haemorrhoids ^ 68
Hair, the 116
gray 116
Index ±1^
PAGE
Handkerchief, the 87
Hanging, execution by. . . 4
Hat, the 140
Haunch- bones, the 6
Head 5
Heart, the 25
in relation to calibre of arteries 102
as affected by concussion 44
dilatation of 84, 102
exercise as affecting 84, loi
growth of , 26
irritable 30, 172
as affected by rheumatism. 28
strain 27, 84
structure of. 25
tobacco 172
Heat generated by foo.'.. 157
of body adjusted by radiation 157
Heat-centre depressed by alcohol 185
Heaves 20
Heredity in alcoholics 203
Hidrosis , 133
Hip-bones, the 8
Hockey 77
Hollander, B 39
Holmes, O. W , 38
Hopkins, S. A 72
Hot bath 131
Humerus, the 6
Humidity an element of climate 117
Hutchison, R 154, 159
Idiots, the brain of. . 38
Immaturity, physical 11
Impulse, rate of nervous 46
India-rubber as clothing. . 139
Indigestion, intestinal 60
Infants, the brain of 38
Innominata, the 7
Instep, the 8
St4 !nde3£
Intemperance in eating 150
Intestine, the large 53, 65
the small 53, 64
Intoxication defined 184
James, William 189, 190-1
Kidneys, the 51;
alcohol as affecting 114
inflammation of. 114
in scarlet fever 114
waste escaping from 112
La Crosse 79
Leather as clothing 139
Leg bones, the 9
Legs, the 23
Legumes, the 192
Ligaments, the 12
Linen as clothing 136
Liqueurs 192
Liquor, spurious 193
Liver, the 54
after alcoholic excess 150
circulation in. 54
urea formed in 150
Lung-membrane, the 18
area of 19
Lungs, the 18, 19
exercise as affecting 83
free from water during life 17
Lymph 105
Lymph-spaces 103
McSherry, Richard 172
Maisch, John M 172
Malted food 60
Mastication 57
Meals, number of 63, 144
Merino 138
Index 215
PAGE
Miles, E. H 75
Milk as food 155
■ skim 1 62
Mind, duality of the 38
Mouth-breathing 86
Mortality from alcohol 157
Muffler, the 141
Muscles, the 14
attachment of 11, 13
fibres of, torn 28
involuntary 15
striped 14
unstriped 14
voluntary 14
Mussulmans, abstinence of 184
Narcotic, definition of a. 184
Neck-wear 141
Nerve-cell, the 37
Nerve-cells, change in 47
Nerves, the 40
sympathetic, the 40
functions of 41
Nervous action repeats itself 47. 48
Nervous impulse, rate of 46
Nervous matter, gray 38
white 38, 47
restoration of 48
Neurasthenia 108
Nicotine, absorption of 168
action of, on muscles 15,173
effect on vaso-motor nerves 170
evidences of, visible 168
physical qualities of ■. 163
physiological action of 163
taken up by osmosis 169
Night air 34
Nitrogen in food 146
elimination of. 149
Nose-breathing 21, 86
2 1 6 Index
PAGE
Oat-meal 154
Obesity, alcoholic ■ 198
Oil as food 147
Oil of the skin 120
Oil-glands 120
Optic nerve and tobacco 171
Out-doors, to sleep 126
Over-strain in athletic contests 24
Oxygen 20, 33
Pancreas, the 5^
Paper as clothing 140
Papillae of the dermis 115
identification by 115
Pdte de foie gras 150
Pease 155
Pelvis, the 7
distorted 7
female 7? 56
Periosteum, the 3
Personal equation 46
Perspiration, the 117
absorption of the 137
controls bodily temperature 119
foetid II, 133
and woolen clothing 138
Phrenology 39
Physiology, definition of 2
Piles 68
Pipe, tobacco i73~4
Plexus, cardiac ^ 44
solar 44
Pores of the skin 117
Posture, abnormal 9^
normal rules for 94
Potato, the 154
Prostration, nervous 108
revival from 44
Protector, abdominal 143
chest 141
Index 217
PAGE
Proteids, the 145
digestion of 63
Punching-bag, the 79
Pulse, the 29
excitable 30
rate 30
Pyridine 163
Radius, the 5
Rectum, the 67
Reflex action 41, 73
centres 41
Respiration, mechanism of 19
modification 20
organs of 17
purpose of 20
rate of 21
Rheumatism, inflammatory 28
Ribs, the 5
Richardson, B. W 170, 176
Sacrum, the 7
St. Martin, Aleiis 64
Saliva, a digestive fluid 58
impaired by tobacco. 167
Salts, inorganic 147
vegetable 147
Scapula, the 5
Scarlet fever, the kidneys in 114
Scholar's stoop, the 92
Scholarship and tobacco 177
Scurvy 148
Sea-bathing 129
"Sea-salt" 129
.Sebaceous glanrls 120
.Second wind 89
Semen, the 56
Serge 13S
Shinny 77
•Shocks, n<;rvous suscc|)til)iiity decreased by 164
Shoddy 138
21 8 Index
PACE
Shoes 142
Shoulder-blade, the 5
Shoulders, round 92
Skeleton, the 2
Skill, advantages of acquired 40
Skin, the 114
oil of the 120
Skull, the 4
Sleep 109
after food 145
Smoke inhaled 167, 169, 175
Smokers' throat 167
Smoking 165, 181
after maturity 182
no evidence of manliness 181
Sparring 7&
Sphincter muscles i^
Spinai cord, the 39
automatic centres in 45
Spine, the 3
cartilages of 4
Spleen, the 55
Sprain 12
Staleness 187
Starch, digestion of 59
as food 146
Starvation, elements expended in 149
Stature, excessive 23
dwarfed by tobacco. 177
Stillg, Alfred 171-2
Stockings • 14^
Stomach, the 52
alcohol absorbed by 62
not be economized upon ._ - 162
water absorbed by 62
Strain 12
Strength distinct from energy 146
Sugar for athletes. 156
an energy-producer. = 156
as food 146, 156
Index ±1^
PAGE
Suspenders 142
Sweater, principle of the 138
Sweat-glands. 117
Sweetbreads 55
Swimming 80, 127
Switzerland, mortality after drinking in 197
Sympathetic nervous system 40
functions of 41
Table, character of the 162
Tea 160
Teeth, the 70
bacteria, action of, on 71
care of 72
decayed, reflex action from ,72
of savages 71
sugar, action of, on. . 71
tobacco, action of, on 71
Tendon 14
Tennis 79
elbow 7
Thigh-bone, the 7
Thirst 61
false 61
Thompson, W. G 166
Thumb, the 7
as a seal 115
Tibia, the 9
Tissue-waste and tobacco 123
Tobacco. . 163
advantages of 165, 181
arrests tissue- waste 173
cancer and 167
chewing 60
custom and t8i
deteriorates drawing 172
diminishes chest-girth 177
dwarfs stature 177
infjittmcnt of 176
irritates heart 172
220 Index
PAGE
Tobacco, harmfulness of i66
in moderation i8i
modes of using 173
motor nerves, action on ■ 171
optic nerve, action on. 171
pathological action of 172
physiological action of 164, 170
scholarship and 178
smoking 165, 181-2
trammels physique 177
in youth , 1 79
Toast. - 152
Toe, the great 10
Toe-nails, ingrowing 10
Toleration a nervous characteristic 164
Toothache, tobacco in 166
To.xaemia, alcoholic 196
Trachea, the • i7. 19
automatic closing of 17
Training, how to break. 24
Tripe - 52
Trousers - 142
Ulna, the • • 6
Underwear, woolen 138
Urea • • . • ■ 149
Urinary bladder. . . ., 56
Urine, daily amount of .55, 113
Valves of the heart. - - • 26
Vegetable acids and salts 147
Ventricles, the - 25
Vermiform appendix 53
Vertebrae . 3
Vesicles, air 18
seminal • • • 5^
Vital capacity 22
table to determine 23
Voice, the nasal • ■ • 88
Index 221
PAGE
Walking for exercise - 80
"Warming up" 81, 89
Warts 121
Washing 131
Waste, elimination of , 1 1 1
by the lungs 112
by the kidneys 112
by the sweat-glands 117
formed in the liver 1:3
Water , 157
absorbed by the clothing. ... 137
not absorbed by the skin 1 20
in the diet, function of 158
quantity of 157
distilled 159
escape from the stomach of. . ■^j^*' 62
in haemorrhage 't'**^\- - • 62, 158
hot, a cerebral stimulant >. 161
ice '. , 159
at meals 62, 158
survival without 158
at the training-table 158
while walking, to drink 61
Watson, Thomas 37
Weight, normal 23
White nervous matter 47
Whitehead, W. R 7
Wind, second 89
Wind[)ipc, the 17
cutting the 19
Wood alcohol 200
Wool as clothing 137
Work, muscular 16
alcohol in 188
Worsted 138
Youth and tobacco 1 79
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