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Personal hygiene applied.
3 1924 003 489 998
B Cornell University
f Library
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http://www.archive.org/details/cu31924003489998
Personal Hygiene
Applied
By
JESSE FEIRING WILLIAMS, A.B., M.D.
Associate Professor of Physical Education, Teachers
College, Columbia University
ILLUSTRATED
PHILADELPHIA AND LONDON
W. B. SAUNDERS COMPANY
1922
-Copyright, 1922, by W. B. Saunders Company
Reprinted October, igaa
MADE IN U. 8. A.
PRESS OF
W. B. SAUNDERS COMPANV
PHILADELPHIA
TO MY WIFE
Team Mate in the Game
To Live Most and to Serve Best
PREFACE
The aim of this book is to improve the quality of human
life. It is evident from the title that this aim seeks its
goal by means of hygiene, but it should be clear also
that no mere recitation of informational hygiene can be
justified if the aim is to be achieved. To improve human
living one must not only set forth the rules of health but
also one must bring them in contact with that deep and
ever-flowing source of human action where ideals, ambi-
tions, attitudes, prejudices, hopes, and aspirations are
bom. To find the scientific rule for health is not more
important than to touch the mainspring to action that
will give life and meaning to the rule discovered.
The interest in health today is very great. In propor-
tion to its importance and in relation to past appreciations
health is not overvalued. But we should be careful not
to appraise it too highly as an isolated value. Oftentimes
we make it too prominent as an end; then it protrudes too
much and mars the whole of life. To recognize that it is
of meaning and significance only in its relation to other
values is tremendously important today. Three of the
finest things in life — heroism, creative work, and child-
bearing — are often injurious to health. To avoid battle
for the right, or to forsake productive work, or to miss
parenthood because of the toll in health that these things
take twists and warps life and mixes values woefully.
The sacrifice of health in personal, selfish, and unsocial
ways can never receive sanction. Contrariwise, the scars
from the "strenuous and dangerous activities of helping
to create" a new rule of right and justice, "a new har-
mony or a new child" are symbols of the divine. Health is
more than perfect digestion, more than perfect bodily
functions. To find what more it is constitutes an impor-
tant part of the problems of hygiene.
10 PREFACE
The first five chapters consider the various aspects of
this problem — ^the meaning of health in terms of life.
The treatment is not complete. No one recognizes their
inadequacy more than the author. To write a philosophy
of life in terms of aims and goals, and to tie such philos-
ophy up with the immediate, thrusting appeals of the
moment, as the problems, in human living are revealed, is
more than this can claim. Rather, I must be content to
sketch certain points of view, to hazard a hope here and
there, to suggest ideal guides, to inveigh against palpably
false ones, and everywhere to emphasize the identity of
hygiene with life and the necessity for knowledge to flow
into action. Therefore, to insist that hygiene can never
be, for life purposes, an academic subject to be learned
merely, and to hold with real conviction that it is useful
only as it is lived, have been controlling guides here.
The remaining chapters consider in a systematic way
hygiene from its scientific side. The finest ideals in the
world cannot prevail against an infected lung; science
with her torch will always be needed to illumine the
processes of life. For discussion purposes, however, the
treatment has been systematic. This has its advantages,
obviously. Its disadvantages, while indirect, are no less
real. Life does not manifest itself in circulatory, nor in
muscular, nor in nervous pathways alone. The unity of
mind and body preclude that. It is always vain to force
the living into set molds. "All the molds crack. They
are too narrow, above all, too rigid, for what we try to put
into them." To preserve the unity and harmony of life
has been attempted throughout. Nevertheless, the dis-
advantage of such organization remains unless the reader
sees beyond the boundary lines.
The book aims to be scientific and accurate according
to the latest information available. It has tried to avoid
propaganda, to convert, or to get people to follow a scheme.
It has aimed to present facts in human experience, to
establish science and intelligence as guides, and to replace
superstition, cults, fads, tradition, and certain instinctive
PEEFACB 11
responses with truer counsellors. In this respect it is
expressing a dominant mood in education today and takes
its position courageously, asking that truth shall decide,
let the results seem what they may.
This book is planned for college students. Not only
to students of health does it seek to present its case but
also to students of sociology, philosophy, and education.
There are reciprocal values to be found in the touch with
other fields. Hygiene has been in need of a sociologic
point of view, a philosophic approach, and educational
standards that would stimulate careful instruction and
would deserve credit in university and college curricula.
Education in special fields for other reasons needs to con-
sider the problem of human health and biologic problems
in living. "Health in Education and Education in Health"
is a significant slogan.
It is hoped that this book may not be constricted to
the school or college field. Physicians, teachers, nurses,
social workers require a book which they may recom-
mend to parents or patients in need of .guidance for
living. The emphasis on the mental and social aspects
of health, as well as the physical, suggests its usefulness in
facilitating social adjustments.
Health results from living in the proper way. It flows
from life as a by-product of actions, responses, or con-
ditions that are wholesome. So that whether in college
or out, the problems of human living remain essentially
the same : to adjust a rather primitive, biologic organism
to a complex civilized society, and to shape society to
provide for man's essential biologic and social needs.
The view held for this problem of human adjustment is
that one should first face the problems and then try to
meet them squarely and honestly, paying whatever price
is required. Therefore, I have spoken vigorously against
the bankrupt methods that aim "to beat the game," to
find a short cut, or to seek a royal road.
I am glad to acknowledge my indebtedness to students
and colleagues for help in the preparation of this book.
12 PREFACE
The former have been stimulating questioners; the latter,
the kindest and most helpful of critics. I wish to acknowl-
edge here my indebtedness to Dr. T. D. Wood, a pioneer
in the problems of health instruction. I bear to him the
homage and respect worthy of a grateful student to a
great teacher. To Professor H. C. Pearson, who has given
many helpful suggestions, to Professors M. S. Rose and
W. H. Eddy, who have proposed many good points in the
chapter on nutrition, to Professor M. A. Bigelow and Dr.
E. E. Foster, who have read the entire manuscript, giving
a keen criticism of form and content, I am under deep
obligation.
In particular, at this time and place, I desire to thank
Professor William H. Kilpatrick who has guided me
through two writings of the first five chapters. For his
invaluable criticism I am greatly indebted.
Citations and quotations from numerous sources are
indicated in the footnotes of the text. These references
are suggestive of helpful material for further study along
the lines indicated. For permission to quote I am greatly
indebted to the pubhshers concerned. I wish to take this
opportunity to acknowledge this permission granted and
to express my appreciation of the courtesy extended by
Abingdon Press, D. Appleton & Co., P. Blakiston's Son
& Co., Curtis Brown, Ltd., The Century Co., Dodd,
Mead & Co., Funk & Wagnalls, Henry Holt & Co.,
Houghton Mifilin & Co., J. B. Lippincott Co., John W.
Luce & Co., The Macmillan Co., Princeton University
Press, W. B. Saunders Co., Chas. Scribner's Sons, Seeley,
Service & Co., Teacher's College, John Wiley & Sons,
Williams & Wilkins Co., and William Wood & Co.
What I owe to others in these matters is very large.
However, the errors, where they occur, are mine.
Teacher s College, Jesse FeikiNG WiLLIAMa.
Columbia University,
New York City,
July, 1922.
CONTENTS
CHAPTER I
The Meaning op Health 17
A Definition of Health, 17 — The Definition Examined, 20
— What Really Defines Health, 22 — Forces Defining
Health Today, 22— To Live Most and to Serve Best, 26.
CHAPTER II
The Health Problem 28
The Nation's Vitality, 28 — Factors in the Health Problem,
35 — Heredity as a Factor, 36 — Environment as a
Factor, 37 — The Individual as a Factor, 39.
CHAPTER III
Intelligence and Ideals 45
Stages in Human Conduct, 45 — ^Forces Determining Hu-
man Conduct, 46— The Force of Intellect, 48— The
Failure of Instinctive Guides, 48 — Intellect and Ideals,
50 — ^The Problem of Health and Ideals, 54 — A Social
Ideal, 55 — ^An Ideal of Social Responsibility Arises
Out of the Nature of Life, 57 — An Ideal of Social Re-
sponsibUity Serves All, 60 — ^The Significance of Social
Pressure in Relation to Ideals, 61.
CHAPTER IV
The Approach for Knowledge op Health 64
The Science of Hygiene is Based on the Facts of Man's
Nature, 64 — "The Biologic Basis of Life, 65 — Evidence
from Biology a Guide for Hygiene, 68 — ^The Human
Body and Its Adjustment, 71 — ^The Human Body an
Energy Mechanism, 71 — The Value of the Biologic
View, 78— The Test of Hygienic Knowledge, 80.
1 13
14 CONTENTS
CHAPTER V
FAOB
Science and Attitudes 82
The Dual Aspect, 82— Science and Health, 83— The Posi-
tion of the Christian Scientist, 84 — What is Osteop-
athy? 98— The Call of the Occult, 99— Scientific and
Humanistic Principles Confused, 101 — Facts and
Superstition, 103 — ^The Challenge of Scientific Medi-
cine, 107 — Man, The Organism, 110.
CHAPTER VI
Hygiene op the Muscular and Skeletal Systems 113
Hygiene of the Muscular System, 114 — Place of Movement
in Human Development, 114 — Significance of Move-
ment and Consciousness, 116 — Habits of Muscular
Activity Characteristic of Different Stages of Human
Development, 116 — Beneficial Effects of Rational Ex-
ercise, 119 — Injurious Effects of the Sedentary Life,
121 — Adaptation of Exercise, 123 — Relative Value of
Different Activities, 130 — Habits of Exercise, 144 —
All the Factors in Health Important, 144r— Hygiene of
the Skeleton, 146— The Matter of Posture, 146— Pre-
vention of Common Skeletal Deformities, 150 — Causes
of Foot Weakness and Deformity, 151 — ^Points of a
Good Shoe, 161 — Flat-feet, 162 — Exercises for Weak
or Fallen Arches, 152 — Perils of Maturity, 153.
CHAPTER VII
Hygiene op Nutrition 155
Sources of Energy, 156 — Digestion, Assimilation, and Nu-
trition, 156 — Caloric Values of Different Articles of
Food, 158 — Classification of Food, 158 — How Vita-
mins Affect Nutrition and Growth, 165 — Foods and
Vitamins, 166 — Destruction of Vitamins, 168 — Min-
eral Salts as a Dietary Essential, 170 — Composition of
the Body in Terms of Elements, 171— The R61e of
Mineral Salts in Food, 171 — The Mineral Salts and
Body Reaction, 177 — The Hygiene of Nutrition, 178
— Causes of Indigestion, 189 — ^Fads and Fallacies in
Diet, 190— Food Adulteration, 194— Alcohol, 197—
Coffee, Cocoa, and Tea, 199.
CHAPTER VIII
Hygiene op the Respiratory System 201
The Essentials of Respiration, 201 — Desirable Tempera-
ture — Proper Methods of Heating, 205 — Proper Hu-
CONTENTS 15
Hygiene of the Respibatort System (Continued) page
midity and Means to Secure It, 207 — Air Movement
and Means to Secure It, 212 — Control of Dust and
Dirt, 213— Bacteria in Air, 214— The Value of Sun-
light, 215 — Nature's Plan for Respiration — The Res-
piratory Tract, 216 — The Matter of Breathing Exer-
cises, 217 — Health of the Respiratory System, 221 —
Colds, 222— Tonsils, 225— Adenoids, 226— Hygiene of
the Voice, 227— Tuberculosis, 229.
CHAPTER IX
Hygiene of the Circulatoky System 239
The Importance of the Circulation, 239— The Blood, 242
—The Vessels, 268— The Heart, 271— The Conva-
lescent Heart, 273 — The Influence of Poisons Upon the
Heart, 274— The Influence of Tobacco, 274.
CHAPTER X
Hygiene of the Excretory System 279
Plan of Discussion, 279 — Nature and Function of the
Skin, 279— Care of the Skin, 281— The Complexion,
286— Care of the Hair, 290— Care of the Nails, 291—
Care of the Hands, 292 — Pointed Paragraphs, 293 —
The Clothing of the Body, 296— Elimination of Body
Waste by the Kidneys, 301 — ^Keeping the Kidneys
Efficient, 301 — ^Injury of the Kidneys by Disease, 302
— ^Kidney Remedies, 303 — Medical Examination, 305
— Intestines as Organs of Elimination, 306 — Causes of
Constipation, 307.
CHAPTER XI
The Hygiene op the Nekvotts System 309
The Nature of the Nervous System, 309 — Factors of Im-
§ortance in Maintaining the Health of the Nervous
ystem, 313 — The Normal Mental Life, 319— Worry,
320 — Development of Wholesome Mental Habits, 327
— Insanity, 331 — ^Alcohol and the Nervous System,
335.
CHAPTER XII
Hygiene of the Sexual Aspects of Life 338
A Difficulty of Terminology, 338— The Sex Instinct in
Life, 339— New Interpretations of Sex, 341— The
Institution of Marriage, 342 — Menstruation, 344 —
Pregnancy, 344 — The Social or Venereal Diseases, 344.
16 CONTENTS
CHAPTER XIII
PAGE
Prevention in Specific Diseases 348
The Emphasis of Hygiene, 348 — The Universal Distribu-
tion of Disease, 348 — ^T3Tpes of Disease, 349 — Causes
of Disease, 349- — ^The Transmission of Disease, 351 —
The Prevention of Disease, 351 — Prevention of Com-
municable Disease, 354 — Prevention of Nutritional
Disease, 366 — Prevention of Acute Poisoning, 368r—
Prevention of Chronic Degenerative Disease, 369 —
Prevention of Fimctional Disease, 369 — ^Prevention of
the Local Infections, 370 — Prevention of Cancer, 370
—What Are the Chances? 372— Summary, 374.
CHAPTER XIV
Hygiene op the Mouth, Eye, and Ear 375
Hygiene of the Mouth, Nose, and Sinuses with Reference
to Specific Infections, 375 — Septic Infections, 375 —
Portals of Entiy, 376— Teeth, 376— Tonsils as Foci of
Infections, 380— The Nose and Sinuses as Foci of
Infections, 382 — Mouth-washes, Sprays, and Gargles,
383— Hygiene of the Eye, 383— The Eyes Need Care,
383— How to Care for the Eyes, 384^-The Cause of
Eye Defects or Disturbance, 386 — The Use of Drops
and Other Treatments, 387 — Common Disorders of
the Eye, 388— Hygiene of the'Ear, 391— The Ear Needs
Care, 391— How to Care for the Ear, 391.
Index 395
PERSONAL HYGIENE APPLIED
CHAPTER I
THE MEANING OF HEALTH
I. A Definition op Health
II. The Definition Examined.
III. What Really Defines Health.
IV. FoBCES Defining Health Today:
1. The Influence of Leaders.
2. The Influence of Organizations.
3. The Influence of the Life of the People.
V. To LrvE Most and to Serve Best.
A Definition of Health. — Health is defined in dictionary
and encyclopedia as a condition of physical soundness, or
as a condition in which the organism discharges its
functions efiiciently. The word "health" is derived from
the Old English word hodth, the condition of being safe
and sound. Today, in the minds of most people, health
has this historic meaning and is considered merely as
freedom from disease.
There is in this definition of health, as freedom from
disease, no appreciation of the varying degrees of health-
fuhiess among those usually classed as well, and no imder-
standing of the heights that could be attained in human
health and Hving if all the available means for improving
health were employed. One need be only a casual ob-
server to recognize that a great niunber of people are
living below their best level of attainment. Many persons
beheve themselves healthy because they are not sick in
bed, and this lack of appreciation of health as a quality of
life prevents the realization of a greatly superior type of
life. It is, perhaps, impossible to say how far any in-
dividual could progress in achieving a finer and higher
2 17
18 PERSONAL HYGIENE APPLIED
level of living. It is not too much to say, however, that
health, as an idea, should imply more than freedom from
disease. Such broadening of the idea would bring not only
increased health values but also desirable social values.
It is of value to think of health as that condition of the
body that makes possible the highest enjoyment of life,
the greatest constructive work, and that shows itself in
the best service to the world. It involves keeping the
body and mind at the highest levels, living at one's best
and not being satisfied with mere absence from the hospital
and sick room. This concept of health, moreover, parts
company with that idea of health which takes it as an
end of hfe. It refuses to consider as healthy the individual
who employs a wonderful physical body for purely selfish
and socially undesirable ends.
Such a doctrine as "health for health's sake" is entirely
unsatisfactory. Health is not an end in itself except for
the individual sick in bed, and then he desires only to free
himself from his disease and "to get well."^ "Health for
health's sake" is similar to such sayings as "sport for
sport's sake" and "art for art's sake." All of these say-
ings err in making an end of the subject. Sport is of value
and should be pursued not for the sake of sport, but for
the sake of the training of mind, body, and spirit that
comes in contesting in a fine way with one's fellows. Art
for the sake of art is mere superficiality and pose. Art
is significant because it portrays in imperishable marble,
canvas, music, or written word the finest emotions and
thoughts of the human race. Health is of significance in
proportion as it denotes a condition of the whole organism,
expressing its functions in joyous play, satisfying work,
and needed service to others.
Health may be defined, therefore, as the quality of life
that renders the individual Jit to live most and to serve best.
The meaning of "to live most and to serve best" cannot be
expressed readily. Such things can rarely be defined
1 Cabot, R. C. : What Men Live By, Houghton Mifflin Co., Boston.
1914.
THE MEANING OF HEALTH 19
acceptably in words. To try to do so would be like an
attempt to define the term "a good life." Phrases of this
kind are to be defined best in terms of personality. The
person is the definition of the term whenever the term
includes the ideals and aspirations of the human heart.
Roosevelt, in The Strenuous Life, Guhck, in The Efficient
Life, and Pastor Wagner, in The Simple Life, set standards
of living that have health imphcations, but neither Roose-
velt, nor Gulick, nor Wagner defined the life that seemed
to them so good. For some "to live most and to serve
best" will mean one thing, for others it will mean some-
thing else. The world may well hope that more and more
men will give to it a human and social meaning, a mean-
ing founded in truth and fuU of good will to all.
Such a definition of health is broad, but it omits no
aspect of life, nor does it include too much. It must be as
wide as Kfe, because life is more than digestion, circulation,
or nerve response. The physical aspects of health must
be interpreted along with the mental and the social. The
accumulating evidence from hospitals, social service
bureaus, and physicians themselves testifies to this unity
of life. The causes of ill health and disease are social and
mental as definitely, though not so frequently, as physical
causes. Moreover, such definition asks that life be
thought of as a whole. Physicians know that they may
not speak of the health of the heart and omit other organs
from consideration. Viewing hfe as a whole and not as
made up of dissected parts does not mean neglect of the
physical. Rather it demands even more clearly that
physical vigor be considered fundamental. It only asks
that body serve mind and spirit; that the "temple of the
soul" be a servant, ready and trained to serve high causes
and noble ends.
This broadening of the concept of health is justified by
Hfe. In the final analysis vigorous body and keen mind
are of the highest value in proportion as they serve the
highest causes. The test of body and mind is the test
not of weight lifting nor of mental gymnastics, but of
20 PERSONAL HYGIENE APPLIED
meeting the crises of life in such a way that a distinct
advance has been made either for the individual or for
society, or both. The ultimate test is the way in which
health is used; it is the test of conduct, because in this test
the physical and the psychical are subjected to the greatest
pressure. The highest and best expressions of conduct
wiU be seen when the sound body and the sound mind
form the spring from which the action flows. This test
is well illustrated by Paton' when he says, "Any person
who is familiar with the most elementary laws governing
human behavior recognizes that the chief test of a sound
mind in a sound body is the ability to act in a crisis."
It is helpful to think of health as a quality of life
capable of enrichment or deterioration. How fine a
quality may be obtained by any individual is unknown,
but the degree of health possible with rational knowledge,
attention, and effort is considerably higher for every
person. Health as freedom from disease is a standard of
mediocrity; health as a quality of life is a standard of in-
spiration and increasing acMevemeni.
The Definition Examined. — ^The definition of health as
the quality of life that renders the individual fit to live most
and to serve best has not hitherto enjoyed any wide accept-
ance. This is true for several reasons. In the first place,
people are not well informed of the way health is secured
and maintained. The home has not been prepared nor in-
clined to instruct in matters of health and the pubhc
schools have only recently been willing to accord hy^ene
a place in the curriculvim. The ignorance of the people in
matters of body structure and function has made easy
the way for charlatans, quacks, and fakirs by clever ad-
vertising to sell their spurious health preparations and
prescriptions. Indirectly flowing out of such a situation
is a great amount of harm, misinformation, and false
guides. One advertisement reads: "Eat what you want,
drink manacea water and digest it." It should be noted
that even if manacea were efiicacious as a digesting water,
> From a letter to the New York Times, July 10, 1917,
THE MEANING OP HEAiyTH 21
the teaching of the advertisement is directly contrary to
all that is important in personal hygiene. It may never
be advisable for any person to eat what he wants; it fre-
quently is very undesirable for him to do so.
In the second place, this definition of health is not widely
accepted because people are so greatly interested in
economic and social success that they are unduly willing
to sacrifice health for the rewards of work. Many busy
men are unwilling to practice hygiene because they say
they have no time for it. Professional and business people
generally trade too much of vitality for work in careless,
inefficient, and wasteful ways. For some, service is such
an inspiration that they hterally wear themselves out in
its pursuit. Service should never mean suicide, although
there may be emergencies when service demands the
sacrifice of life. One is only fit to serve, even as one is
only fit to work, as one keeps oneself prepared to live most
and to serve best.
And finally, this definition has no imiversal appeal be-
cause people lack a philosophy of life that would keep
values in proper proportion, that would see straight, and
that would Hnk the part to the whole, the personal to the
social. The vain effort to buy happiness and to buy
recreation is expressive of the same fruitless beUef — ^that
personal health can be bought for a price. Pubhc health
is purchasable in the sense that sufficient money for
adequate sanitation will control the transmission of com-
mimicable disease, but personal health cannot be bought
by appropriations of money. It can only be possessed by
spending time for the care of the body, by selling some-
thing of work for recreation, by giving of self in objective,
disinterested work for others. It is important to re-
member that one always pays. To achieve vitality,
strength, personal efficiency costs something that must be
taken from work, from instinctive pleasures, or from in-
dulgence of imwholesome habits. There is no way "to
beat the game" of life. The stream of Hfe will be rich,
abundant, lasting in proportion as the sources which con-
22 PERSONAL HYGIENE APPLIED
stantly nourish it are flowing. And these sources are
neither magical nor mysterious. They belong to every
man and, briefly, are, fresh air, food of proper kind and
amoimt, wholesome exercise and recreation, proper habits
of posture and care of the body, avoidance of alcohol and
other poisons, and proper attitude of mind.
What Really Defines Health. — The examination of the
definition proposed shows that health cannot be defined
academically. No writer on hygiene can do more than
indicate desirable guides and the path of his discussion.
For most people health is defined by the ideas and ideals
of the periods in which they live. The Athenian Greek
subjected to the standards of harmony and beauty in
Greek life, the Roman citizen in the grasp of militaristic
virtues, the ascetic, a pale and palhd product of the
monastic system, were all definitions of health in terms of
the ideas and ideals of their times and places. Simon
Stylites "rotted with the dew" because for him there was
no inspiration in health and vitality. Wherever the
monastic system and the scholastic philosophy touched
hfe they withered it. The ideas and ideals of the time and
place make the definitions of life.
Forces Defining Health Today. — The old ideas have
little sanction today. The scientific and the historic
studies have rewritten the story of human life. With
new emphases, health has new meanings. The civilized
nations are getting away from the ideas of asceticism with
its contempt for the physical. We, in America, have
never had the militaristic virtues, and the workings of
beauty have been too little known. More characteristic
of our age and land are the developing social conscience
and the increasing sense of social responsibility.^ This is
no passing mood, but a tendency of deeper growth. It is
hardly necessary to say that it is filled with rich possi-
bilities for the improvement of life physically, mentally,
and socially.
'King, H. C: Rational Living, The MacmiUan Co., New York,
1907, pp. 99-102.
6lE MEANING OF HEALTH 23
The Influence of Leaders. — This sense of social re-
sponsibility is expressing itself through leaders, through
organizations, and through the life of the people. It has
given us great leaders to define health in terms of Uving,
as it should be defined. The immortal Eoosevelt with the
out-of-doors upon him, the beloved Burroughs singing his
songs to the accompaniment of nature's harmonies, have
pointed out the way. Leaders and teachers everywhere
are stressing in their lives and in their works social re-
sponsibihty.
The movement for the conservation of our natural re-
sources is a part of this mood; and the people are saying,
"More precious than mines, or rivers, or forests is the
health and vitality of the nation."' Fisher's "Report on
National Vitahty,"^ the revelations of the Selective
Service Act,' and lessons from the World War in many
fields of life have stimulated a growing appreciation of the
social significances of ill health with a better definition re-
sulting. As illustrative of the power of these forces in our
life today witness the report^ of the commission for the
sttidy of secondary education of the National Education
Association. This report, "The Cardinal Principles of
Secondary Education," sets forth health as the first of
seven objectives for secondary education. Educators
have ceased talking of education only in intellectuaUstic
terms and have begun to consider health as a cardinal
principle of education.
The Influence of Organizations. — ^Numerous organiza-
tions have sprung into existence in response to this mood
of social responsibihty for health. WeU-estabUshed
agencies have become increasingly active. Child health
has been particularly the concern of many recent move-
1 Winiams, J. F. : The Conservation of the Nation's Most Valuable
Resources, Educational Review, November, 1918.
* Fisher, I.: Report on National VitaHty, Bulletin 30, Govern-
ment Printing Office, Washington.
'Final Report of the Provost Marshal General, Government
Printing Office, Washington, 1920.
* Bulfetin No. 35, 1918, Bureau of Education, Department of the
Interior, Washington.
24 PERSONAL HYGIENE APPLIED
ments. The Child Health Organization, the National
Tuberculosis Association, the Joint Committee of the
American Medical Association and the National Educa-
tion Association, and the National Child Health Council
are doing splendid service in propaganda, teaching, and
setting of standards, based upon careful study of con-
ditions and needs. The older organizations, such as the
Children's Btu^au of the Department of Labor, the
American Eed Cross, the National Child Welfare Associ-
ation, the Life Esrtension Institute, the American School
Hygiene Association, the Elizabeth McCormick Memorial
Fund, and other foundations, are co-operating in many
programs for the conservation and improvement of
human health. Boards of Health, State Departments of
Health, and the United States PubUc Health Service are
raising standards and thus helping to define and give
meaning to health.
The Influence of the Life of the People. — ^But even more
powerful than leaders and more extensive than the work
of organizations is the influence of society itself as ex-
pressed in the actual hfe of its members. The customs
and mores of the people are reaching higher levels. Much
remains to be done, both in social and in personal effort,
but there are, nevertheless, signs of an open trail to better
health. The interest in play and recreation, the out-of-
door and camping customs so recently developed, the
improvement in dress, and the increasing education of
children in hygiene are favorable signs, indeed. The hope
that William James* expressed some years ago is being
fulfilled: "I hope that here in America more and more the
ideal of the well-trained and vigorous body will be main-
tained neck and neck with that of the well-trained and
vigorous mind as the two co-equal halves of the higher
education for men and women aUke. The strength of the
British Empire hes in the strength of character of the
individual English man, taken all alone by himself, and
'James, William: Talks to Teachers on Psychology, H, Holt &
Co., New York, 1916, p. 205,
THE MEANING OF HEAI/TH 25
that strength, I am persuaded, is perennially nourished
and kept up by nothing so much as by the national worship,
in which all classes meet, of athletic outdoor hfe and
sport."
At one time intentional physical education in America
was linoited to the stilted and artificial exercise of the
German and Swedish systems of gymnastics. These
systems never really stirred the spirit of the people. Im-
pregnated with the spirit of the older European institu-
tions, they had httle in common with our democracy and
the social ideals shaping this nation. A militaristic ideal
incorporated in the schools and taught from pulpit and
platform might do for us what it did for Germany in the
development of physically strong, docile minded in-
dividuals, but such an aim would run counter to the
dominant trait of the American people and could only be
achieved by the destruction of democracy and its in-
stitutions of freedom. This type of physical education
has largely yielded to a better. In its place there has been
a phenomenal growth in play and all forms of athletic
sports and games. Not all the growth, sad to say, has been
wholesome. The athlete has shown too frequently in
competition, and especially in the professional field, the
absence of those social and moral qualities of paramount
importance today .^
The absence of the educational point of view in the
management of school and college athletics and the em-
phasis on the professional, spectacular, and exhibitive
elements are to be deplored. The activity of alumni
primarily interested in "putting the college on the athletic
map" has made questionable contributions.
This movement for play and physical activity, wide-
spread though it is, is not yet everywhere appreciated and
respected. In many respects the hberal arts colleges are
stiU breathing the breath of scholasticism in the theory
that guides their cultural education. The pressure of
1 Williams, J. F. : The Education of the Emotions, Teachers Col-
lege Record, May, 1920, pp. 201-216,
26 PERSONAL HYGIENE APPLIED
studies, the long hours demanded in laboratory and class
room leave no choice for the youth to be anjrthing else but
anemic and physically weak. There is no comprehensive
scheme in the minds of many who lead in educational
matters to provide for that broad training of the body
that results in characters of force, initiative, and noble-
ness. It should be remembered that the "bookworm"
who neglects his physical needs is to be condemned equally
with the athlete who neglects his mental growth. This
neglect of the physical in education not only deprives the
youth of opportunity for wholesome growth, but by failure
to teach habits of exercise in purposive play and games it
lays the foundation for further physical deterioration in
adtilt hfe through inability to use and to enjoy the physical
means of recreation.
To Live Most and to Serve Best. — Health as a quality of
life is a challenge to all leaders, to all organizations, to all
persons, everywhere, to interpret health in terms of
service. The definition given at the beginning of this
chapter claims recognition from aU those who now seek
merely the hberation of man from disease, from inefl&ciency,
from physical weakness, and degeneracy. It asks that
personal and social effort to improve health, to eradicate
disease, to enrich the processes of life shall be directed
constantly toward the purpose of hfe itself as that may be
understood. Not health, but hfe itself; to hve most and
to serve best, this is the goal.
Cabot^ is sounding the same note when he says: "As-
suming that in everyone there is an infinite and restless
desire to get into the life of the world — ^to share any and
all life that is hot and urgent or cool and clear — we can
tackle this infinite task in two ways:
"By trying to understand the universe in the samples of
it which come to our ken, and to draw from these bits of
knowledge which typifies and represents the whole. That
is science.
• Cabot, R. C. : What Men Live By, Houghton Mifflin Co., Boston,
1914, pp. 84, 85.
THE MEANING OF HEALTH 27
"By trying lo serve. When we try to serve the world
(or to understand it) we touch what is divine. We get our
dignity, our courage, our joy in work because of the great-
ness of the far-off end always in sight, always attainable,
never attained. Service is one of the ways by which a
tiny insect Uke one of us can get a purchase on the whole
universe. If we find the job where we can be of use,
we are hitched to the star of the world, and move with it."
CHAPTER II
THE HEALTH PROBLEM
I. The Nation's Vitality:
1. Losses that Cannot Be Easily Stated.
2. Estimated Losses.
3. Revelations ofthe Selective Service Draft.
II. Factors in the Health Problem.
III. Heredity as a Factor.
IV. Environment as a Factor:
The R61e of Legislation.
V. The Individual as a Factor:
1. The Necessity for Education.
2. Lack of Education.
3. Health Rules Violated Because of Ignorance or Indiffer-
ence.
4. The Dynamic Force of an Ideal.
The Nation's Vitality. — In the last few years there has
been a great deal of interest in the conservation of our
national resources. There have been sufficient reasons
why we should conserve our national wealth, and a great
many people have been interested in conserving forests,
water power, and national mines. But there are many
sources of national wealth. From a broad standpoint the
greatest resource of the nation is the health of the people.
The loss that accrues yearly in this part of our wealth is
more dangerous and more terrible for the welfare of the
nation than the loss that comes in the exploitation of our
forests and mines.^
In the report on "National Vitality,'"' elsewhere re-
ferred to, preventable sickness and preventable deaths
have been estimated. Fisher states that about 42 per
cent, of the deaths of persons in the United States could
' Williams, J. F. : The Conservation of the Most Valuable Re-
sources of the Nation, Educational Review, November, 1918.
* Fisher, I. : Report on National Vitality, Bulletin No. 30, Govern-
ment Printing Office, Washington.
38
THE HEALTH PBOBLEM 29
be prevented or potsponed "if the knowledge now existing
among well-informed men in the medical profession were
actually applied in a reasonable way and to a reasonable
extent."
That sickness and death are at time unnecessary and
are preventable is well known. This fact, however, is
based upon scientific preventive measures and in no way
is allied with the mistaken view that ignores matter and
denies disease. Contrariwise, it is the plainest matter of
statistics and common sense observation that the nation's
vitality is wasted by lack of application of the available
preventable measures of science.
In terms of morbidity and mortality rates (see Table I,
pp. 30, 31) the resources of the nation are squandered more
recklessly, more continuously, and more surely in peace
than in war. The peace losses are not so dramatic, but just
as significant. We are inchned to speak of the tremendous
loss of life in war, and we are horrified by such disasters
as the Titanic, and the ones at Halifax and Mt. Pelee.
Because of custom and traditional behef that babies die
easily we have grown careless about the loss of life below
the age of five (Fig. 1, p. 32). The significance of this loss
in England has been pointed out by George Bernard Shaw in
an address on the Nation's VitaUty. He is quoted in part:
"If we take the nimiber of babies conceived in the womb
of the women of this nation and who ought to be born, we
have 938,000. The number that succeeds in getting born
is about 800,000. This is not a good beginning. It means
that 138,000 have not sufficient vitality to get themselves
born; it also means that the mothers were not properly
fed and properly instructed. Of the 800,000 who do
manage to enter the world, 100,000 die before they are
one year old. This means dirty milk or no milk at all —
slums, bad food, ignorance. We lose 100,000 before one
year of age; we drop another 100,000 before the age of
fifteen, just when they are becoming industrial producers
and available for military service, and of the remainder
who do grow up we find that another 100,000 have to be
30
PEBSONAl, HYGIENE APPLIED
TABLE I
Principal Causes op Death
Census Bureau's Summary of Mortality Statistics,
1920
Cause of death.
All causes.
Organic diseases of the heart.
Pneumonia (all forms)
Tuberculosis (all forms) ....
Tuberculosis of the lungs^.
Tuberculous meningitis. . .
Other forms of tuberculosis
Acute nephritis and Blight's
disease
Cancer and other malignant
tumors
Cerebral hemorrhage (apo-
plexy)
External causes (suicide and
homicide excepted) ....
Accidental falls
Automobile accidents and
injuries
Bums (conflagrations ex-
cepted)
Kailroad accidents and in-
juries
Accidental drowning
Accidental absorption of
deleterious gases (con-
flagrations excepted).
Accidental shooting. . . .
Mine accidents and in-
juries ._
Machinery accidents and
injuries
Street car accidents and
injuries
Injuries by vehicles other
than railroad cars, street
cars, and automobiles
Effects of heat other than
burns
Other external causes . .
Influenza
Congenital debility and mal-
formations
Diarrhea and enteritis (total)
Diarrhea and enteritis (un-
der two years)
Diarrhea and enteritis
(over two years)
Arterial diseases, atheroma,
aneurysm, etc
Diabetes
Diphtheria and croup
Appendicitis and typhlitis . .
Bronchitis
Puerperal affections other
than puerperal septi-
cemia:
Number of deaths.
1919
1,096,436
111,579
105,213
106,985
94,772
5,175
7,038
75,005
68,551
65,951
61,263
9,629
7,968
6,409
6,304
5,854
2,884
2,350
2,179
2,082
1,916
1,970
536
11,187
84,113
56,714
47,044
37,635
9,409
18,976
12,683
12,551
10,029
10,913
9,538
19201
1,142,558
124,143
120,108
99,916
88,195
4,895
6,826
78,192
72,931
70,780
62,492
10,323
9,103
6,645
6,426
4,977
3,012
2,262
2,171
2,153
1,746
1,698
270
11,706
62,097
61,080
47,605
38,514
9,091
19,977
14,062
13,395
11,702
11,609
10,976
Rate per
100,000
population.
1919 1920
1287.4
131.0
123.5
125.6
111.3
6.1
8.3
88.1
80.5
77.4
71.9
11.3
9.4
7.5
7.4
6.9
3.4
2.8
2.6
2.4
2.2
2.3
0.6
13.1
98.8
66.6
S5.2
44.2
11.0
22.3
14.9
14.7
11.8
12.8
1306.0
141.9
137.3
114.2
100.8
5.6
7.8
89.4
83.4
80.9
71.4
11.8
10.4
7.6
7.3
5.7
3.4
2.6
2.5
2.5
2.0
0.3
13.4
71.0
54.4
44.0
10.4
22.8
16.1
15.3
13.4
13.3
12.5
Percentage
of total.
1919
100.0
10.2
9.6
9.8
8.6
0.5
0.6
6.8
6.3
6.0
5.6
0.9
0.7
0.6
0.6
0.5
0.3
0.2
0.2
0.2
0.2
1.0
7.7
5.2
4.3
3.4
0.9
1.7
1.2
1.1
0.9
1.0
0.9
THE HEALTH PROBLEM
31
Principal Causes of Death (Continued)
Cause of death.
Nvunber of deaths.
Rate per
100,000
population.
Percentage
o{ total.
1919
19201
1919
1920
1919
1920
All causes.
1,096,436
1,142,558
1287.4
1306.0
100.0
100.0
4,714
8,865
8,853
9,732
3,302
1,726
1,546
1,275
695
684
289
100
115
7,347
3,296
6,338
5,955
7,860
6,704
6,386
4,567
687
1,132
6,146
4,950
5,508
4,823
4,149
3,907
2,383
3,732
3,275
2,186
2,806
358
103,247
15,603
10,968
10,120
9,314
8,959
3,169
1,616
1,417
1,124
640
555
247
97
94
7,969
7,712
7,571
6,861
6,805
6,241
6,205
4,477
645
1,083
5,828
5,800
5,281
5,030
4,787
4,287
4,004
3,574
3,136
2,721
2,322
508
109,985
15,505
5.5
10.4
10.4
11.4
3.9
2.0
1.8
1.5
0.8
0.8
0.3
0.1
0.1
8.6
3.9
7.7
7.0
9.2
7.9
7.5
5.4
0.8
1.3
7.2
5.8
6.5
5.7
4.9
4.6
2.8
4.4
3.8
2.6
3.3
0.4
121.2
18.3
12.5
11.6
10.6
10.2
3.6
1.8
1.6
1.3
0.7
0.1
0.3
0.1
0.1
9.1
8.8
8.6
7.8
7.8
7.1
7.1
5.1
0.7
1.2
6.7
6.6
6.0
5.7
5.5
4.9
4.6
4.1
3.6
3.1
2.7
0.6
125.7
17.7
0.4
0.8
0.8
0.9
0.3
0.2
0.1
0.1
0.1
0.6
a
8
3
0.7
0.3
0.6
0.5
0.7
0.6
0.6
0.4
0.1
0.1
0.6
0.5
0.5
0.4
0.4
0.4
0.2
0.3
0.3
0.2
0.3
8
9.4
1.4
1.0
Respiratory diseases other
than pneumonia and
0.9
Hernia and intestinal ob-
struction
0.8
Suicide (total)
0.8
0.3
By hanging or strangula-
0.1
By poison
0.1
0.1
By cutting or piercing in-
0.1
3
By jumping from high
3
3
a
0.7
0.7
0.7
0.6
0.6
Cirrhosis of the liver
Homicide ftotal^
0.5
0.5
0.4
By cutting or piercing in-
0.1
0.1
Paralysis without specified
0.5
Puerperal septicemia
0.5
0.5
General paralysis of the in-
0.4
0.4
0.4
0.4
0.3
0.3
0.2
0.2
All other defined causes
UnJmown and ill-defined
9.6
1.4
» The state of Nebraska with an estimated midyear population of 1,301,737 was
admitted to the registration area in 1920.
« Includes acute miliary tuberculosis.
» Less than ^ ot 1 per cent.
Note- Total number of deaths and the death-rate in the death registration area
of the continental United States in 1919 and 1920 by leading causes, together with
the percentage which each cause contributed to the total.
32
PERSONAL HYGIENE APPLIED
rejected for military service because they are unfit; that
is 57 per cent, destroyed in peace for the 2| per cent,
destroyed (in one year) by the whole German army firing
shot and shell at them."
Losses that Cannot Be Easily Stated.— By using statistics
we can with fair accuracy determine the economic loss
¥<•
JlTo
3S—
sa-
ls—
/a—
o
?M
_aoo
_too
ft
I
>
/
'~v,
y
K
^
1
"^
1
-^
■-1
►--.
^
1 —
I-"
s.
^
K
\
r
\
\
\
■^
_ J- /« ir M ,jj-jo jf w tr ri mo or to it^to.tcw.li^ \
f K /<■ » J3- So w *> «r J» «■ «« tr » 74- «.'«•?» tf ■* j
Fig. 1. — Mortality by age periods: 1. Early childhood dangerous
to lite. 2. After age of three the danger duuinishes greatly until
puberty. 3. Period of adolescence full of danger, showing increased
rate at twenty-three years. 4. Beyond this rate remains nearly a
straight line until old age. (From "The Duration of Life and Con-
dition Associated with Longevity," by Alexander Graham Bell,
Washington, D. C, 1918, p. 10.)
that comes from deaths and illness that are preventable.
There are other losses, however, that are not so readily
estimated. The losses in the purely personal, in the human
sphere that show in the psychologic effect upon the mind
and spirit are incomputable. These losses are in the
accumulation of sorrow, in the depression that follows the
THE HEALTH PROBLEM 33
breaking up a home long established. Indirectly flowing
out of the losses of preventable sickness and death are a
number of social problems. The close relation between
sickness and ineflSiciency, between poverty and sickness is
a correlation that has long been apparent to those who
work in the field of the social agencies.
The very close correspondence existing between poverty
and sickness is expressed by a recent report of the New
York Association for Improving the Condition of the
Poor. It shows that out of thousands of dollars spent in
relieving destitute families, 96 per cent, was given to
famihes who had to seek aid because of sickness or death
in the family. The Charity Organization Society in a
report! by the committee on the Prevention of Tubercu-
losis records the social study of 35 families suffering from
tuberculosis. In one place the report says:
"Reclassifying these 35 families in an attempt to relate
their economic dependency to their tuberculous condition,
we find that:
"(a) Prior to tuberculous infection
Twenty-one families were apparently self-sup-
porting;
Eight families were occasionally dependent;
Six families were chronic dependents.
"(6) After tuberculous infection
One family still apparently self-supporting (re-
ceived sanitation outfit only).
Twenty-seven families received occasional relief.
Seven famihes were chronic dependents (i. e.,
received some regular allowance, which was
main support of family),"
From the Charity Organization report as well as from
general facts of life it may be understood that there is a
loss in dislocation of homes, in dependency, in human
suffering not to be measured in economic values. Such
* Tuberculosis Families in Their Homes, p. 33. The Association,
of Tubercnilosis Clinics and the Committee on the Prevention of
Tuberculosis, Charity Organization Society, New York, 1916.
3
34 PEHSONAL HYGIENE APPLIED
loss is no less real because it cannot be expressed in actual
figures.
Estimated Losses. — Realizing that there are losses which
cannot be computed, we yet may estimate the economic
loss due to the death of persons from preventable causes.
After many balances, Fisher has arrived at a statement
of the value of a human Ufe as measured in dollars. The
following gives these values:
At birth $ 90.00
At 5 years 950.00
At 10
At 20
At 30
At 40
At 80
2000.00
4000.00
4100.00
2900.00
700.00
Average $1700.00
Every year about 1,400,000 persons die in the continental
United States,* and on Fisher's basis of preventability of
42 per cent, the loss in dollars would exceed $1,000,000,000.
Just as we can estimate the loss that ensues when wages
are not earned, so it should be possible to estimate with
some degree of accuracy the economic loss due to sorrow,
depression, inefficiency due to lack of physical vigor, and
the other indirect losses associated with a condition of
unfitness that is not usually classed as disease.
If we estimate the annual loss from deaths that are
reasonably preventable to exceed $1,000,000,000, it does
not seem extravagant to estimate that $5,000,000,000
would be representative of the loss that comes from persons
not living at their best.
Revelations of the Selective Service Draft. — ^Recently the
results of the draft examinations were available. The
record indicates our national weakness. The Provost
Marshal General's report shows the following:
' The Census Bureau's summary of the amiual report on mortality
statistics (pages 30, 31) shows 1,142,558 deaths as having occurred in
1920 within the death registration area of continental United States.
The death registration area has an estimated population of 87,-
486,713, or 82.2 per cent., of the estimated population of the UnitM
States.
THE HEALTH PROBLEM 35
Total men called 3,082,945
Total examined by local boards 2,510,706
Total rejected by local boards for physical reasons . . 730,756
Percentage rejected of those examined 29. 11
To this percentage of rejeetions by the local board
should be added the rejections at the cantonments. The
medical corps at the cantonments rejected from 2 to 11
per cent, of the men certified by the local boards. The
total rejections must, therefore, be somewhere between
30.53 and 36.80 per cent.
If we applied Fisher's estimate of 42 per cent, preventa-
biUty to those cases rejected by Draft Boards we should
have over 300,000 additional men between the ages of
twenty-one and thirty-one for service to the nation. The
incompetence, the social maladjustments, the sickness,
the early deaths in this 300,000 cannot all be measured.
The bhghting of hopes, the broken dreams of parents, of
wives, the lowered vitality due to sorrows, disappoint-
ments, and failures cannot be measured. Putting the
whole health problem on the economic^ and social levels
we find an imperative need not only to prevent sickness
but also to improve the quahty of hfe.
Factors in the Healtii Problem.-^As we have seen,
statistics show a great amotint of preventable sickness,
preventable deaths, lowered vitaUty, and general physical
unfitness for life. Often the factors at work producing iU
health appear hopelessly conaplex. Frequently a circle of
unfortunate circumstances seem to inclose the individual,
but in any analysis it wiU be found that individual health
is the expression, on the one hand, of influences that
started to act at the beginning of individual Ufe, and, on
the other, of influences that have acted upon the individual
since that time. For discussion purposes these factors
may be classified in three groups:
1. Hereditary influences (biologic);
• The political economist would make a more critical analysis of
the worth of a human life than the one given here. Read EssayB in
Social Justice by T. N.. Carver, Harvard University Press, 1916, pp.
173-202.
36 PERSONAL HYGIENE APPLIED
2. Conditions of the environment before birth and after
(physical and social) ;
3. Reaction of the individual to environment (personal).
These factors are modifiable within certain limitations.
They are also related. The way an individual responds to
a situation is in part a matter of original nature and in
part environment, but in a very real sense, also, it is a
matter of education that has helped to form habits, that
has favored certain attitudes, that has inspired ideals.
This force of education gives direction to the response that
is possible by nature and permitted by environment. The
influence of these three factors will be considered sepa-
rately.
Heredity as a Factor. — It is known that heredity con-
tributes definitely to the vigor, vitahty, or constitution of
man. For example, it is known that certain races are more
susceptible than others to certain diseases. In short, the
germ-plasm of certain individuals contains factors that
render those individuals more liable to early sickness and
early death, or, as ia other cases, to hardiness and lon-
gevity.
The force of heredity is indicated by ConkUn': "Fur-
thermore, from its earUest to its latest stage of develop-
ment it is one and the same organism; the egg is not one
being and the embryo another, and the adult a third, but
the egg of a human being is a human being in the one-
celled stage of development, and the characteristics of the
adult develop out of the egg and are not in some mys-
terious way grafted upon it or transmitted to it."
What the individual has at birth of vigor, of resistance
to disease, of "constitution," is made up in largest part of
what his parents gave him in the germ-plasm of which he
is a development.
It is a very significant fact and to some persons rather
discouraging that the individual is born into the world
with certain capacities that mark the limits of his develop-
1 Conklin, E. G. : Heredity and Environment, Princeton Univer-
sity Press, Princeton, New Jersey, 1917, p. 108.
THE HEALTH PROBLEM 37
ment. The biologic world is in essential agreement^ that
there is no transmission of characteristics that are ac-
quired in the life of the individual, so that the child, with
certain "chance" variations excepted, will receive from
the parents only what the parents have to give in the
germ-plasm which they receive from their parents.^ It
must be understood, however, that the development of
any one person is conditioned by the enAoronment into
which that one comes, and one of good heredity may
achieve less in real work and real success than one with
heredity not so good, but placed in a better environment.
Parents need to be concerned not only with the heredity
they convey to their children but also with the sort of
social and physical environment they prepare for them.
Social and physical environment is often as valuable, and
at times more significant, than the biologic inheritance.
Health, strength, and vigor of the germ-plasm determine
in a favorable environment the limit of individual achieve-
ment, but in an unfavorable environment the point
reached is less than that which was possible according to
the germinal promise. Society needs to be concerned not
only with the biologic factors but also with the social and
personal. For the individual all three are essential.
Enviromnent as a Factor. — Health is an expression of
the influence of heredity; it is also modified by environ-
ment. At times what appears as hereditary defect is
really environmental. Many of the most serious ob-
stacles to health are environmental. Such obstacles are
more powerful as factors among the poor, although the
economic influence in this respect is conditioned largely
by ignorance.' Poverty and ignorance are inseparable
' Recent experiments indicate that some forces may be capable
of producing inheritable defects. See Stockhard, C. R., and Papani-
cokow, G. N., Amer. Nat., 150, 65, 144, 1916; Jour. Exper. Zool.,
vol. 26, No. 1, p. 119, 1918; Macdowell, E. C, and Vacari, E. M.,
Jour. Exper. Zool., 33, 209, 1921.
* McDouga,!!, W . : Is America Safe for Democracy? Chas.
Scribners Sons, New York, 1921.
^Metchnikoff, E.: The Prolongation of Life, pp. 39-84, G. P.
Putnam's Sons, New York, 1908.
38 PERSONAL HYGIENE APPLIED
companions of disease, and when accompanied by de-
fective heredity place formidable barriers in the way of
fine living.
But unfavorable environment is seen not only among
the poor. The environment may be unfavorable for the
finest development of the individual even when the
circumstances of life are otherwise fortunate. The "Poor
Little Rich Girl" as a type represents the handicap
under which the members of that class live. It is
as difficult at times for a child of the Avenue to secure
vigorous health as it is for the child of the steel mills;
it is not so general because the latter situation is
always productive of a lessened opportunity for develop-
ment.
As common environmental obstacles to health we may
note inadequate housing conditions, lack of opportunities
for wholesome recreation, archaic factory and shop sani-
tation, prolonged hours of work, unprotected food and
water supply of communities. All of these conditions may
be corrected by legislation or otherwise regulated so as to
leave no element injurious to health.
Certain aspects of the environment are largely or wholly
beyond the reach of man. Such are climate, productivity
of the soil, deposits of minerals, the plains or forests.
They are not subject to legislation except in a regulatory
way to prevent exploitation of valuable resources of the
nation.
The Role of Legislation. — Society should provide the
most acceptable environment possible. As regards
housing, labor, recreation, food and water supply legis-
lation is for this purpose a logical procedure. Laws may
be passed and then enforced to secure abolition of tene-
ments that are unsafe and unsanitary, to obtain oppor-
tunity for leisure and recreation, to prescribe the hours of
labor, and to protect the food supply. Such legislation
must be accompanied by education. Social welfare laws
now on the statutes are less successful for their purposes
today because relatively too little attention is given to
THE HEALTH PROBLEM 39
educational propaganda. Education in the purpose and
value of laws passed should accompany their application.
Legal attack on all social problems without educational
measures often results in disrespect for all law. Radical
changes of custom may readily produce the sort of tyranny
or lawlessness exhibited in Russia in the early months of
the Soviet regime. Too much value should not be assigned
legalistic measures for improvement of the environment.
Certain socialistic groups in America, as elsewhere, are
incUned to give too much weight to the potency of law
or force in a human organization of man's enviroiunent.
To write and pass laws in harmony with nature, to work
with and not against nature's forces, involves an appre-
ciation of life that esteems other things than the economic
merely.
The Individual as a Factor. — How frequently or to
what extent heredity is a handicap to health is not known.
Nor has the full force of environment in controlling health
been determined. The children of alcoholic, syphilitic, or
tuberculous parents are presented at birth with health
hazards. Homes in dark, damp places and work in in-
sanitary trades and professions miUtate against vigorous
health. Probably all of these environmental and heredity
factors are infrequent risks compared to the more or less
constant influence of the individual himself. As a factor
in the health problem the individual and his response to
all sorts of situations bulk large. Training, education —
these are the great determining forces. That the personal
factor is significant may be proved by the fact that the
health problem is serious for many whose heredity and
environment are both satisfactory. The finest heredity
and the most favorable environment will not remove the
health hazards for the following types:
1. One who believes that the body will care for itself in some
way without giving it any special care or intelligent attention.
One who understands that an automobile or a watch needs
care and attention of a scientific and experienced kind, a,nd
yet gives no recognition to the claims of the human machine
in this respect.
40 PERSONAL HYGIENE APPLIED
2. One who follows the promptings of instinct and lives on the
plane of the lower animals. In matters of hunger, exercise,
and sex this type is particularly prone to err in this regard.
One who is often quite willing to attribute to man attributes
of a higher being in all instances except hunger and sex.
The fauure to appreciate the r61e of intelligence in man in
problems arising out of these instincts is in the main the
cause for much of the gastric disturbances of the individual
and the prevalence of venereal diseases in society.
3. One who fails to realize the high points that could be reached
by living at his best. This type lacks ideals, fine standards,
and habitual attitudes favoring wholesome forms of living.
Any one or all of these conditions may be existing in the
life of any one individual, and yet all of them are modifiable
by education and effort on the part of the individual.
The Necessity for Education. — The health problem will
be solved only when education in all its power is brought
to bear upon problems of human Uving. Legislation is
helpless without its interpreting aid, and problems of
heredity can be solved for man only by its sanctions.
The social legislation of the day is ultimately dependent
upon education for its success.
Opinion of society is expressing itself with reference to
the marriage and propagation of the unfit in a very defi-
nite way. Appreciating the real danger to the health and
vigor of the nation in the numerous children bom of
diseased and defective parents, society is attempting to
make it difficult for those who are unfit to marry, or if
married, to propagate their kind. The effort to control
marriage is illustrated in the Eugenic Marriage Law of
Wisconsin. This law is of insignificant value because it is
easily and readily evaded, does not secure a blood test
that would rule out syphilis, and is not accompanied by
educational efforts to develop sanction for its provisions.
Essentially, then, it is not worth a great deal because it
has not quickened the citizens of the state to habits of
response that would favor racial service and racial in-
tegrity above personal likes.
The sterilization law of various states is palliative, but
justifiable, as striking at one side of the problem. It is
THE HBAI/TH FBOBLEM 41
worthwhile, but incomplete and partial. The positive
educational factors upon which the law is drawn are
neglected.
The efforts of society to provide for the repression of
the unfit types and to promote finer and more desirable
types must be built around the development of habits of
control that will serve society .^ There should be, un-
questionably, among aU people a stronger appreciation of
the value of a strong biologic inheritance. This can be
secured only by training and education in which certain
social attitudes will be approved and the opposites dis-
approved. Such training and education of young people
would make it impossible for strong types to "fall in love"
with weak and whoUy imdesirable biologic types. Such
training would not rule out love and romance, but would
simply control through habitual attitudes the choices that
would awaken love, just as habituation, the result of
training with reference to races, makes it impossible in
almost all cases for the white and negro to marry. There
are from a biologic standpoint many marriages that are
as catastrophic in their biologic effect as the marriage of
white and negro may be socially. Such training of the
yoimg would make not only for health in the individual
himself, but, in addition, would provide the basis for in-
telligent love in line with the principles of eugenics.
In A Connecticut Yankee in King Arthur's Court, the
Queen, Morgan le Fay, responded to the Yankee's argu-
ments against the murder of her page with the words,
"Crime!" she exclaimed. "How thou talkest! Crime,
forsooth ! Man, I am going to pay for him !' '
"Oh, it was no use to waste sense on her. Training — ^training is
everything; training is all there is to a person. We speak of nature;
what we call by that misleading name is merely heredity and train-
ing. We have no thoughts of our own, no opinions of our own; •
they are transmitted to us, trained into us. AU that is original in
us, and therefore fairly creditable or discreditable to us, can be
covered up and hidden by the point of a cambric needle, all the
» Anon.: The Glass of Fashion, G. P. Putnam's Sons, New York,
1921, pp. 137-166.
42 PERSONAL HYGIENE APPLIED
rest being atoms contributed by, and inherited from, a procession
of ancestors that stretches back a billion years to the Adam-clan,
or erasshopper, or monkey, from whom our race has been so tediously
and ostentatiously and unprofitably developed."
The heredity and environment of Morgan le Fay
probably were very defective, but her education had made
it impossible for her to be other than what she was.
Lack of Education. — Much of the present need for pubhc
health work and many errors in personal hygiene are due
to lack of education of a proper kind at the right time.
It is a matter of common knowledge that often people
resent the effort to improve living conditions. Organiza-
tions aiming at health values and providing health pro-
grams meet opposition in carrying out programs of health
preservation. This opposition is less marked today than
formerly, and it is reasonable to suppose that with more
education in such matters it will cease to be a direct and
active deterrent of health administration.
To this end the fact must be realized that the home
and the members of the family are not laws unto them-
selves. The mother who sends a child to school when she
knows he is not well wiU more and more receive the
censure of the community, because in doing so she imperils
the health of the other children in the school. Medical
inspection in the schools to be reasonably successful must
have the loyal co-operation of the parents of the school
children. The education of the parent in proper attitudes
toward society would help the parent to be as interested
in preserving the health of the other children in the school
as she is in expressing the maternal instinct for her own
child. The infrequency of such response is a token of the
lack of education in this regard.
The mother who is angry because the Medical In-
spector advises that Johnny's teeth be filled, and the
merchant who objects to the restriction of the Board of
Health in withholding a license because his shop is in-
sanitary, are individuals who lack a social education.
Such individuals may be educated to avoid for them-
THE HEAl/fH iPROBtifiM 43
selves the causes of disease, but they are defective in
social training. Their health is of some value in propor-
tion as they are able to support themselves and cause no
burden to the state, but as regards their ability to co-
operate with society in advancing the best interests of all
they are socially sick. The individual factor in health
may completely overshadow the influence of heredity and
environment. It is clear, therefore, that instruction in
hygiene must be something more than stating the number
of hours of sleep that man needs or the kind of clothes
he should wear. Informational education is always
necessary, but it must be made effective by habituation,
proper attitudes, and ideals.
Health Rides Violated Because of Ignorance or Indiffer-
ence. — ^At times young people violate health rules because
of ignorance, and both young and old ignore health
teaching at times because it conflicts with personal desires
or with established habits. If ignorance alone were at
the root of the trouble, we might expect great improve-
ment in health status by an increase of health books in all
schools and in every community. Those who work with
young people in the hygiene field know that such a
remedy, although helpful, would not be a complete success.
Conferences with college students invariably show that
they are acquainted with the knowledge of hygiene, but
have no appreciation of its application to themselves.
In an annual report (1917) by the Professor of Hygiene to
the President of the University of Cincinnati there is the
following statement: "Conferences with students have
shown that while the individual frequently knows what is
hygienic, he rarely makes the appUcation to himself."
Rules of health are helpful in proportion to their use.
There must be habituation, and this can come only
through training and education in which ideals have had a
prominent part.
The Dynamic Farce of an Ideal. — "To beat the Hun,"
"to win the war" caught the ear of a people awakened to
the significance of a great drama in history. Catch phrases
44 PERSONAL HYGIENE APPtlED
that adorned cheap posters they were, and yet expressive
of a grim determination, fighting for lofty ideals. Out of
the World War arose high idealistic motives that inspired
many to become interested in personal health as an aspect
of national service. During the war groups could be seen
in more than one city cheerfully joining in a morning
tramp to promote vigor, or following some special pre-
scription dictated by a medical examination. Boy Scouts,
Girl Scouts, and other young persons were similarly in-
spired. But the war did not last long enough to secure
habituation in such modes of Hving.
Now the war is over! The great dramatic "hinterland"
of "beating the Hun" is gone! Something else is needed
to perpetuate and to carry on this spirit of service — an
ideal that wiU give habitual attitudes on all problems of
living, an ideal that will be above economic values or in-
stinctive m-ges, an ideal that will secure maximum eflB-
ciency and achieve a level of performance above the com-
monplace! The answer to the health problem is con-
cerned vitally, therefore, with a consideration of ideals
and habits.
CHAPTER III
INTELLIGENCE AND IDEALS
I. Stages in Human Conduct.
II. Forces Dbtbkmining Human Conduct:
1. The Force of Instinct.
2. The Force of Intellect.
III. The Failure op Instinctive Guides.
IV. Intellect and Ideals.
V. The Problem of Health and Ideals.
VT. A Social Ideal.
VII. An Ideal op Social Responsibility Arises Out op the
Nature op Lipe:
1. Each Individual is a Link in the Chain of Life.
2. Each Individual is an Heir to the Inheritance of Life.
3. ResponsibUity for Life.
VIII. An Ideal op Social Responsibility Serves All.
IX. The Significance op Social Pressure in Relation to
Ideals.
Stages in Human Conduct. — The conduct of a man is
determined by environment acting through various ways
upon the original impulses, tendencies, or instincts of his
nature. We may with profit distinguish, as McDougall'
suggests, three levels of conduct, each of which represents
successive stages to be traversed in turn. These stages are :
1. The stage of instinctive action in which original
tendencies are expressed without modification, except that
produced by the influence of pains or pleasures. Pain or
pleasure in any situation is the determiner of conduct in
this stage. The impulses to strike, to eat, to run away
are expressed fuUy and completely if they give pleasure;
they are inhibited if they give pain. This stage represents
a maximum of natm-e acting and a minimum of nurtiue.
It is found in most complete form among wild barbaric
peoples.
2. The stage in which the tendency to instinctive
'McDougall, William: An Introduction to Social Psychology,
John W. Luce & Co., Boston, 1918, Chapter VII.
45
46 PEBSONAL HYGIENE APPLIED
action is modified by rewards or punishments. These
rewards or punishments are usually administered by the
social environment or, as in the case of certain rehgions,
they may accrue after death. In this stage also the con-
demnation by society of individual action prevents the
continuation of the act and tends to inhibit its initiation
in the future. The control here is fear. Such control by
society is necessary in the present state of the world.
Values of significance to the group are thus protected and
conserved from destruction by the instinctive action of
the individual, obhvious of social welfare. Such control
for the individual is entirely unsatisfactory, because when
group judgment is not acting the individual is with-
out sufficient guides. This stage is found not only in
uncivilized society but also in recognized civilized
states.
3. The stage in which conduct is controlled, modified,
and directed by an ideal. Under the influence of ideals
original tendencies to action are modified, strengthened,
or weakened, so that the individual's conduct represents
an expression of ideals. It is clear that such conduct will
be called good, worthy, or right by society in proportion
as the ideals serve high aims of social worth and signifi-
cance. This stage is foimd among advanced members of
civihzed society.
Forces Determining Human Conduct. — The stages in
human conduct show a progressive series leading from
instinctive responses typical of the lower animals to the
responses guided by ideals which are typical of the best
in intelligent man. The problem of living finely and well,
the particular problems of the health of man are expres-
sions of the development of man in terms of these stages
of human conduct. No adequate study of hygienic living
can deal merely with hygienic rules because well-known
hygienic rules are continually violated. Knowledge of
the truth may still permit the dominance of instinct. To
understand the forces determining human conduct lies at
the very beginning of understanding the problems of
INTELLIGENCE AND IDEALS 47
living. Instinct and intellect together are shaping human
conduct.
The Force of Instinct. — ^All men, apart from training,
possess tendencies to respond in certain typical ways to
certain typical situations. These tendencies to respond
are inherent in the nature of man. Without training, this
nature would appear to be a vastly different thing than
most persons would imagine it to be. Thorndike,^ in
writing of the need of education, says, "If all human
beings save newborn infants vanished to another planet,
and if by a miracle the babies were kept ahve for a score
of years, preserving whatever knowledge and skill came
from natural inner growth, and lacking only the influence
of the educational activities of other men, they would at
the age of twenty-one be a horde of animals." It is un-
questionably true that any individual would be ashamed
to be associated with the creature he himself would be by
original nature alone. Man without the influence of
training would show a truly barbaric type of conduct. The
instincts of his original nature subjected to no modification
would exhibit the cruelties, fears, and fightings of primitive
man, and perhaps even of the lower animals themselves.
There is in every human action and in all human con-
duct the underlying impulse to primitive instinctive ex-
pression. For some persons the first stage, as described
by McDougall, represents the extent of their develop-
ment as members of human society. Moreover, it is
doubtless fair to say that whenever human conduct is
particularly selfish, personal, and unsocial, unmindful of
the rights and needs of others, the original and less
socially useful instinctive forces are having full play; and,
conversely, that whenever human conduct shows a sub-
jugation of the essentially selfish, instinctive tendencies to
the needs of social life, the influence of training is upper-
most and the instinct of man has succumbed to the in-
tellect of man.
iThomdike, E. L.: Education, p. 4, The Macmillan Co., New
York, 1912.
48 PERSONAL HYGIENE APPLIED
The Force of Intellect. — ^Among barbaric peoples in-
stinct dominates; among civilized peoples instinct is in
continual warfare with intellect. In civilized society the
child after birth is subjected to a variety of environmental
factors, all varying expressions of man's intellect. Train-
ing (to include traditions, mores, etc.), education, nurture
are the terms used to designate these factors. The quality
and distribution of the enviromnent determine the type
of response seen in the members of society. The conduct
of any one person is measured frequently in terms of his
opportmiities, other things being equal. To bring to bear
upon the original tendencies influences that shall shape
selfish conduct into unselfish conduct is the immediate
aim of the social environment. To initiate such influences
and to respond to such influences indicates the action of
other than instinctive forces, in fact, indicates the opera-
tion of intellect.
The story of human development is a moving drama in
which instinct and intellect with its ideals are the chief
factors. Thorndike' describes the primacy of these ideals
in the following passage:
"There is a warfare of man's ideals with his original ten-
dencies, but his ideals themselves came at some time
from original yearnings in some men. . . . InteUigence
and reason are fit rulers of man's instincts just because
they are of the same flesh and blood. They are not foreign
conquerors, imposing a law that is better because it comes
down from above. They are sons of the soil, as indigenous
as hunger and thirst, chosen to rule because their laws
mean the best harmony of all the instincts."
The Failure of Instinctive Guides. — Most of the original
tendencies in man need the modifying influence of in-
telligence. Some instincts need to be strengthened, some
directed into new channels for expression, and some that
are of real worth to be curbed under certain conditions.
The instinct of the mother to care for and to protect her
•Thomdike, E. L.: Educational Psychology, Vol. I, p. 311,
Teachers College, Columbia University, New York, 1919.
INTELLIGENCE AND IDEALS 49
child is a valuable instinct not only for the child but also
for the race. But this instinct, while admirable in its
intent, frequently results in disaster for the child. If the
mother is ignorant of the cause of disease her original
tendency may mean not protection for the child, but
definite harm. The worthwhileness of an instinct is to
be judged not by its intent, but by its results as measured
in human life.
In general it seems clear that instract alone is a failure
in guiding human conduct. This is so for two reasons:
the modem environment is vastly changed from the
primitive in type, and the purely instinctive acts fail
usually to appreciate the rights and needs of others.
The human environment has changed markedly, es-
pecially in the last two hundred years. It is becoming
more and more complex and artificial, and provocative of
unhealthful conditions in man. Instinct as a guide is lost
in a crowded subway, in a modern restaurant, in apart-
ment houses, in automobiles. The varied health problems
that confront modern man require intelligence for their
solution. This intelligence must show itself not only in
the guidance of the individual through the maze of
civiUzed forms but also in the formation by society of
wise provisions for the welfare of all. Public health ad-
ministration, medical inspection, scientific sanitation, in-
struction in personal and community hygiene, adequate
opportunities and facihties for play and recreation repre-
sent an appreciable development of the intellect with
reference to matters of health. Reliance on instinct to
protect man from disease germs, to detect and cure
disease, to properly care for waste and water supply, to
know the proper way to live, or to develop adequately in
an .urban environment would be the height of folly.
Instinct as a guide in modern civilized life is a failure be-
cause of ihe changed environment of man.
Instinct is a failure also because it does not appreciate
the rights and needs of others. This is particularly true
in manifestations of the sex instinct. This instinct, if left
50 PERSONAL HYGIENE APPLIED
to itself, is primarily selfish, ruthless in. its desire, Un-
mindful of others. In lower animals under the conditions
that existed in their development this instinct is useful, and
thus directed by nature it is extremely serviceable to the
species. The story of the sock-eye salmon in breeding
season is an epic poem of self-sacrifice for the group. In
man, however, this instinct if uncontrolled in the highly
developed society of modern man is productive not only
of disease and ill health but also of imhappiness and in-
dividual and social disaster.
Lower forms of life may be allowed to act on a purely
instinctive plane, but it is becoming more and more im-
possible for man to be guided oidy by instincts, especially
as these guides are in their effects so particularly personal
and individual. This control of the instinctive impulses
to action is the sort of thing that we may expect to come
because of the evolution of the human being. The social
and moral significance of such control is understood more
and more by psychologists and sociologists. McDougall
says, "While the lower forms of social conduct are the
direct issue of the prompting of instinct, the higher forms
of social conduct, which alone are usually regarded as
moral, involve the voluntary control and regulation of the
instinctive impulses."
Society must, therefore, by more authority in the
regulations governing human actions provide that margin
of safety that is not given by the thoughtless, the in-
different, and the mentally incapacitated. It must
stimulate the development of intelligence as a guide, and
must renoimce, either as understood or as advocated, a
theory of education that is based on instinctive response.
Intellect and Ideals. — To plan to Uve by intellect and
not by instinct involves no negation of nature. Nature is
expressing herself as well or better through intellect than
through instinct. Thorndike* in enviable fashion says,
"Intellect is of the same flesh and blood with all the in-
"Thomdike, E. L.: Educational Psychology, Vol. I, p. 310,
Teachers College, Columbia University, New York, 1919.
INTELLIGENCE AND IDEALS 51
stincts, a brother whose superiority lies in his power to
appreciate, use, and save them all."
Not alone in man's ability to reason, use tools, and
engage in constructive work is the intellect a mark of
superiority over the lower animals but also by the ideals
that arise as expressions of its activity. And the very
ideals that guide and use the instincts for superior achieve-
ment in life arise out of the very matrix of man's intel-
lectual Ufe. To quote from Thorndike^ again, "Its ideals
are kith and kin of man's original hungers and thirsts and
cravings. 'What are ideals about?' asks Santayana,
with customary insight, 'what do they ideahze except
natural existence and human passions?' That would be
a miserable and superfluous ideal that was nobody's
ideal of nothing. The pertinence of ideals binds them to
nature, and it is only the worst and flimsiest ideals, the
ideals of a sick soul, that elude nature's limits, and beUe
her potentiaUties. Ideals are forerunners of nature's
successes, not always followed, indeed, by their fulfilment,
for nature is but nature, and has to feel her way; but they
are an earnest, at least, of an achieved organization, an
incipient accomplishment, that tends to maintain and root
itself in the world."
Modern man and his barbaric brother differ in ideals
or in the extent or range of their distribution. They differ
in no other way essentially. But the very ideals that
characterize the intellectual life of civihzed man are useful
for purposes of life only as they foster habitual attitudes,
directing conduct. We do not have ideals to admire, or
to talk about vainly, or to pray over. They are to modify
conduct. In proportion as they help to form attitudes
tending to lead to desirable responses are they significant.
Ideals are serviceable, then, according to the extent to
which they direct action, especially as they foster habitual
attitudes that lead to fine and noble responses. They are
of relative value. An ideal of cleanhness for purposes of
hiunan society may not be worth as much as an ideal of
^ Tbomdike, E. L.: Loc. cit.
62 PERSONAL HYGIENE APPLIED
fair play. All men have ideals of a kind, but we recognize
poverty or wealth in this sphere by the quality of the
ideal that directs and controls. The usual socialistic
doctrine with its philosophy of the beUy gives scant
recognition to ideals in comparison with economic factors
as guides for living. In matters of health, economic values
too frequently set the standard for hygiene. Thus, some
persons will be interested in hving hygienically because
it is cheaper to keep well than to pay the expense involved
in getting well, but such guidance is frequently ineffective
because it is not capable of directing those who are willing
to sacrifice health and to attain ends that are selfish and
personal. This fact is well illustrated in the following
experience:
A college student who was leaving college to enter a
naval unit was recounting plans for the last night in a
certain city. The plans involved drunkenness and vice
in its most undesirable forms. I called to his attention
the danger in loss of health through the debauchery of
himself in alcohol and by the exposure to deadly venereal
disease. His reply was characteristic of those whose
conduct conforms to McDougall's first stage and who
measure life in terms of economic values! "I'm willing to
trade my health for the sake of these pleasures and enter-
tainments." When I brought to his attention the obliga-
tion that he owed to the race for preserving the quality of
health that he had so that he could pass it on at least
preserved and if possible improved, he replied, "The race
doesn't look after me, why should I be responsible to the
race?" The problem was, then, not to give him scientific
knowledge of hygiene, not to point out the economic
loss due to venereal disease. He had the knowledge and
he was wiUing to trade health for what he was inclined to
call fun. The problem was to awaken in him a response
to social values, to a spirit of chivalry toward not only
women and men but also toward those who come after.
Acutely it resolved itself into indicating the ways in which
the race looked after him, and in arousing in him a sense
INTELLIGENCE AND IDEALS 53
of responsibility toward the race. He greatly needed
ideals that would help to place him as an individual in the
scheme of things.
The instinctive guide even when buttressed by economic
supports may fail; it always fails in the crisis of hfe.
McDougalU points out so clearly the fallacy in such con-
trol that it is worth while to quote him at length: "The
regulation of conduct by the regard for the approval or
disapproval of our fellowmen has certain limitations and
drawbacks. In the first place the motives involved are
fimdamentally egoistic. Second, the approval or disap-
proval of our social circle cease to be effective sanctions of
right conduct as soon as we can be quite sure that our
lapse from the standard demanded of us will never be
known to those in whose minds we habitually see our-
selves reflected."
It is well known that the individual living on this low
plane will not conform if there is no danger of being
"found out." To remedy this defect many people have
supplemented the sanction of public opinion with the
theologic doctrine of an all-seeing eye — an omnipotent one
who rewards and punishes. This doctrine is increasingly
less potent today. For purposes of life we shall have to
depend more and more upon ideals, and for purposes
of health, to live most and to serve best may well satisfy the
needs of health and the larger goals of life.
The problem of Uving finely is in part a problem of
seeing straight, and seeing straight is nothing less than
getting in touch and harmony with the great principles of
law that rule the universe. One of these principles is the
essential unity of life, and carries with it not only the in-
heritance of the past, but, for the individual, a real re-
sponsibility for future generations. This means ideals of
a high order. To the intense individualist, to the selfish
seeker of personal pleasures, and to certain types of social-
ists this principle means nothing.
^McDougall, W.: An Introduction to Social Psychology, John
W. Luce Co., Boston, 1918, pp. 179-233.
54 PERSONAL HYGIENE APPLIED
It would have been helpful if I could have told my
college student the story of Gloria Swann.^ Gloria, a
chorus girl, longed to be clever as she saw cleverness
around her. After passing through a significant change
of attitude toward life in which she sensed the relation of
each individual to the race, she arrived at a great thought.
One night she heard one of the girls of the chorus recoimt-
ing a rather questionable experience of the evening before.
It brought forth to Gloria's mind this contemplation:
"Fom: thousand generations have kept the Hght burning
for her, and now she's letting the wick go sooty Uke
that."
The Problem of Health and Ideals. — It is important to
emphasize the fact that the problems of hygienic living
touch the whole Ufe. Hygiene cannot be considered in
water-tight compartments. The control of appetite, the
development of habits, the selection of preferred forms of
recreation are shaped by ideals. It is also important to
emphasize that ideals must give rise to habitual attitudes.
The way one responds today determines pretty largely
the way one will respond tomorrow to the same situation,
other things being equal. The power to show control in
great moments is gained by the use of control in less
significant times presenting Uke demands. Habitual re-
sponse is the factor to reckon with. If the situation S,
has been followed by response R, without annoyance, the
bond S-R in the nervous system has been strengthened,
and in the future S will readily give rise to R, other things
being equal.^
Health habits are dependent upon this very law of
neurone action, and ideals, in the service of health and
fine living, must act by arousing a definite attitude toward
definite specific problems. An ideal of health as a quahty
of life rendering the individual fit to live most and to serve
best will foster attitudes serving the individual and the
• Weston, George: The Salt of the Earth, Saturday Evening Post,
November 30, 1918.
=! Thomdike, E. L. : Educational Psychology, Vol. I, Chap. XII,
Teachers College, Columbia University, New York, 1919.
INTELLIGENCE AND IDEALS 55
group. Both must be served. Abundant life and gen-
erous service are the hope of society. Alone either is
worth very little.
A Social Ideal. — ^An ideal of social responsibility is the
need of the times. Human conduct will be acceptable
when the responsibility of the individual to society, to
the past, and to the future for the whole of life has been
met. Such an ideal of social responsibihty is the need
of education today. Communities and states and
even the nation itself must reorganize education spirit-
ually. This does not mean merely new attention to
forms of worship, but it does mean emphasis on the
reUgion of service for the common weal and a standard
of social honor that puts the health and happiness of
all first, and the individual needs or desires second.
It is a question of attitude or mood in which we are
taught.
Galsworthy! suggests the same thought when he says:
"Now the sole hope that the future may be better than
the past or present centers aroimd the possibility of sub-
stituting for that bankrupt ideal (maximum production of
wealth to the square mile) the ideal of the maximum
production of health and happiness; for whatever the
fashion of our speech and the complexion of our thought,
this is not precisely the same thing."
Again he says, "If there be a saving way at all, it is
obviously this: substitute health and happiness for
wealth as a world ideal; and translate that new ideal into
action by education from babyhood up."
An ideal of social responsibility must be a developed
ideal, the result of education in the home and in the
school. It is not instinctive, although it arises out of the
same soil that provides the instincts. The evolution of
the moral sense is essentially the carrying over from one
generation to another of the modes of actions, the typical
responses demanded by an organized society and con-
» Galsworthy, John: Where We Stand, Atlantic Monthly, Feb-
ruary, 1920, p. 173.
66 PERSONAL HYGIENE APPLIED
sidered by one generation to be worth perpetuation in the
succeeding one.^
In the lower animals there is no carrying over of moral
codes and standards. Sacrifice of self for others, when it
occurs, is an unconscious act; but in man such action,
representing the finest expression of the moral sense, is
conscious. Because man is conscious, a being of intellect,
a fashioner of ideals, and because ideals are not inherited
tendencies like the instincts, the teaching of ideals of so-
cial conduct is of tremendous importance for the welfare
of the race, and is of more significance in race culture than
mere legislative laws governing marriage, child bearing,
and social behavior.
For the individual there is no essential conflict between
what is good for the individual and what is good for the
race. That program of hving which is most wholesome
for the individual is also most propitious for racial progeny.
An ideal of social responsibihty strikes at the selfishness
that leads to loss of health; it cuts right across the super-
ficial and shallow in hving and reaches down into the
facts and truths of nature. In this sense it immeasurably
enriches individual himian life if values are not mixed.
The woman who refuses to bear children because of some
of the personal deprivations and losses that come has
retained her maidenly figure perhaps; she has not missed
the regular sessions of her club; she has not interrupted
the round of parties, entertainments, and amusements;
but she has lost in very vital ways by substituting a lap-
dog for the human offspring. Ultimately, therefore, the
motive of social responsibility enriches fife if one only
sees straight. For the selfish, vain, and indolent, for the
snob, feminist, and social parasite, the values that mean
racial improvement, racial vigor, rich racial inheritance
are not very appealing.
On the other hand, human culture, human improve-
ment, hygienic and fine living will be guided by values
' Conn, H. W. : Social Inheritance and Social Evolution, Abinedon
Press, New York, 1914, p. 77.
INTELLIGENCE AND IDEALS 57
that root themselves in the nature of man as represented
by the social evolution of the race. The growing social
consciousness and sense of obUgation to others that
characterize man and mark him off from the lower animals
is a fact of such importance that its full significance when
appUed to the problem of human culture has never been
adequately emphasized. It is certain, however, that
nothing very lasting will come out of the health move-
ment so long as its appeal is selfish and directed merely at
prevention of disease.' The spectacle of a nation having
plenty of food and going without so that other nations
could Uve was possible because of the great dramatic
ideal presented by the World War. The continual drama-
tization in the schools of an ideal of race culture, of an
ideal of social responsibihty is a crjdng need of the times.
An Ideal of Social Responsibility Arises Out of the
Nature of Life. — The ideal of social responsibility bears no
false document of identity. It arises out of the very
nature of life and human society. It serves faithfully the
origin, development, and purpose of human Ufe, because,
1. Each individual is a fink in the entire chain of life,
2. Each individual is an heir to an inheritance of hfe,
both biologic and social, and by the same token each in-
dividual is a trustee of the same goods for posterity, and
therefore,
3. Each individual is responsible for the preservation of
the quaUty of Ufe received from ancestral stock and with
other members of society, for the preservation of the social
environment conducive to health and happiness. More-
over, this responsibility implies not only preservation of
life and opportunities received; but whenever possible
progressive improvement. Health as a quality of life
challenges each individual to make that health finer,
richer, more complete, and abundant; it challenges men
and women to preserve wholesome opportunities for living
and to make them increasingly more abimdant and useful.
1 Paton, S. : Human Behavior, pp. 160-212, Charl^ Scribner'e
Sons, New York, 1921.
58 PERSONAL HYGIENE APPLIED
To make clear the full implications of the above state-
ments is a matter of importance.
Each Individual is a Link in the Chain of Life. — If we
trace life back through the countless ages of the past we
find one fundamental fact of nature. The impulse of life,
of living matter represented in each individual, is an im-
pulse forging for the period of that one's life a link in the
chain of all life.^ So numerous are the links and so varied
the chain that one is inclined to consider one's life as the
beginning and end of the life one represents. Such is not
the case. The individual represents many forces that
have worked in the lives of his ancestors, and in a way he
represents a mosaic of them. If it is a beautiful mosaic,
it is strongly incximbent upon him to preserve its lines and
colors, and if possible to so care for this inheritance that
it will be improved with age. Such an inheritance one
should value more highly than the inheritance of a silver
spoon in the family for generations, or a social position
attained by chance and held with difficulty.
On the other hand, if the mosaic be cracked, here is an
obhgation indeed. It must not be injured more, and if
possible the defect should be remedied. Such an inherit-
ance may be improved by proper living; perchance, by
proper marriage the defect may not be so marked in the
next generation. In any case, in the field of human life,
there is a wonderful laboratory for the performing of ex-
periments in which there can be adequate controls, suffi-
cient guidance, and definite records.
Each Individual is an Heir to the Inheritance of Life. —
It is only a step from the appreciation of the fact that
the individual is a hnk in the chain of life to the compre-
hension of the importance of this fact for a generation
and a nation. We, citizens of these United States of
America, today are laying the foundations for the life of
those who shall live in our places and do the work we have
been doing. We have been concerned recently with
• Bergson (Henri), in his Creative Evolution, expresses the thought
given here. He elaborates and develops it in a most satisfying way.
INTELLIGENCE AND IDEALS 59
keeping liberty alive in the world, with preserving the
unity of this nation, with making "the world safe for
democracy."
We have preserved our liberty and our unity, we have
helped make the world safe for democracy, but it is also
important that we assign to our heirs not only freedom
from political slavery but also freedom from the ravages
of disease; not only freedom from aggression by an arro-
gant military power but also freedom from insidious drains
on our vitaUty.^
Responsibility for Life. — Acceptance of the biologic re-
latedness of men and women^ and the inheritance of hfe
possibilities lead logically to a standard of social respon-
sibility. To live most and to serve best is to recognize this
standard. But the sense of responsibiUty for others must
not become a meddlesome habit of benevolent paternal-
ism. The individual must achieve health and happi-
ness; they are not to achieve him. The control by organ-
ized society should be exercised only to protect the
majority in matters approved by the majority. Mem-
bers of society who cannot respond to approved standards
of living either must be helped to respond acceptably or
made harmless to prevent the realization of effective
living by others.
Autocratic principles in the service of others suffer in
a modern world the fate of autocracy everywhere. But
where control is clearly needed and clearly sanctioned, as
in communicable diseases, purity of food and water-
supply, sanitation of public places, care of excreta and
garbage, there should be no half-hearted acceptance of
the responsibiUty. Such administrative control should be
accompanied by educational efforts to sanction and secure
the gains for the group.
Ideals are not always immediately achieved. Woodrow
'■ Williams, J. F. : The Health Problem from a New Angle, Educa-
tional Review, January, 1920. McDougall, W.: Is America Safe
for Democracy? Charles Scribner's Sons, New York, 1921.
2 King, H. C.: Rational Living, The Macmillan Co., New York,
1914.
60 PERSONAL HYGIENE APPLIED
Wilson went to Versailles in 1918; the Washington Con-
ference was held in 1921. To work toward ideal and
intelligent controls that will overcome superstition, ignor-
ance, and the unworthy instinctive impulses in man is
the path to progress. But inability of any group to rise
to the heights of idealism involved in the solution of a
problem may make it necessary for the Federal Govern-
ment to step in and protect the individual as an asset of
the state. With the Government the holding of ideals
is just as valuable as for the individual. It is important
to state, however, that ideals exist for government in
proportion as they serve to guide the people of a nation.
We call this force that shapes laws and regulations public
opinion. Public opinion is forceful, it is powerful, and
yet it is so simple that when once the people of the nation
find themselves holding with conviction an opinion, an
ideal, in a very short time it is translated into law-
It is conceivable, therefore, that an ideal of social
responsibility may become so forceful in individual liveS,
and a conviction concerning human duty may become so
strong, that there will result not only improved personal
living but also more effective sanitary control of disease,
more thorough and complete health work in the schools,
desirable improvements in housing laws and regulations,
increased protection for workers in hazardous trades, and
better methods for controlling the appalling death-rate of
infants. Ideals should mean more and not less health;
more and not less happiness.
An Ideal of Social Responsibility Serves All. — ^The
ideal of social responsibility involves no real hardships,
but it presents no royal road. It will always lead the way
to new accomplishments, sometimes by new roads through
imbroken ground, sometimes by connecting old path-
ways. It will doubtless help to correct some prevailing
attitudes. For youth and for old age happiness is held
in high esteem, and for some an ideal of responsibihty to
society smacks of all that is destructive of happiness as
they know it. These fooUsh ones think of happiness in
INTELLIGENCE AND IDEALS 61
terms of dance halls, horse races, and lobster palaces.
They spend their energy to produce wealth with the
avowed purpose of buying amusement which they call
happiness. They miss the subtle fact that happiness can-
not be bought, that it cannot be conferred; that it must
be earned, it must be won. Though they travel over the
earth to find happiness, they will miss it unless they carry
it with them in their hearts. Happiness, like health,
flows from life as a by-product of activities that are
worth while and satisfying.
But for both youth and old age an ideal of social re-
sponsibility may have real meaning. To the youth able
biologically to preserve and to pass on to future genera-
tions desirable human quaUties, such an ideal comes as a
challenge that he may accept, knowii^ that he will need
all that he possesses of fortitude and courage. To the
one who has passed the meridian of life the appeal is con-
cerned chiefly with the influence of hving that is to be
exerted and with the preservation of the best treasures of
the social inheritance. Custom, tradition, the mores of
the people are powerful forces determining largely the
idnd of response that posterity wiU give. Social in-
heritance is as important as the facts of organic heredity.^
For both, young and old, such an ideal will quicken and
give meaning to life. Both may become interested in
passing on an inheritance, biologic or social, that shall be
a fulfilment of trusteeship. To bequeath to immediate or
distant offspring biologic and social jewels % incomparably
superior to the oft valued bequest of battered silver
spoons, pewter plates, or old clocks.
The Significance of Social Pressure in Relation to
Ideals. — Ideals vary. Some persons have many, some
have none; and no one is compelled to hold any particular
ideal and no one can force an ideal upon another. Ideals
are achieved; they belong; they can never be legislated
into being nor made to live by edict or pronoimcement,
» Huntington, E.: Civilization and Climate, pp, 35-4$! Yale Unl'
versity Press, New Haven, 1915.
62 PERSONAL HYGIENE APPLIED
And just because this is so we shall have need often to
remind ourselves of this variability in human beings. In
such fashion we shall want to reinterpret that hallowed
phase of the Declaration of Independence that "All men
are created free and equal." Now, the facts are just the
opposite. Persons are not equal at all. They have vary-
ing capacities for growth and development. In a sense
we are equal before the law, but to say that pohtical
equality alone is meant begs the question, since "I am
just as good as you are" accurately depicts the common
attitudes on equaUty. It ought to be quite clear that
equality is not conferred nor provided by government.
Equality, hke so many precious things in Ufe, must be
won. The only test is that of worthy achievement.
Since ideals cannot be compelled, but must be won,
since equality cannot be conferred, but must be achieved,
since happiness cannot be bought, but must be earned,
since aU the worthwhile things of hfe come from Uving in
the right way, it is important that society be careful to
provide for each individual the most appropriate and best
hfe opportimities possible. Such provision may require
social pressure by the group.
In speaking of the aims of education — some might call
them ideals — Thorndike^ with characteristic clearness
describes the way social pressure is commonly exerted.
He writes:
"No one is compelled by any inner necessity to accept
as his aim in education for himself or his feUow-men the
improvement and satisfaction of human wants — the
cultivation of a good will, impersonal pleasures, knowledge
of things and men, habits of open-mindedness, and physical
and mental efficiency, and only the best individuals do
accept these aims. Fagin tried to debase Ohver's wants
and to satisfy his own at the cost of everyone else's.
Manufacturers may try to fit the children of a community
to be nothing save efficient workmen. Baptists may plan
iThomdike, E. L.: Education, p. 14, The Macmillan Co., New
York, 1912.
INTELLIGENCE AND IDEALS 63
their schools in utter defiance of Methodist and Presby-
terian wants. A parent may count the satisfaction of his
child's vanity above the satisfaction of a hundred other
children's rights.
"Social pressure is required to prevent foUy and in-
justice in education as elsewhere. Fagin can, if he likes,
consider no wants save his own, but all men acting to-
gether can, if they hke, hang him therefor. Parents may,
if they like, consider no wants save their child's, but other
famiHes can have that child expelled from the school, or
the parents from the community. Manufacturers can
vote to take money from high schools for trade-schools,
but others vote also. The state can suppress sectarian
schools altogether if it thinks that an unfair discrimination
among wants is made by them."
Ideals are essential for the realization of the best in life;
they are, therefore, essential for all hving. They are, in
the intelligent life, well supported by truth, by the facts
of life. They keep their feet on the ground. They do not
confuse the ought and the is, but by using the materials of
life they seek constantly to achieve higher levels.
CHAPTER IV
THE APPROACH FOR KNOWLEDGE OF HEALTH
I. The Science op Hygiene is Based on the Facts op Man's
Nature.
II. The Biologic Basis of Lipe.
III. Evidence from Biology a Guide fob Hygiene.
IV. The Human Body and Its Adjustment.
v. The Human Body an Energy Mechanism:
Sources of Energy.
VI. The Value op the Biologic View.
VII. The Test op Hygienic Knowledge.
The Science of Hygiene is Based on the Facts of Man's
Nature. — In order to understand the kind of food best
suited to man, the needs of the physical organism, the
way in which the mind works, the manner in which bac-
teria and parasites grow in the body, it is necessary to
know the kind of organism the human body is, its mode
of development from lower forms of life, its origin from
those forms, and the way in which environment has
molded and controlled the development of the body.
The science of hygiene must, therefore, be based upon the
knowledge of the natm-e of the human organism if it is to
be something more than tradition, custom, and super-
stition. It is interesting in this respect to remember that
the beliefs of many peoples regarding the care of the
body are not scientific, and in proportion as they are
merely traditional they are of less value in producing
hygienic hving. BeUefs among the more ignorant negroes,
the peasant Chinese, the wild tribes of Borneo and the
Philippines instance the influence of superstition as a
guide in hving. The ignorant negro will give more
credence to a superstitious belief, as a rule, than to a
scientific viewpoint. This is due to the comparatively
short period this race has been in contact with forces of
education. It is interesting in this connection to note
64
THE APPBDACH FOR KNOWLEDGE OF HEALTH 65
that negroes in college and iiniversity, representing as
they do the highest types of their race, accept and practice
as faithfully the dictates of science as the more socially
favored white races.
The Biologic Basis of Life.-^To understand man's
nature it is essential to know the biologic basis of man's
hfe, and the way in which he attained unto the kind of
being he is today. The simplest and lowest forms of
animal life are the Protozoa. These are single unicellular
organisms and represent in structure the units of structure
in the human body. As life evolved higher forms we see
at a higher level the group of animals called the Ccelen-
terata, examples of which are hydras, sea-anemones, jelly-
fishes, and coral animals. They are so-called because they
are distinguished by having a coelum, or body cavity, which
serves as a digestive sac. Such tissues as nerve and muscle
are not present, or very poorly developed, and the systems
of circulation, respiration, and excretion are entirely ab-
sent, although the functions of these systems are carried on.
At a still higher level in the scale of development of Ufe-
forms emerges the type illustrated by the lower flat
worms. Here for the first time appears muscular tissue
in significant amount. The muscles are arranged in
circular and longitudinal fashion around the trunk of the
worm and serve for locomotion.
The appearance of the muscular system increased the
range of locomotor activity for the animals so endowed;
it made possible a richer enviromnent; but it required
marked speciaUzation of the body cells. In proportion as
the muscle cell gained abiUty to do speciaUzed work it
lost ability to care for all the. processes that are required
in Uving tissue.^ This specialization of certain cells re-
quired that other cells take up the work of supplying the
muscle cells with food and of removing the waste occa-
sioned by their activity. Thus it is that special cells ap-
peared to furnish the food and oxygen needed by the
'■ Bigelow, M. A. and A. N. : Introduction to Biology, The Mac-
millan Co., New York, 1913, Chap. II.
5
66 PERSONAL HYGIENE APPLIED
muscles, and other special cells took unto themselves the
work of removing the waste. This is the beginning of the
circulatory and excretory systems.
Professor Tyler^ expresses this change when he says,
"We must never forget that the development of the
muscular system carried with it, or dragged after it, the
development of our most important viscera, kidneys,
lungs, heart, and blood-vessels and, as we shall see later,
of the brain itself."
The contraction of muscle is dependent upon a stimulus
that will caiise it to act so that muscle cells required the
addition to the very simple nervous system of correspond-
ing nerve-fibers. The increased power of locomotion
brought the animal into new environment and new situa-
tions, and from now on through fishes, reptiles, lower
mammals, as the cat and dog, arboreal mammals, as the
ape up to man, the whole history of the developing life is
the history of an increase in complexity and function of
the nervous system. The brain, as the final and most
complex structure to develop, presents an organ of wonder-
ful usefulness to man. It exercises control over the other
centers of the nervous system and hence over all the
parts of the body. Part of this control goes on without
the knowledge of its action on our part and irrespective of
our will in the matter. It is impossible to make the heart
stop beating by thinking or to make the liver secrete bile
by reading about it. This control over the vital organs of
life is automatic and involuntary, and although we know
conditions that would modify the type of reaction that
occurs, we are limited greatly in an effort to guide the
response. We have through the development of con-
sciousness and the will a certain power over the muscles
of the body and, in accordance with the way in which
the organs of the body arose, we are able most effectively
to reach their processes through the action of the skeletal
muscles of the body.
' Tyler, J. M. : Growth and Education, Houghton MiflBin Co.,
Boston, 1907, p. 26.
THE APPBOACH FOE KNOWLEDGE OF HEALTH 67
The outline given here aims to be brief, and yet the facts
are so important that they must be adequately stated.
For this purpose we quote Tyler^ again:
"The human body is composed of many distinct systems
and organs, all indissolubly united in one organism, where
'every part is at once means and end to every other part.'
The health and life of the whole organism may be dis-
turbed or destroyed by the weakness of any one of these
numerous parts. What we often call the lower organs,
the viscera, are absolutely essential to Ufe, and hence by
far the most important. They are fundamental as well
as essential. Anything which disturbs our digestion or
the removal of waste equally disturbs the clearness and
vigor of our thought. Every part must be of the highest
possible efficiency. One great aim of education should be
to 'make the weakest part as strong as the rest.' If
there is to be no schism in the body the organs must be
properly balanced in weight and power. Otherwise the
overgrown part robs some other organ of its fair share of
nutriment, and throws upon it burdens which it cannot
bear. If any part is, for any reason, to be exposed to ex-
cessive strain, that part must be fortified and strengthened
during its period of growth in early Ufe. But every other
part should be correspondingly strengthened to back it
up in its emergency.
"It is hardly possible that in so complex a being as man
all parts and organs should develop with equal rapidity
at one and the same time. . . . We should expect to find
that there is a special time for the rapid development of
each organ. We should naturally expect that the more
fundamental organs, hke those of digestion, excretion,
and respiration, will develop early to meet the needs of
other growing parts, and that some will be held back to
give time and opportunity for this important process.
"We cannot fail to notice the immense amount of time
devoted by nature to the development of the muscular
system. Why did she linger so Ipng over it before going
1 Tyler, J. M,: Loc. cit., p. 38.
68 PEHSONAL HYGIENE APPLIED
on to the development of the brain, especially of the
cortex, with its mental powers? Evidently it must be of
far greater importance and have far larger latent capaci-
ties than we have usually supposed. The muscular
system is the strategic center, so to speak, from and
through which we can reach, exercise, and strengthen the
intestines, lungs, kidneys, and all the organs essential to
life, but which are beyond the direct control of the will.
Hence the sturdy vigor of our ancestors and the dangers
of a sedentary life.
"We have found that different portions of our muscular
system have arisen at different ages, and that they grow
younger as we go out from the trunk to the ends of the
fingers and downward to the toes. The central and funda-
mental are older than the peripheral and accessory."
Professor Tyler describes how these muscles are con-
trolled by nerve-centers, and explains that the centers in
control of the muscles of the trunk are older, tougher, and
have more endurance than those of the muscles of the
extremities. To quote him^ again:
"Therefore we are not surprised to find that the best
physiologists insist upon the fullest possible development
of these fundamental centers. They are the seats of en-
durance which enable us to hold out against the strain of
modern fife, especially in the hurry and fret of our great
cities. They must be strengthened at all cost in the
children of parents who show any signs of traces of
nervous weakness, in all the children of the business and
professional classes, and in those children who will later
enter these fines of work. The high-strung American girl
needs this preventive and developing treatment more than
any other form or kind of education. No child can have
too much of it, and in every case it is far better to have
fuU enough than too little."
Evidence from Biology a Guide for Hygiene. — It is of
very great importance to point out that the digestive
system developed in relation to needs arising in the body,
1 Tyler, J. M,: Loc cit., p. 41.
THE APPKOACH FOB KNOWLEDGE OF HEAIVTH 69
chiefly the needs of the muscles. It used food that was
altered little before digestion. However varied in kind
the food was among different races of man, it nevertheless
retained in all a prevailing coarseness and simplicity.
Civilized man has changed both his physical life and the
character of his food supply. It will never be possible for
him, as he is constituted, to Uve an essentially vigorous
Ufe and digest his food with ease and efficiency, without
a wholesome participation in physical activity and with-
out the use of natural food. A good deal of discomfort and
lack of appreciation of the problem of feeding the human
man would be avoided if this simple principle were vmder-
stood and acted upon. It is interesting to read what
James^ says regarding the development of a type of man
that will not require a strong muscular system and wiU
be free from adequately chewing coarse wholesome food.
His description of this type follows:
"I recollect years ago reading a certain work by an
American doctor on hygiene and the laws of life and the
type of future humanity. I have forgotten its author's
name and title, but I remember well an awful prophecy
that it contained about the future of the muscular system.
Human perfection, the writer said, means abiUty to cope
with the environment; but the environment will more and
more require mental power from us, and less and less will
ask for brute strength. Wars will cease, machines will do
all our heavy work, man will become more and more a
mere director of nature's energies, and less and less an
exerter of energy on his own account. So that if the homo
sapiens of the future can only digest his food and think,
what need wiU he have of well-developed muscles at all?
And why, pursued the writer, should we not even now be
satisfied with a more delicate and intellectual type of
beauty than that which pleased our ancestors? Nay, I
have heard a fanciful friend make a still further advance
in this 'new-man' direction. With ovir futiu'e food, he
1 James, W.: Talks to Teachers on P^chology, H. Holt & Co.,
New York, 1918.
70 PERSONAL HYGIENE APPLIED
says, itself prepared in liquid form from the chemical
elements of the atmosphere, pepsinated or half-digested
in advance, and sucked up through a glass tube from a
tin can, what need shall we have of teeth or stomachs
even? They may go along with our muscles or our physical
courage, while, challenging even more and more our
proper admiration, will grow the gigantic domes of our
crania, arching over our spectacled eyes, and animating our
flexible little hps to those floods of learned and ingenious
talk which will constitute our most congenial occupation."
Contrariwise, the future of homo sapiens will depend
neither upon his ability to do without exercise nor to
subsist upon tablets of food elements, but rather upon his
abiUty to harmonize the demands of his biologic nature
with the requirements of civilized life.
Professor Snedden^ has pointed out some of the sig-
nificant changes in civilization that bring to the biologic
organism serious demands on its adjustment capacity. He
says that man
1. Early took on erect stature and ceased vegetarianism.
2. Disposed of hair and took on clothing.
3. Ranged the world and assembled many kinds of pathogenic
bacteria.
4. Took to work which overtaxes eyes and nerves.
5. Developed much "sitting," thus encouraging insufficient use
of torsal structure.
6. Developed concentrated and cooked foods, thus encouraging
partial atrophy of teeth and jaw structure.
7. Developed means of artificial heat, thus reducing climatic
stimuli.
8. Lives much imder cover, thus reducing stimulating or chem-
ical values of air breathed.
9. Has postponed marriage, thus imposing a period of severe
sexual strain between sexual maturity and time of approved
marriage.
10. Has developed routine toil instead of the intermittent work of
the ancestors.
11. Has made of some men (forinerly) and many women creatures
of decoration rather than useful social functions.
12. Has substituted for the close concrete fears of the primitives
the "long range" intellectualized apprehensions and solici-
tudes (worries) of provident Ufe.
' Unpublished lecture delivered in Svunmer Session, Columbia
University, 1921.
THE APPBOACH FOR KNOWLEDGE OF HEALTH 71
It is not important to agree with all of these suggested
changes, but it is important to understand that modern
life has thrown upon the biologic organism severe strains,
and to understand further the fundamental needs for the
preservation of the health and vigor of the body„
The Human Body and its Adjustment. — The biologic
evidence indicates that man's evolution has brought an
inheritance of structure and function that requires thought-
ful care and attention by the individual and society to
devise ways and means of meeting the artificial conditions
imposed by civilization. The experience of man indicates
everywhere that the fundamental biologic needs cannot
be ignored. Fortunately, the increased interest in health
today is helping to overcome some of these environmental
handicaps. One may be the veriest tyro in hygiene and
yet know of the efforts everywhere to combat the dangers
that Snedden suggests. The interest in posture, the era
of wholesome dress, the development of senmis, the
establishment of isolation measures, the play and recrea-
tion movement, the crusade against the sedentary hfe,
the agitation for coarse, wholesome food, the open air and
camping programs, the keen interest in and study of social
hygiene, the emphasis on the importance of physical
work, the recognition of athletics for men and women both,
the development of instruction in mental hygiene — all
attest to the appreciation of the problems presented by
civilized hfe. It is most fortunate that these movements
are adjustive, that they are based on biologic needs, and
are not trying to develop a type of man like the one to
which WiUiam James has referred. Many of the false
standards of civihzation with their emphasis on the
maximum production of wealth will be changed. The
biologic adjustment will be made easier with the advent
of more rational attitudes.
The Human Body an Energy Mechanism. — ^The ability
of the body to adjust itself to new situations as well as to
function properly in old and famihar ones is related to its
abihty to release and use energy. The individual with
72 PERSONAL HYGIENE APPLIED
abundant energy may not always meet the problems of
living satisfactorily either from a personal or social view-
point, but surplus energy is a necessity for the best
voUtional control and, hence, for rational action. Its
release and expenditiire determine largely man's ability to
adjust to the various problems presented in complex
modem life. The energy aspects of life are set forth
clearly by Osbom^:
"So far as the creative power of energy is concerned, we are on
sure ground! In physics energy controls matter and form; in physi-
ology function controls the organ; in animal mechanics motion con-
trols, and ia a sense creates, the form of muscles and bones. In
every instance some kind of energy or work precedes some kind of
form, rendering it probable that energy also precedes and controls
the evolution of life."
For a long time the body has been considered as an
organism with abiUty to receive, store, and express
energy. The manifestations of life in action have always
appealed as energy manifestations, but the known and
unlmown chemical reactions going on in the body, while
seemingly on an energy basis, have never been fully under-
stood. The phenomena of growth and development have
always been obscm-e even when we had information about
hormones and the power of certain internal glands to
control the metabolic changes going on in the body. It is
extremely valuable to set forth the way in which this
control is exercised. Obsom says, "every physiochemical
action and reaction concerned in the transformation, con-
servation, and dissipation of energy produces also, either
as a direct result or as a by-product, a physiochemical
agent of interaction which permeates and affects the
organism as a whole or affects only some special
part."
By an agent of interaction is meant a force connecting
the force of action and reaction. It refers to what is going
on between parts and is similar in type to the interaction
' Osbom, H. F. : The Origin and Evolution of Life, Charles gcrib-
n?r's Sons, New York, 1919, pp. 10, 11,
THE APPROACH FOR KNOWLEDGE OF HEALTH 73
between a driver and a driven horse by means of the reins.
A nerve impulse in this sense is an interacting agent, since
it connects the action of a distant nerve-cell with the re-
sponse of a muscle in vigorous contraction. A hormone
produced in cells in one part of the body and passing in
the blood may affect the activity of cells far remote.
Osbom^ goes on to say:
"Through such interaction the organism is made a unit and acts
as one, because the activities of all its parts are correlated. Since
it is known that many actions and reactions of the organism — such
as those of general and localized growth of nutrition, of respiration
— are co-ordinated with other actions and reactions throu^ inter-
action, it is but a step to extend the principle and suppose that all
actions and reactions are similarly co-ordinated; and that while
there was an evolution of action and reaction there was also a corre-
sponding evolution of interaction, for without this the organism
would not evolve harmoniously."
To quote Osbom^ again, "Evidence for such imiversality
of the interaction principle has been accumulating rapidly
of late, especially in experimental medicine and in experi-
mental biology."
The experiments of Morgan and Goodale bear this out.
Loeb,' in his recent book, Movements, Tropisms, and
Animal Conduct, shows the evidence from the biologic
laboratory. The actions of animals are determined by
the influence bearing upon the many sensory receptors.
The response to the stimulus is determined by the energy
available. These facts mean for those who would live
most and serve best that energy should be abundant at all
times as a guarantee of the best adjustment, the best
choice.
It should be noted further that the tissues and organs
of the body are especially adapted to receive, store, or
express energy. This characteristic is especially valuable,
for it enables a balance and control to exist in the body
without which there would be no harmony either in
1 Osbom, H. F.: Loc. cit., p. 16.
" Ibid.
» Loeb, J. : Forced Movements, Tropisms, and Animal Conduct,
J. B. Lippincott Co., Philadelphia, 1918,
74 PERSONAL HYGIENE APPLIED
development or in action. Osbom^ again states this point
in excellent phrase:
"AU visible tissues, organs, and structures are seen to be the more
or less simple or elaborate agents of the different modes of energy.
One after another of the special groups of tissues and organs are
created and co-ordinated — organs for the capture of energy from the
inorganic environment and from the life environment, organs for
the storage of energy, organs for the transformation of energy from
the potential state mto the states of motion and heat. Other agents
of control are evolved to bring about a harmonious balance between
the various organs and tissues in which energy is released, hastened
or accelerated, slowed down or retarded, or actually arrested or
inhibited."
The method of energy manifestations is being gradually
explained and understood. We are beginning to under-
stand that all actions and reactions, dependent for their
power upon energy, are co-ordinated; they control and
modify the organism in accordance with the influence that
the particular actions give. This gives us the scientific
background for the teaching that our actions today de-
termine in a very definite way the kind of response we will
give tomorrow. This has been stated by Bergson' and
some time ago by James. James says' in this connection:
"What he shall become is fixed by the conduct of this
moment."
Energy plays an important part here, especially in all
ethical situations. To quote James again:
"The ethical energy par excellence has to go farther and
choose which interest out of several, equally coercive,
shall become supreme."
Thus energy, abundant energy, lies at the very root of
Ufe. It fixes largely the choices made; it qualifies the
vision. Only with abundant energy co-ordinating the
body functions is the immediate thrusting appeal of the
moment turned aside for the distant view, the higher goal.
The more recent studies in medicine, biology, physics,
' Osbom, H. F. : Loc. cit., p. 17.
2 Bergson, H. : Creative Evolution, H. Holt & Co., New York,
1913, pp. 34, 35.
' James, W. : Psychology, H. Holt & Co., New York, vol. i, p. 228.
THE APPROACH FOR KNOWLEDGE OF HEAI/TH 75
and chemistry indicate, therefore, that the human body-
is not to be thought of as an aggregation of cells and
organs that act irrespective of the control afforded by an
interacting mechanism, but rather should it be considered
a unified whole, guided at times by a circulating substance
in the blood, at other times by an impulse from nerve-
cells. There may be other ways in which the control and
balance of the body is maintained, but at present we are
familiar only with these forms. The human body, like
all bodies for that matter, is an energy mechanism. It
acts without reference to its size and is, except in the case
of some muscular actions, not dependent upon its size.
The amount of released energy in the individual is de-
pendent more upon the activity of his nerve tissue and
the character of his internal secretions than upon his
height or weight. The human body is dependent upon the
same food sources for energy that serve the other animals,
and the availabihty of these sources controls in large
measure the amount and character of the energy expressed
in the Ufe of the individual.
Sources of Energy. — ^Ultimately the source of all energy
for man is the sun, according to the theory of photosyn-
thesis. Lavoisier and de Saussure laid the foundation of
the understanding that the action of solar heat and hght
is a perpetual source of living energy. But for man it is
perhaps equally important to recall the following con-
ception of the cycle of elements that passes through plants
and animals: The animal is sustained by the plant and
the plant, in turn, is dependent upon the animal for the
waste that forms the source of certain essentials in plant
metabolism. The energy of the sun is captured by the
plant through the chlorophyl and is stored in food.
The plant with chlorophyl is able through the action
of the solar energy to form carbohydrates. In addition,
fats and protein are manufactured in the plant and
mineral compounds are absorbed from the soil. The
chlorophyl action is very interesting. The leaves of the
plant with chlorophyl in the presence of sunUght separate
76 PERSONAL HYGIENE APPLIED
oxygen atoms from the carbon in the molecules of carbon
dioxid (CO2) and hydrogen atoms from the water (H2O),
storing up the energy of the hydrogen and carbon products
in the carbohydrate substance of the plant.
In this way the starches and sugars of the plant deposit
their stored energy in the tissues of the plant. Such energy
is avilable for the animal and will be released to the animal
by the addition of oxygen in the cells. This is an important
fact, that the energy of food requires oxygen for its utiliza-
tion and will be released when oxygen is brought in con-
tact with it. It is thus seen that the energy of the sun
transformed into the chemical potential energy of the
elements, carbon, hydrogen, and nitrogen, is transmitted
by the addition of oxygen in the animal into motion, heat,
or functional activity of glands.
The sources of human energy, therefore, are the plants
and oxygen. Other animals serve to yield food energy
for man, but they, in turn, are dependent upon this same
source. An understanding of simple plant physiology,
therefore, frees us in part from the exigency of attributing
to a mysterious power the phenomena of growth, develop-
ment, and action.
But are there other sources of hmnan energy than those
involved in the chemical action and reaction that ap-
proximates the test-tube experiment, and are we left in a
hopeless materiahstic position if we are unable to attribute
to a Supreme Power the actions of life and the phenomena
of growth and development? In many ways we are im-
measurably enriched, because we are not acting on sup-
position, but on fact as determined by experiment.' We
have no need to postulate mysterious forces either to
explain man's action or to interpret the record of his
growth. The mechanisms'" available in man and sensitive
to the changing situations in life are capable of releasing
energy at moments of great demand. Proper attitude
1 Conklin" makes an excellent statement of this view with reference
to development of the body in Heredity and Environment, pp. 43-51.
" Caimon, W. B. : Bodily Changes in Pain, Hunger, Fear, and Bage,
Appleton & Co., New York, 1916.
THE APPROACH FOR KNOWLEDGE OP HEALTH 77
toward any situation will result in the proper response,
and for this response the whole of life is prepared to act.
It is important to state, therefore, that we have no
evidence that there is any force acting on the body to
determine its response except as it acts by stimulating
the varied mechanisms of the body. Thus any situation
that produces a state which is called emotion also produces
profound internal changes in the body which are a part of
the response. The enormous strength exhibited by man
under the influence of a situation provoking the external
signs of fear or anger is not due to any force that has en-
tered the body, but to a group of internal changes char-
acterized by a free release of energy that was present in
the body all the time.' A Supreme Power does not act by
bringing some force into the body, but through our re-
sponse to situations of stimulating character we may be
aroused to release in any particular effort more than we
habitually expend. Most people have httle appreciation
of the tremendous power they possess, and many people
spend their whole life without at any time calling on those
great energizing mechanisms which result in great achieve-
ment. A coroUary of this is that most people never live
up to the highest level of their best, and, as a rule, fail to
appreciate what health, happiness, and love really are.
We can hope for a great increase in effective living when
more people bring into their lives the powerful and stim-
ulating forces which enable them to release and trans-
form energy that the body possesses into the doing of a
really important work and the hving of a really effective
life. The strongest and most powerful forces in this re-
spect are ideals of service. If the ideal of social respon-
sibihty really belongs to one, its value wiU be seen in real
achievement.
The health of a man and his best welfare cannot be
determined by a mechanical or materialistic test. In the
working out of any scheme for the development of the
best in the individual full appreciation must be given to
* Cannon, W. B.; Loc. cit.
78 PEBSONAL HYGIENE APPLIED
those indirect factors that profoundly influence the con-
duct of the individual and always determine results in
the final analysis. The human mechanism, while made
up of organs and cells that receive their energy from the
sun through the plants in the same way that cells in other
animals receive their energy, is in man nevertheless subject
to a different kind of control. It will be important to keep
this point in mind because the solution of many of the
problems of Hving is dependent upon an understanding of
the emotional and psychic factors involved in health, and
the power of intelligence in maintaining health. "What
we wish to insist on is that man's intelligence is a fact,
that it is immensely and in effect immeasurably superior
to the intelligence of the lower animal, and that this in-
telligence can become the significant guiding factor in
man's conduct."^ The reahzation of the essential chemical
character of man need never exclude an appreciation of the
fact that this chemical character is one that is controlled
by a nervous system that has given to us intelligence and
ideals, both a promise of God in man.''
The Value of the Biologic View. — ^When it is recalled
that exercise, food, air, rest, sleep, and bathing form a
very large part of the subject matter of hygiene, we reahze
the value of looking at the body from a biologic point of
view. The story of animal life must never be forgotten.
The primitive cell, as represented in such an animal as
the Protozoa, is able to move, to gather and digest food,
to take in oxygen and expel the waste, to rest and keep
itself free from the poisons that would most readily injure
it. This organism combines in one cell all the functions
that man must care for in different systems of the body,
but man is just as dependent as this cell on the effective
workings of these functions. This fact should never be
forgotten. Unfortunately, it frequently is forgotten in the
absorbing activities of the nervous system. But the
' Bergson, H. : Creative Evolution, Henry Holt & Co., New York,
1913, pp. 98-185.
"Thomdike, E. L.: Educational Psychology, Teachers Colleee,
New York, 1919, pp. 306-312. '
THE APPROACH FOB KNOWLEDGE OF HEAI/TH 79
nervous system itself is dependent upon these other proc-
esses for its very foundation and sanity, so that one can
hardly hope to achieve any real and lasting success through
the nervous system without caring in an intelligent way
for the biologic basis of life.
Let there be no misunderstanding on this point. He
who would have health must work for it. Wishing for it
will not achieve it; ideals without intelligent effort are
dead. It is not something that can be bought at the
comer drug store or achieved by mental or spiritual proc-
esses. Health, strength, and vigor in any person is
health, strength, and vigor of the vital organs of the body,
including the nerve-centers of the cord, and it should be
clear and compelling that this strength comes largely from
the use of the muscles of the body, and especiaUy the
trunk muscles in youth. If we would lay the foundation
for health, strength, and power we must run, jump,
climb, swim, and engage in play and sports that have
engrossed man since earliest times. One need expect no
real results by five minutes of formal exercise in the bed-
room on retiring or by deep breathing at an open window.
The way to health is the path of wholesome activity.
This implies something more than riding ia street cars,
eating prepared and predigested foods, breathing deeply
for five minutes in twenty-foiur hours, and working over
long periods without reasonable time for rest, recreation,
and sleep.
There need be no essential conflict between the demands
of health and the demands of the intellectual and moral
life. If health is not thought of as an end, but only as a
means for the accomplishment of worthwhile work in life,
no conflict will arise. That life which may be called
"good" will be physically wholesome, mentally keen and
fervid, and morally sound.
To have health and not to use it in socially serviceable
ways is, of course, morally wrong. The man or woman
who refuses to use health and strength for the accom-
phshment of service to society has no justification today.
80 PERSONAL HYGIENE APPLIED
The two extremes are recognized here: the individual who
fosters health for health's sake, and the one who loses his
health in the effort to achieve a piece of work. Of the two
courses, the latter is preferable. Professor Thorndike re-
marks in this connection:
"To some extent we barter our health for the other
valuables — ^knowledge, skill, and habits of utiUty to the
commimity. At present we probably sell too much of
health, but it woidd be equally unwise to sacrifice every-
thing for health. It is better to be a Socrates with a
headache than a perfectly healthy pig. There must be a
compromise."
The art of fine living consists of the greatest irdellectual
development and the most worthy social service possible,
without loss of power to continue the race adequMely, to
enjoy life fully, and to be a real source of happiness to others-.
The Test of Hygienic Knowledge. — The test of the use-
fulness of hygienic knowledge is to be found in its con-
tribution to the art of fine living. A considerable amoimt
of health advice and instruction has been made for in-
dividuals and provides no guide for all. Many persons
learn some particular practice because a friend who was
ill was advised by the physician to do thus and so.
Any particular health advice must be made and upheld
because it is of value not in healing the sick, but in keeping
the well strong and happy, in preventing iUness, and
making the individual more efficient and useful. The
test of its value is not is it good for the sick, but is it
rational and scientific for the well. The treatment of the
convalescent is not the treatment of the vigorous man of
affairs or the healthy teamster who may by hygiene be-
come more vigorous and more strong.
Hygienic or health knowledge must apply to the whole
of man. It is to be criticized as a system if it is effective
only in neurasthenic states. The use of faith cures, or
spinal adjustments, or the practice of abstaining from the
use of meat, or the carrying of an onion in the hair for
relief of headache, are partial, limited, and incomplete
THE APPROACH FOB KNOWLEDGE OF HEAI/TH 81
procedures. They may have special application in special
cases. But confusion of special measures with systems
must not be made. The few trees must never be taken
for a forest; the few swallows, for a summer. The hy-
gienic procedure that purports to possess universal char-
acters must be viewed with suspicion. The life of man in
his adjustment to the strains of modem life, in his hopes
and aspirations, in his work, play, recreation, indeed, in
his love and worship, is not to be guided by mystic for-
mulae, nor to be saved by special methods. Hygiene is to
be tested by its contribution to the whole of life.
CHAPTER V
SCIENCE AND ATTITUDES
I. The Dual Aspect.
II. Science and Health.
III. The Position of the Christian Scientist:
1. The Christian Scientist Not Prepared to Judge.
2. The Christian Scientist Ignores Facts.
3. The Danger from Christian Science.
4. Social Responsibihty and Christian Science.
5. The Kind of Disease that Christian Science Cures.
IV. A Recent Akrival:
What is Chiropractic?
V. What is Osteopathy?
VI. The Call op the Occult.
VII. Scientific and Humanistic Principles Confused.
VIII. Facts and Superstition:
Patent Medicines and Fear.
IX. The Challenge x)f Scientific Medicine.
Examples of the Methods of Scientific Medicine.
X. Man, the Organism.
The Dual Aspect. — The problem of personal hygiene is
a problem that involves science which provides us with
the accurate knowledge of the way in which to care for
the body, and habitual attitudes which use this scientific
knowledge in the service of ideals.
The laws of health are given by science. They come
from the food laboratory, biology laboratory, health de-
partments, statistical bureaus, university departments of
hygiene, organizations such as the Public Health Associa-
tion, Anti-Tuberculosis League, American Medical Asso-
ciation, and State and Federal bureaus, such as the United
States Public Health Bureau and State Departments of
Health. These health departments and bureaus for hy-
gienic living test out the traditional and customary modes
of living and serve as effective and authoritative sources
for the determination of the values of any particular
hygienic practice. The laws of health, if they are to serve
83
SCIENCE AND ATTITUDES 83
as good guides, must be accurate and scientific, and at no
time can they depend upon superstition and hearsay. A
certain number of people believe that rheumatism may
be avoided by carrying in the pocket a red kidney bean.
Such belief is probably founded upon the single experi-
ence of one man who carried a bean in his pocket and
never had rheumatism. It is unnecessary to say how
fallacious such reasoning is, and yet in more subtle and
confusing argimients there is need to hold to the general
tenets of scientific proof of the value of any particular pro-
cedure. One of the responsibilities of the educated person
is to refrain from being moved by superstition. Wisdom
expresses itself in many ways; one way is by the use of
scientific guides as distinguished from the occult, mys-
terious, and superstitious. "Education is the vaccination
that confers immunity, but it does not always take."
The laws of health are given by science; the practice of
them is a matter of habit in which ideals and attitudes
have shared largely. For the best results in education
health habits should never be automatic except in the
routine care of the body. For meeting the complex, widely
varjong problems of human adjustment, the only safe-
guard is ideals of hving that shall foster and strengthen
desirable attitudes. The most scientific theory of correct
living, made automatic, might succeed in an artificial
environment, but for life in the present world it needs
constant correction by intelligence and constant motiva-
tion by ideals.
Science and Health. — It is contended here that the
laws of health are given by science, and the science invoked
here is that of the laboratory, the health departments,
and the Ufe of the world. In contrast to this view is the
conception of health as held by a group that claims to
recognize science and to base its guides upon the teachings
of Christ. The rehgious character of their behef acts as a
deterrent to criticism, but the health impUcations are so
' Dunlap, K. : Mysticism, Freudianism, and Scientific Psychology,
pp. 112-130, C. V. Mosby Co., St. Louis, 1920.
84 PEKSONAL HYGIENE APPLIED
prominent that the position of the Christian Scientist
should be examined.
The Position of the Christian Scientist. — ^The Christian
Scientist negates all science of health as we know science
in physics, chemistry, engineering, and biology, and puts
in its place a claim, an insistence that there is no such
thing as body and, consequently, no such thing as disease.
The realities of bacteria, the toxicity of toxins, the de-
struction of poisons have no place in his thought because
for him they are non-existent. He ignores them. His
attitude is similar to that of the ostrich in hiding from
sight by poking its head in the sand. How can people
who have made no study of the sciences of pathology,
bacteriology, and the history of disease form intelligent
opinions regarding the cause, the symptoms, the diag-
nosis, and treatment of disease! Their "science" consists
in denying the existence of disease through a type of
glorified suggestion, and, having no capacity for scientific
study of cases or real investigations of causes and treat-
ments, they are totally unable to speak with any authority
regarding disease.
Their followers and enthusiasts are, in the main, those
who have been "cured" of imaginary afHictions. They
present no body of thought that is helpful in stating either
the science or the ideals that should help science in serving
manhood and womanhood. Moreover, in the neurotic
cases, where results are secured, the individual is in-
fluenced by a hocus pocus instead of being guided by
the psychologic truths that would rationalize life for
him.
In noting that Christian Science cures certain cases
students of hygiene frequently ask, "If Christian Science
gets results in some cases, why is it not a good thing for
society?" Aside from other reasons for its disapproval, it
should be noted that any system, scheme, or program that
rehes upon hocus pocus, upon fancy rather than fact,
upon crude credence rather than truth, should not appeal
to one interested in living intelligently. The curing of
SCIENCE AND ATTITUDES 85
neurasthenics by mysticism is not increasing the in-
telligent processes of the human race.
The position of the Christian Scientist is, therefore, one
of irrationaUty, a position not supported by science, and
totally unacceptable for purposes of an intelligent life.
The Christian Scientist Not Prepared to Jvdge. — The
devotees of Christian Science, as of other well-wishing
systems, are not prepared to judge of health or disease,
primarily because they know so httle about them. Start-
ing from assumptions contrary to fact, they reach fanciful
conclusions in the health field in precisely the same way
that they arrive at convictions in other fields. In a
masterly discussion of values in human life Royce^ in his
chapter on optimism, pessimism, and the moral order
examines the philosophy of this group. As a moral and
reUgious teacher Professor Royce is interested in studying
Christian Science and other pseudo-optimistic doctrines
with reference to their spiritual impUcations. He says many
things that help to explain the mental twist of these people:
"Extremely characteristic of the mood of such rehgious optimism
is in many minds a dread of the natural order as science knows it.
Your optimist of this type, if he devotes himself to political theoriz-
ing, has a peculiarly violent dislike for economic facts. To his mind
there are no evils in society except competition and poverty, which
will both cease as soon as we by chance fall to loving one another
and to owning the property of the nation in common. Crime is not
a result of anything deep in human nature; selfishness is a mere in-
cident of a defective social system. With fewer hours of labor we
should have many times the spirituaUtjr we now have. Sin is not
only mere ignorance; it is something still more limited; it is mere
ignorance of the proper theory of the functions of government. . . .
Evil being an illusion, the spiritual powers being in complete owner-
ship of the entire world, there is no reason why any day the scene
of our sorrow should not be entirely transformed. In the hope of
such transformation the faithful wait and trust. Meanwhile they
expect little help from mere science, which once for all deals with
the world of mind and of sense in a lower sphere."
Professor Royce goes on to make plain that such doctrine
is not truly spiritual at all, nor does it represent a genuine
idealism.
^ Royce, J. : The Spirit of Modem Philosophy, Houghton Mi£9in
Co., Boston, 1892, p. 446.
86 PERSONAL HYGIENK APPLIED
In a remarkable book Jastrow^ has sensed this peculiar
position of the Christian Scientist and indicts the public
for enormous credulity. He says in part:
"To complete the collection of types of credulity, we should
have an instance in which a system of interpretation of facts— not
a mere narrative — ^in itself startling and contradictory to ordinary
experience, gains wide-spread credence, and that in spite of pro-
noimced inconsistency with verifiable observation and common
sense. These conditions are remarkably well satisfied by the recent
promulgation of the doctrines of Christian Science. Even in this
field of intellectual effort the land of the free and the home of the
brave has contributed an article worthy to compete with the foreign
product. Eagle-like this system spreads its wings and soars free
from the bonds of sense or earth-bound realities, free from human
logic and the errors of mortal mind, free from the material impedi-
ments which nature has inconsiderately set in our paths, free to
make things so by thinking them so, free to set method, learning,
and experience at naught. And surely it calls for courage of no
common order to resist the seductive appeals of eye and ear, to sail
steadily on heedless of the calls of sirens of rationality, convinced
at the outset that things cannot be as they are, and refusing the nod
of recognition to the plebian idols of the' ills of flesh. It is not
necessary in this connection to recount the beliefs of this system;
it is sufficient to point out that when thousands of intelligent persons
give practical adherence to, and enroll themselves under the banner
of one who teaches that a bunion would be an adequate cause of
insanity, if only we held the same belief about the bunion as we do
about congestion of the brain; that smallpox is contagious by reason
of the same agencies as make weeping or yawning contagious; that
fear may be reflected in the body as fractured bones, just as shame
is seen rising to the cheekj that anatomy and physiology and hygiene
are the husbandmen of sickness and disease, while the reading of a
text-book of Christian Science is equally effective in producing
health; that when a healthy horse takes cold without his blanket it
is on account of the poor creature's knowledge of physiology — ^then
such persons can hardly complain if they are cited as instances of
modern credulity."
The Christian Scientist Ignores Facts. — The history or
course of a disease is known by the records of its occur-
rence, its morbidity rate, its mortahty, and its complica-
tions. The influence of any new method of treatment may
be determined by statistical study of the death-rate. The
death-rate is subject to the same kind of scientific testing
as the birth-rate, immigration, or any other process in
' Jastrow, J. : The Psychology of Conviction, Houghton Mifflin
Co., Boston, 1918.
SCIENCE AND ATTITUDES
87
which the facts are gathered. The use of antitoxin for the
treatment of diphtheria has been one of the triumphs of
scientific medicine. It is the pecuhar mind of the Christian
Scientist that can ignore the following table^ giving the
number of deaths per 10,000 of population before and
after the use of antitoxin:
Death-bate prom Diphtheria and Croup per 10,000 Population
aty.
Before
anti-
toxin.
After antitoxin.
1887-
1893
1896-
1899
1900-
1905
1906-
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
Denver
12.9
1.7
2.9
2.3
1.6
0.5
0.8
0.4
0.3
0.1
0.8
1.1
1.0
New York. .
14.5
6.3
5.1
3.8
2.6
2.2
2.6
2.9
2.4
1.9
2.1
2.3
2.2
Philadelphia
11.9
9.6
4.0
3.3
3.1
2.3
2.1
1.9
1.8
2.2
2.5
2.1
2.4
Chicago
13.1
5.0
2.8
2.3
3.8
4.1
4.1
3.2
2.7
3.1
4.7
2.7
2.2
In the above cities the effect of the antitoxin treatment
upon municipal mortaUty figures has been directly pro-
portionate to the extent to which the health departments
have beheved in its efiicacy and encouraged its use by
furnishing it free to the poor and sending their own in-
spectors to administer it. From 1896 to 1899 the rate in
Philadelphia was not greatly affected, due to an opposition
to its use on the part of the health authorities. After its
use was extended the rate fell, and in the years from 1900
to 1919 Philadelphia compares favorably with the other
cities in the list.
What is true for diphtheria and antitoxin is more
strikingly shown in the results from typhoid inoculation.
The value of inoculation against typhoid is strikingly
shown by a comparison of the cases of and deaths from
typhoid in the United States Army before and after com-
' Data for the table taken from Holt, Diseases of Infancy and
Childhood, p. 1002, Report of the New York City Health Depart-
ment for the years 1900-1920, and figures supplied by the Depart-
roent of Commerce, Bureau of the Census, Washington, D. C.
88
PERSONAL HYGIENE APPLIED
pulsory inoculation. The following, given by Major
Lyster, covers the period from 1908 to 1914:
Vaccination Against Typhoid in the United States Abmt
Number of
Number'
Cases
Army
Year.
persons
receiving
61
mean
vaccinated.
three doses.
typhoid.
strength.
1908*
239
74,692
1909*
830
621
282
84,077
1910*
16,093
11,932
198
81,434
1911*
27,720
25,779
70
82,802
1912
40,057
aU
27
88,478
1913
25,086
aU
4
90,752
19141
35,902
aU
7
92,877
■ Voluntary inoculation.
t Compulsory inoculation.
Since 1912 the cases 27, 4, 7 were, with few exceptions,
in men who were not inoculated for some reason or other,
or who had contracted the disease before enlistment.
Ttphoid Morbiditt and Mortality Rates in United States
Armt, 1903-1912
Years.
Death-
rate
per
1000.
AdnuBsion
rates
per
1000.
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
.28
.27
.30
.28
.19
.23
.28
.16
.11
.03
5.82
3.62
3.57
5.66
3.53
2.94
3.03
2.32
.81
.31
—
Havard* shows the value of inoculation in- compiling the
admission and death-rate for typhoid for the years 1903-
' Havard, V. : Manual of Military Hygiene, Wm. Wood & Co.,
New York, 1917, pp. 36, 37.
SCIENCE AND ATTITUDES 89
1912. It should, be noted that the large number of men
voluntarily submitting to inoculation accounts for the low
rate in 1910 and 1911, immediately before it became com-
pulsory.
Havard/ in commenting on the value of inoculation
against typhoid, says:
"During the four yeaxs 1909-1912 no deaths occurred among vac-
cinated soldiers in the United States."
Woodhull,^ in commenting on typhoid in the Civil and
Spanish-American wars, says:
"According to statistics used by Major F. F. Russell (Military
Surgeon June, 1909) the Federal army alone had more than 80,000
cases of typhoid fever in the war for the Union. During five months
in the Spanish War (Official Board on Typhoid Fever) we had
20,738 cases and 1580 deaths among 107,973 officers and men in
camps within the United States, or 19.26 per cent, sufferers from the
disease."
The American Army in the World War had compulsory
inoculation. Making allowances for failures in technic or
in organization, it is to be noted that from September 1,
1917 to May 2, 1919 there were 213 deaths from typhoid
in an army with a mean strength for that period of
2,121,958
Additional evidence is available in comparison of the
camp at Jacksonville in 1898 (Spanish-American War) and
the camp at San Antonio in 1912 (mobilization on the
Texas Border).
At Jacksonville before typhoid inoculation there were
10,759 soldiers, 2000 cases, 248 deaths; at San Antonio,
with compulsory vaccination, there were 12,801 soldiers,
2 cases, no deaths. It is an interesting and instructive
fact that in the Spanish-American War 243 soldiers died
of wounds and 1580 perished of typhoid fever (Fig. 2).
In the light of such evidence it is, indeed, surprising
how apparently intelligent persons will oppose and carry
' Harvard, V. : Loc. cit.
sWoodhull, A. A.: Military Hygiene for Officers of the Line,
John Wiley & Sons, New York, 1909, p. 308,
90
PERSONAL HYGIENE APPLIED
ISO
MO
UO
120
no
100
90
80
70
60
SO
40
30
20
limmsH-MiEiiicAi mil
KUOUTin iUlUT
nnwiD nuiCB
irucium AunsT
TirHowcniRiLnin
WMiT or «>»
VACCIUTIOI AUIMST
nnioio cowuLsoRT
ENTIRE TEAR
(itOHLP bar]
Fig. 2,
SCIENCE AND ATTITUDES
91
on obstruction propaganda in order to retard scientific
disease prevention. Comparison of smallpox and typhoid
in the three wars should be illuminating on this point.
The following figures given by the Office of the Surgeon
General, War Department,^ show a vivid comparison for
typhoid in three wars:
Deaths prom Disease in Three American Wars
Disease.
Number of deaths
that occurred in
World War, Sep-
tember 1, 1917 to
May 2, 1919. Av-
erage strength ap-
proximately 2,121,-
Number of deaths
that would have oc-
curred during the
period September 1,
1917 to May 2, 1919
if the CSvil War
death-rate had pre-
vailed (July 1, 1861
to June 30, 1865).
Number of deaths
that would have oc-
curred during the
period September 1,
1917 to May 2, 1919
if the Spanish-
American War rate
had prevailed (May
1 to September 30,
1898).
Typhoid
fever
Smallpox. .
213
5
48,978
9,135
65,292
36
The intelligent person will not ignore such facts when
dealing with matters so vital to health and happiness.
Obscuration of history, belief in fantastic claims, and
theories incapable of demonstration wiU be ignored by the
rational mind.
The Danger from Christian Science. — The teaching and
practice of Cluistian Science is dangerous to society be-
cause it ignores the transmissibihty of disease, and hence
subjects the community to cases that should be isolated.
All the work in the pubHc health field today emphasizes
the danger to others that comes from contact with mild
cases. We have only recently appreciated the significance
of "walking typhoid" as presenting a condition in which the
' From a letter by Colonel W. P. Chamberlain, M. C, Decem-
ber 2, 1921, File S. G. O. 710 (Typhoid).
Fig. 2. — Typhoid fever. Annual admission rates per 1000 of
white enlisted men of the United States Army for the years 1880 to
1919 inclusive. (By courtesy of the War Department, OflSce of the
Surgeon General.)
92 PEBSONAL HYGIENE APPLIED
individual had the disease in such mild form that he was
not aware of the infection and yet was capable of infecting
others. Many of the conununicable diseases have mild
forms, and so when they faU into the hands of certain
quacks and irregular systems of healing marvelous cures
are reported by invoking a divining rod or ruling out error
or other ridiculous methods. Not infrequently individuals
recover from infections without medical attention. The
explanation of this fact is so well given by Chapin^ that
his own words are quoted:
"The scientific physician does not pretend to cure maladies by
drugs and medicines. Nature performs the cure. All diseases are
self-limited and end in complete or partial recovery or in death.
By understanding the natural history of disease, however, the
physician aids nature at a critical point in her struggles. This
may be accomplished in many ways. He may assist in the elimina-
tion of rapidly collecting poisons, or in sustaining a failing heart or
relieving a congested limg. By many similar actions the physician
daily saves lives that would otherwise be lost. Needless death
and disabihty are frequently avoided' by the art of the scientific
physician. It is in imaginary, functional, or quickly limited dis-
eases that the patient may get along well without any special treat-
ment. Unfortunately, the mental healer does not always attend
this kind. Imaginary cancers disappear, but the real ones persist,
with the hopeful time of early removal irrevocably gone. Incipient
tuberculosis and many other diseases, in the early and curable
stage, are allowed to become chronic and hopeless. The real dis-
eases eventually get into the hands of the physician, but often too
late to save health or Ufe. Here is where the tragedy comes in."
It is important to understand the danger to the health
of the nation that hes in the propaganda of the Christian
Scientist. The danger is real and insidious because it
operates under the guise of religion, on the one hand, and
a heaUng cult on the other. It reaches not only those who
have imaginary disease but also those who are sufferers
from serious organic disturbance. Christian Scientist
practioners are not capable of diagnosing or treating
disease because of their lack of training and their false
assumptions. In this connection Chapin^ says:
iChapin, H. D.: Health First, The Century Co., New York,
1917, p. 217.
2 Ibid., pp. 214, 215.
SCIENCE AND ATTITUDES 93
"How can people, who confessedly have not made a scientific
study of the pathology and natural history of disease, give reliable
reports as to the results of any or no treatment? Many of them
deny the real existence of the very disease they pretend to cope
with so successfully. Eveiy thinJdng person must reaUze that
reports and statistics of ordinary or miraculous cures from such a
source cannot stand real investigation. Yet such statements some-
times influence people who are accustomed to verify claims when
positively made. When these assertions are coupled with general-
ities that sound elevated and pious, the unthinking may be
impressed.
"Even scarlet fever may be treated by high thought and lofty
utterances. Those who have scientifically studied this malady are
constantly looking for its insidious, severe, and permanent compUca-
tions. Some cases, however, as we all know, are mUd in type and
need no special medical treatment except careful watching for com-
phcations and an avoidance of the spread of infection to others.
The only way to detect these complications is by careful examina^
tions of the vital organs liable to be affected by the poisons of the
disease. The various healers are not competent to do this; there-
fore the eventual results are unknown. . . . How many cases
of infectious disease . . . "passed on" or are now passing through
life with crippling and avoidable complications, no one wiU ever
know. Neither will it ever come to light how many cases of scarlet
fever and similar dangerous infections have been spread to others
by this sort of treatment. Here lies the most serious social aspect
of this question to the community."
Social Responsibility and Christian Science. — Typical of
the operation of Christian Science in such a serious disease
as diphtheria is the case of a child in New Jersey who re-
ceived only "absent" treatment. An editorial in the
Journal of the American Medical Association reviews this
case with reference to the question involved.' It is worth
reading in this connection:
"A New Jersey salesman, who claims to have been a member of
the 'Christian Science' faith for three years, was recently found
guilty of manslaughter because he had permitted his nine-year-old
daughter, who was suffering from diphtheria, to die without medical
treatment. The little girl was given 'treatment' — 'a,bsent' and
otherwise — by a professional 'Christian Science' practitioner. The
man was fined $1000 and costs. The judge, in imposing sentence,
is reported to have said:
" 'In the light of present-day science, which is the result of many
years of progressive experiment and demonstration, no one is justified
in neglscting the use of such agencies as have been shovm to be efficient
in tns treatment of malignani and contagious diseases, and this is
1 Jour. Amer. Med. Assoc, May 22, 1920.
94 PERSONAL HYGIENE APPLIED
especiaUy true where one is charged with responsibility over the life of
another, and particularly of a child of tender years, who has no option
but to rely on the common sense and good judgment of its natural
protector.' '■
"The verdict has brought to light, as such verdicts are likely to
do, the loose thinking that characterizes so many of the so-called
intellectuals of today. Well-meaning people, who deny that they
are followers of Mrs. Eddy, have written to the newspapers de-
nouncing the verdict and declaring that it is little less than a crime
that a man should be punished for foUowing the dictates of his
conscience. The main point stressed by such people seems to be
that as children occasionally die of diphtheria under medical
treatment, there is no reason for getting excited when a child dies
under 'Christian Science' treatment. The argument, of course, is
fallacious. The efficacy of the modem scientific medical treat-
ment of diphtheria is not a matter of theory, belief, or conscience —
it is a matter of fact. Its eflBcacy is as demonstrable as is the
efficacy of the Westinghouse air-brake. The parent or guardian who
fails to give his child or ward the benefit of modem medical treat-
ment for diphtheria becoihes as culpable as a railroad would be if
it failed to equip its passenger trains with air-brakes. Sometimes,
it is true, the air-brake fails to avert a fatality; but that is not the
fault of the brake, nor is it any argument for ite abolition.
"If an adult in his own right mind wishes to be treated by
'Christian Science' or any other unscientific methods, there can
be no objection, provided the disease from which he is suffering
may not, through such treatment, become a menace to the com-
munity. Children of tender years, however, should not be sacri-
ficed to the distorted views of those who are supposed to be their
protectors.
"Religious beliefs should be respected, and, in general, they are
respected. Where, however, religious beliefs oonfhct with the gen-
eral welfare, such beliefs must give way. Presumably, the Mormons
were sincere in their belief in polygamy; that particular tenet of
their religion, however, had to give way to the more enlightened
behef of the rest of the community. The Dukhobors that migrated
to Canada were undoubtedly sincere in their belief that they should
go nude, and the practice of this belief was undoubtedly less a
menace to the community than are some of the bizarre views held
by 'Christian Scientists' regarding the cause and treatment of
disease. Nevertheless, the Dukhobors had to put on clothes. It
is conceivable that we might have transplanted to this country
some of the religious beliefs of India, but it is doubtful whether
pubUc opinion in the United States would ever look with equa^
nimity on Sutteeism, even though the widows might declare that
being burned on the funeral pyres of their deceased husbands was
a matter of their own personal belief and was none of the concern
of the general public. Only a few weeks ago a man in Chicago
shot his son with the avowed intention of killing the boy because
he feared the lad was acquiring bad habits and he wished to save
the boy's soul. We have not yet noticed any letters of indigna-
' Italics are mine. — J. F, W.
SCIENCE AND ATTITUDES 95
tion protesting against the man's arrest. Possibly this is because
he represents a minority. Should such beliefs ever reach the dig-
nity of a religious cult with money and well-organized pubUcity
machinery behind it, there would doubtless be found many to
defend the killing of minors for the purpose of 'saving' them."
The Kind of Disease that Christian Science Cures. — The
cures of Christian Science are the cures of imaginary
diseases that develop readily in people with unstable
nervous systems. The psychiatrist, the nerve specialist,
and often the "family doctor" succeed with the same
types.
In the course of routine and daily work physicians and
surgeons of the medical profession are performing wonder-
ful cures, operations, and diagnoses.
"An interesting though not unique case is described in
a recent bulletin sent out by the Federal Board for Vo-
cational Education. Among the blinded ex-service men
was a negro who seemed to be bUnd in both eyes. Neither
eye could perceive five fingers at any distance. He had
faint hght perception and there was hope of sight restora-
tion in one eye. The man was about to be assigned to a
workshop for the blind when a physician managed to
persuade him that he was not blind. The report of the
case reads: He was suffering from psychoneurosis hys-
teria giving rise to marked blepharospasm' and photo-
phobia^ and amaurosis.' AH physical findings negative.
Treatments by suggestion completely cleared up all
symptoms and I discharged this man cured.
"This case is not referred to because it is unique in
medicine, for, as physicians know, it is not. Had the man
regained his sight, however, while under 'Christian
Science' treatment or while having his vertebrae pushed
by a chiropractor, what a to-do would have been made of
it. The case would have become a classic in the annals of
' Blepharospasm — spasm of the circular muscles of the eyelids. —
J. F. W.
' Photophobia— fear of light.— J. F. W.
•Amaurosis — blindness of the retinal or optic nerve type. —
J. F. W.
96 PERSONAL HYGIENE APPLIED
the cult. As it is, the incident would never have reached
the public eye had it not been for the bulletin of the
vocational educational board." '
A Recent Arrival. — The violation of fundamental hy-
gienic rules of hving causes a variety of disturbances in
health, so that many people are continually below par.
They think badly, they feel badly, and then they act
badly. Such persons, when uninformed, offer a splendid
field for the charlatan and the fraud.
One of the recent cults, claiming . to treat disturbed
bodily states as well as disease itself, is known as chiro-
practic. Its exponents are called chiropractors.
What is Chiropractic? — Just what chiropractic is re-
mains a mystery. It is a method of spinal manipulation,
but aside from that it is unknown in science. Pamphlets
of the chiropractors contain statements concerning bodily
physiology that are unproved, speculative, and, to say
the least — ^novel.
Recently an interesting attempt to define chiropractic
appeared in a bill presented to the New Jersey Legislature,
in an Act to Regulate the Practice of Chiropractic. The
opening paragraph of the act follows:
"Definition of Chiropractic: The term chiropractic when used in
this act shall be construed to mean and be the name given to the
study and apphcation of a universal philosophy of biology, theology,
theosophy, health, disease, death, the science of the cause of dis-
ease and art of permitting the restoration of the triune relation-
ships between all attributes necessary to normal composite forms,
to harmonious quantities and qualities by placing in juxtaposition
the abnormal concrete positions of definite mechanical portions
with each other by hand, thus correcting all subluxations of the
articulations of the spinal column, for the purpose of permitting
the recreation of all normal cyclic currents through nerves that
were formerly not permitted to be transmitted, through impinge-
ment, but have now assumed their normal size and capacity for
conduction as they emanate through intervertebral foramina — the
expressions of which were formerly lacking — named disease."
Surely the author of the act would have no difficulty in
explaining the Einstein theory of relativity.
' Jour. Amer. Med. Assoc, March 27, 1920, p. 890.
SCIENCE AND ATTITUDES 97
Chiropractic will remain a debatable subject, even to
chiropractors, until scientific standards and tests are
applied to it. It may grow by advertising methods, it
may record "cures" by adjustment of subluxations, but it
will remain a claim and a cult until it meets satisfactorily
the sort of tests that intelligent men everywhere make to
cause and effect questions.^
When chiropractic can prove that all disease is due to
"subluxations of the spinal column," then failure in any
one case will not be condemned. However, the report of
the New York Times (December 12, 1921, p. 6) of the
death of David Lebish after two days' treatment by a
chiropractor should give concern. Especially since the
autopsy showed that the boy died of a ruptured appendix
following the "adjustments" of the chiropractor.
The character of a chiropractor's training, the extent of
education, and even an index of intelligence are given by
the following statement pubhshed (at advertising rates)
by a chiropractor of Waukesha, Wisconsin. In giving the
pathology of gall-stones and kidney stones he says:
"Gall-stones are due to an excessive amount of heat in the gall-
bladder which crjrstaUizes the calcareous material in the bile and
forms stones. This excessive heat results from the loss of calorific
or heat control of nerves due to nerve pressure in the middle dorsal
vertebral region. Adjustment of the causative subluxation restores
the condition to normal. Renal stones are caused in the kidneys
in the same manner."
Now, unfortimately, the public is so ill-informed on
anatomy and physiology that it cannot always judge in-
teUigently. But any lajnuan might well ask, "How would
an 'adjustment' remove stones already formed? If ex-
cessive heat causes the stones, would removal of pressure
on heat nerves destroy the stones by freezing them?" To
get laymen to ask thoughtful questions on matters of
personal and pubUc health is very important for the wel-
fare of man. InteUigent questions in this field are not
* See a series of six articles in Leslie's Weekly, beginning January
7, 1922, on Chiro-quack-tic, by Severance Johnson.
98 PERSONAL HYGIENE APPLIED
impossible if sufficient time and attention are given to
instruction in the schools in physiology and in hygiene.
What is Osteopathy? — Osteopathy is defined^ as "A
system of treatment based on the theory that diseases are
chiefly due to deranged mechanism of the bones, nerves,
blood-vessels, and other tissues, and can be remedied by
manipulation of these parts." Osteopathy^ emphasizes
the tendency of the human body "to remain in a state of
health" and claims that the "fundamental predisposing
cause of disease" is disturbance of normal nutritive proc-
esses. It further claims that "a prominent cause of dis-
turbed nutrition is anatomic malposition of the various
parts of the body," and, moreover, that such malpositions
"are frequently capable of correction by manual pro-
cedures." "Osteopathic thinkers protest against the
hasty adoption of surgical measures" in surgery, which is
considered "a branch of osteopathy."
It would seem that osteopathy could advance its
position in the professional and scientific world if it
could present a series of cUnical cases of malaria (diag-
nosed by demonstration of the Plasmodium malarise in
the blood), of syphilis (diagnosed by the Wassermann
test made in an accepted laboratory), and of diphtheria
(diagnosed by demonstration of Klebs-Loffler baciUi)
cured by manipulations. It should be noted that osteop-
athy in its insistence on anatomic malposition as a cause
of disease presents a limited truth. A misplaced uterus,
kidney or stomach, a spinal curvature or postural de-
formity may lead to disturbed nutrition, pain, and fre-
quently to disturbance of function. But these facts and
conditions are recognized by the scientific physician. The
extensive development of physiotherapy in hospitals and
private practice is based upon this recognition of physical
causes in disease and physical means of treatment. Such
recognition should not blind one to the protean forms in
* Webster's New International Dictionary.
' Announcement of the College of Osteopathic Physicians and
Surgeons (Los Angeles, California, 1021).
SCIENCE AND ATTITUDES 99
which disease appears. Truth and fact should be accepted
whether they fit the theory or not. Tubercular meningitis
may disrupt osteopathic theory, but it is a fact of life.
The tirade against overzealousness in surgical practice
cannot justify osteopathy as a means of treatment of
disease. To operate too soon or too often is quite as bad
as to operate too late or too infrequently. Surgical judg-
ment is a human quality; it does not belong to any school
of healing.
Osteopathy is to be judged, even as chiropractic,
Christian Science, or medicine, by the provisions made for
training of its students, by the scholastic standards main-
tained, by the scientific character of its work, and finally,
by the ethical standards of the profession.
Life to most persons is too precious to be lost needlessly.
The osteopath treating with manipulations an ignorant
person suffering from diphtheria when antitoxin is avail-
able, or "adjusting" for syphihs when arsphenamin is
known, assumes a responsibihty that cannot easily be
discharged.
The question every patient should ask is: Does my
physician use every known and scientific means available
to diagnose my condition and treat myself? Or is his
mind shackled by an unproved theory, an imtenable
hypothesis? The sufferer from headache as well as the
sufferer from cancer should wish to have such questions
answered satisfactorily.
The Call of the Occult. — It is difficult to educate people
to ask such questions. Men in all stages of development
have been believers in spirits, and from time to time have
brought forward evidence to support their belief. The
witch riding a broom and the modem "Patience Worth"
all spring from the same source and are equally irrational.
Tap the stream of life where you will, the same kind of
belief in the mystical that leads men to expect cancer
cures from healing mental rays will spring forth. Probably
no phase of this behef in spirit-agency is more persistent
than the naedical. Health for such persons is the summum
100 PERSONAL HYGIENE APPLIED
bonum, and they will reject scientific evidence and pro-
cedure acceptable in other fields and in other problems,
to partake of Eddyism, New Thought, a magic regulator,
mysterious patent medicines, and other palpable frauds.
"One could write a history of the human mind in terms of
the cures that people underwent and the reasons offered
for the cults. One could start with hmnors and tempera-
ments, and wind through exorcism, laying on of hands,
mesmerism, clairvoyance, and Christian Science, and with
any number of side excursions to delay one's progress.
Spiritualist healers who in a trance state prescribe harm-
less drugs at hurtful prices are by no means obsolete."
Behevers in the occult and mysterious are often sincere,
but their sincerity is no cloak that will hide the classifica-
tion into which they must come. They represent clinical
types that are well marked and fairly differentiated. The
scientific man from his point of vantage "sees the en-
semble of a forest in what to the wanderers in the jungle
of human nature is only a tangle of trees." That in-
dividuals of scientific training, work, and accomplish-
ments at times get lost is no refiection on their back-
ground — the immediacy of a great sorrow, which one is
imprepared to meet, may produce a mirage of the mys-
terious and occult.
For the ignorant person formulae with mystical signs
and procedures wiU always be helpful in banishing fear
and in controlling subconscious forces. But any intelligent
plan for Hfe looks to a scheme of things in which Socrates'
advice, "Know thyself," is a guide to go by. The quarrel
with the mystical, mysterious, and occult is precisely this:
it dethrones reason and intelligence and seeks a solution
by hocus pocus. The intelligent man or woman planning
for hfe cannot be satisfied to trust his or her "all" to any-
thing that smacks of charms or laying on of hands. The
occult calls to the weak and foolish; for the strong, science
will ever be the guide. Its truths, no matter how painful,
how difficult to bear, requiring adjustments, no matter
how long deferred, will have meaning for these.
SCIENCE AND ATTITUDES 101
Scientific and Humanistic Principles Confused. — The
faith that men have in programs, procedures, and results
in some fields may be rational, but in other fields with
similar controls, it becomes topsy-turvy and rejects the
bases that should compel action. There are recognizable
these variations from rational belief in the actions of a
considerable number of antivivisectionists, antivaccina-
tionists, conscientious objectors, and others who oppose
any program by society in which they must co-operate.
A keen analysis of such attitudes would diagnose the
condition as one of a psychosis.
These individuals are as careless of truth and scientific
accuracy as they are of the falsity of their position.
Throughout the war the "anti" press printed dispatches
charging that our army surgeons, in order that the manu-
facturers of serums might grow rich, were murdering our
soldiers by wholesale under pretense of giving them pro-
tection from typhoid.
In April, 1918 a circular issued by the National Anti-
vivisectionist Federation asserted that inoculation of
American soldiers was causing thousands of deaths Lq the
army cantonments. The circular, as reported by the
New York Times,^ contained the following statement:
"Thousands of deaths dehberately inflicted upon om-
soldiers and sailors have passed the scandal fine. It has
become a tragedy."^
A reporter from the New York Times interviewed Mrs.
David Belais, vice-president of the National Antivivisec-
tionist Federation, and the following is reported in the
New York Times':
"She said last night that Mrs. Henderson, who signed the cir-
cular dedaring that 'thousands of deaths deliberately inflicted upon
our soldiers and sailors have passed the scandal line,' Uved at Way-
land, Massachusetts, and that the circular was sent out with the
approval of the officers of the society, although they took no official
action upon it.
1 The New York Times. April 9, 1918. The Federation reports
this circular out of print (March, 1922).
2 Ibid. » Ibid.
102 PERSONAL HYGIENE APPLIED
"Mrs. Belais was most reluctant to answer when asked repeatedly
whether she or the organization had any evidence whatsoever that
'thousands,' hundreds, or tens had died as the result of inoculation.
She finally said that she had received letters telling of men in the
service who had been made 'very iU' through inoculation, but
admitted that she had no evidence of any sort that any consider-
able number of them had died. Pressed to tell if she had evidence
that even one had died, Mrs. Belais said that the letters were con-
fidential and that she could not disclose their contents.
"She deplored the use of the word 'dehberately' in the circular,
sajdng: 'Of course the society doesn't beUeve they kill them on
purpose. It is an abstract beUef with me,' Mrs. Belais added,
'that the practice is dangerous and imjustifiable.'
"Asked about the alarm the society's statement might cause among
famiUes of Soldiers, she said:
" 'I hope it does create great alarm, because I think there should
be a great cry against forcing people to submit their bodies to such
treatment.' "
The achievements of scientific medicine have ever been
humane. The decrease in the death-rate from typhoid,
diphtheria, and smallpox has meant the saving of human
life. Science seeks knowledge of the truth for the service
of mankind.
The antivivisection efforts during the war were par-
ticularly typical of the mixed values that guide these de-
luded hvmianitarians. Their suit to prevent the Red
Cross from using funds for animal experimentation was
characteristic of their appreciation of relative values.
Jastrow,' in speaking of this incident, says:
"To state that vivisection has brought no benefit to mankind,
in face of the overpowering evidence to the contrary, shows the utter
bhndness to evidence of a convinced sentimental prejudice; to urge
that prejudice at this time and thus to cripple the humanitarian
efforts that redeem the awful calamaties of war shows the complete
disregard of humane considerations to which unreason may lead.
In the face of this instance of bigoted opinion, the strictures above
applied to it seem criminally lenient. Like the delusions of the
insane — to which such fanaticism is allied — the distinction between
innocent and dangerous beliefs is most treacherous. Society cannot
afford an attitude of tolerance; the menace of extreme conviction is
too serious."
' Jastrow, J. : The Psychology of Conviction, Houghton MifBin
Co., Boston, 1918.
SCIENCE AND ATTITUDES
103
PRUSSIA.
HOLLAND.
WITH COWPULSONT VACCINATION OF CHILDflEH
gwTtnino A ecMOOu
AtrSTBZA.
WITHOUT cownasoMV
VACCIMATION.
AflarthaLnefieri
wupftued.
JL^jIW
k
llLijJ
iJ^
.ISO
_110
- 80S
I
_ 80 Jj
_»
-SO
_ »
uas-i87«
Arenc*
jMT^ Deftthi
ftomamRll-
poz In tTOf
100.000^
AUMUl Vctthf
ftom imtll^pox
In em; 100,900
iollKUtUtl.
186Q-lfiI3
Aftngs
fhtm imdU
pozlnereiT
100,000
|ab»Mt>na.
:t)|:|;ei£8SB 33SCS
Annuit Desfhi
tiota nDiiII-p«
In wtrj 100,000
iahablUBfi.
18U8-187«
Areng*
jeorlj X>Mtha
tnm ■m«]|>
pox 1b trt^
100.000
\9^ti S&3S
Auul Death!
tma amall-pox
la eTer; 100,000
InbtUluU.
Fig. 3. — ^Table showing value of vaccination (Carsten),
Facts and Superstition. — Scientific medicine collects,
distributes for observation, study, and criticism the facts
upon which it bases its procedure. The laboratory is open
for inspection; the methods of obscuration are not used.
104 PERSONAL HYGIENE APPLIED
The value of antitoxin in diphtheria and the efficacy of
typhoid inoculation have been stated. The determination
of truth does not, unfortunately, lead automatically to
the rejection of superstition by all people.
The history of smallpox ought to have meaning and does
show significance to the intelligent mind. Before smallpox
vaccination was discovered the epidemics of smallpox that
swept Europe were more devastating to hfe than the in-
fluenza epidemic of 1918 and 1919 in the United States.
It is important to note in this connection the value of
vaccination as shown by countries having compulsory
vaccination and those not having it (Fig. 3).
In contradistinction to the available records of scientific
medicine are the wild newspaper propaganda of that
noisy group calling themselves antivivisectionists, anti-
vaccinationists, and naturopath "physicians." In spite of
fact, in defiance of truth, there exist emotional and irra-
tional exponents of fanciful theories of disease and health.
Superstition, custom, behef — these are the fetishes they
worship. On questions of health they belong mentally
with the group of natives in South India, described by Dr.
Manley,' as they were attempting to drive the "Demon
Smallpox" from the village of Ongole:
"The tom-toms beat all night and this morning the streets are
fairly covered with chicken feathers. For black smallpox has taken
the city and must be driven out. The priests have told the people
to kill chickens and strew their feathers in the streets so they will
catch the eye of Polerimah, the plague demon, and distract her
attention. The tom-toms throbbing in the air will either frighten
her or please her so much that she will forget to jumj) down the
throats of any careless mortals whom she might find with mouths
opened in speakihg, or with lips parted, or sleeping with uncovered
faces. Yes! the goddess Polerimah is angry with the people.
"In the very heart of the bazar, our native servants told us, we
should find Polerimah in all her glory. . . . But instead I saw only
a squat little figure, no more than a foot tall, made of black mud
and covered with tinsel. She was soaked with lemon-colored water
which dripped off her shoulders into a widely spreading puddle
round her feet.
"'Why so much wetness?' I asked with an amused smile.
' From a letter by Dr. Manley to the Journal of the American
Medical Association,
SCIENCE AND ATTITUDES 105
_ "'They must keep her cool,' answered our guide with great dig-
nity, 'n she gets warm she gets mad. So they have built tluJs
temple of reeds to protect her from the sun, and every few minutes
the priests pour saffron tinted water over her. Whatever happens
she must be kept cool.'
***********
'"Now what will they do?' we asked.
"'They are arranging to escort the goddess out of town,' said our
guide. ' 'They have done everything they could to appease her anger
and make her happy; and now they are going to carry her out of
town while she is m a happy frame of mind, and throw her in the
ocean.'
"The procession was formed. First came the priest carrying on
his head a basket in which werei the bull's entraife, crowned by his
head, holding in his hideous grinning mouth the bone of his front
foreleg. Behind him came the goddess, carried on the head of an-
other priest. And as the throng proceeded down the street, people
by the wayside wrung the necks of chickens and threw the headless
bloody bodies over the people's heads toward the image. The horns
blew, the tom-toms throbbed, and the people yelled themselves
hoarse, waving their reeds in the air. What is the priest screaming?
" 'Yell, brother, yell! Let confusion reign! Let not the terrible
Polerimah suspect our feU designs, and fsul upon us before we are
safely rid of her!'
"Following in the wake of the procession I came up to a young
mother who was hurrying along dragging a tiny child by the hand.
The Uttle girl was staggering, her bare body was a mass of scars,
her eyes heavy and dull with the intoxication of the dread disease.
The child's mother cried out to Polerimah to have mercy. As her
wails mingled with the shrieks of thousands the procession passed
down the crooked, dusty road and out of sight.
"Tonight, out there in the dark somewhere, many young mothers
are sitting in black despair, because in spite of all their sacrifices to
the demon, the Kves of their babies stricken with the fearful plague
are surely ebbing away."
Patent Medicines and Fear. — Of the many ignoble
characteristics of the "patent medicine" business none is
more despicable than its appeal to fear. The business
thrives on fear and seeks by its advertising to create fear.
An epidemic of disease is the occasion for new nostnuns
to appear claiming to prevent or cure the disease in ques-
tion, and for old ones to set up new claims in harmony
with the needs of the moment. The exploitation of the
New Orleans public at the time of the yellow fever epi-
demic, the pamphleteering of the New York pubUc at the
time of the meningitis epidemic, the blatant advertising
106
PEHSONAIi HYGIENE APPLIED
in 1918 and 1919 during the influenza epidemic, and the
unwarranted claims made for sprays and gargles during
the epidemic of infantile paralysis bear witness to this
appeal to fear. But epidemics are not necessary for their
fear campaigns. The onset of winter is a sign for in-
creased activity for the exploiters of pills, emulsions,
syrups, and decoctions. If the winter is severe they will
FEDERAL FOOD & DRUGS ACT
HERE ARE ITS POWERS AND LIMITATIONS REGARDING
THE SALE OF "PATENT MEDICINES"
IT APPLIES ONLY TO PRODUCTS THAT
ARE MADE IN ONE STATE AND SOLD IN
ANOTHER (INTEBBTATE COMMERCE).
IT PROhllBITS TALSE OR MIBLEAOWa-
STATEMENTS < IN OR ON THE TRADE
PACKAQE OHLT ) REGARDtNa COMPOSITION
AND SOURCE OF ORIOIN.
IT PROHI BITS "FAL8B AND FRAUDULENT
STATEMENTS ( IN OR OM THE TRADE
PACKAQE OHLT l REQARDING CURATIVE
EFFECTS.
IT REQUIRES the manufacturers
TO DECLARE UN OR ON THE TRADE PACKAGE
ONLY ) THE PRESENCE AND AMOUNT,' IN
THEIR NOSTRUMS, OF ALCOHOL. MORPHIN,
OPillM, COCAIN, HEROIN. EUCAIN, CHLORO-
FORM. CANNABIS INDICA, CHLORAL HYDRATE
AND ACETANILID AND THEIR DERIVATIVES.
IT DOES NOT APPLY TO products
THAT ME SOLO IN THE SAME STATE AS
nUT m WHICH THET ARE MADE IMTRA;
STATE COHMERCEh
IT DOES NOT F^OHIBITpalseor
MISLEADING STATEMENTS IN NEWSPAPER
ADVERTISEMENTS. CIRCULARS. WINDOW
DISPLAYS. ETC.
IT DOES NOT PROHIBIT ANY KINO
OF A UE REGARDING CURATIVC EFFECTS
IF THAT LIE IS TOLD ELSEWHERE THAN , IN
OR ON THE TRADE PACKAOgI
IT DOES tjfij REQUIRE -patent
MEDICINE" MAKERS TO DECLARE EVEN
THE PRESENCE OP SUCH DEADLY POISONS
AB PRUSSIC ACID. CARBOLIC ACID, ARSENIC,
BTRTCHNIN-NOR ANT OF SCORES OP
OTHER DANGEROUS DRUGS!
Fig. 4.— The limitations of the Federal Food and Drugs Act are
more significant than the powers. (By courtesy of the American
Medical Association.)
protect against exposure and cold; if the winter is mild
they will protect against changing temperatures !
There have been many exposm^s* of the frauds per-
petrated by the "patent medicine" business. Samuel
Hopkins Adams in the New York Tribune has conducted
exposes showing the sordidness and inherent worthlessness
* The question is sometimes asked by students, ''Why are 'patent
medicines' permitted to make such extravagant claims?" The weak-
ness of the Pure Food and Drugs Act is shown in Fig. 4,
SCIENCE AND ATTlTtJBES 107
of many of the most widely advertised quacks. Accurate
and scientific information may be had on practically every
nostrum on the market in the two splendid volumes of
Nostrums and Quackery, published by the American
Medical Association, 535 N. Dearborn Street, Chicago,
Illinois.
The Challenge of Scientific Medicine. — Scientific medi-
cine is based upon the study of the normal structure and
function of the human body and the variations of that
normal, called disease. In disease the cause, course, com-
plications, and outcome of diseased processes together
with the results of treatment must be determined. There
is no acceptance in modern medical practice of speculation
for accurate observation; that as a procedure was dis-
carded over a century ago. Careful observation of
phenomena, exact interpretation and measurement of
signs, complete history of the course of disease, are the
fundamentals of medical practice. Every year diseases
are yielding to the painstaking efforts of practitioners,
research workers, and experts. Many problems have
been solved; many remain to be solved. There are still
diseases that cannot with absolute correctness be diag-
nosed. Scientific medicine is frank, free from taint of
hypocrisy, fraud, and charlatanism.
The great advance in medical science, outside the field
of surgery, has been the use of the biologic sciences upon
which must always rest the tests in diagnosis and the
rationale of therapy. Why presumably rational people
wUl permit a chiropractor to treat for a condition undiag-
nosed, or a Christian Scientist to give treatments while
ignoring the pictures the a;-ray will show, are to be ex-
plained in terms of Goddard's "levels of inteUigence."
The intelligent man cannot choose the superstitious when
the scientific is available.
Examples of the Methods of Scientific Medicine. — ^As an
illustration of the procedure available in diagnostic clinics,
accessible to most physicians, in hospitals and free clinics,
the following scientific examinations are used today for
108 PERSONAL HYGIENE APPLIED
the determination of the state and condition of body
fluids, cavities, and structures :
I. Examination of the condition of the stomach:
1. Ewald test-meal.
2. Tests for the digestive ferments; complete gastric
analysis.
3. Fractional determination of gastric contents (Rehfuss).
4. String test (Einhom).
5. Examination of duodenal contents.
6. Motility of gastro-intestinal tract.
7. Roentgenologic examination of the entire digestive
tract, both fluoroscopic and radiographic.
8. Complete stool examination, iucluding microscopic and
chemical tests for blood and toxic substances.
II. Examination of the condition of limgs and bronchi:
1. Fluoroscopic and radiographic examinations of lungs
and chest contents.
2. Bacteriologic and microscopic examination of the
sputimi.
3. Tuberculosis complement-fixation test.
4. Von Pirquet test.
5. Sensitization tests for asthma and hay-fever.
6. Bronchoscopy.
III. Examination of the condition of the heart and blood:
1. Fluoroscopic and radiographic examination of the
heart, aorta, and mediastinal structures.
2. Determination of blood-pressure, systolic and diastolic.
3. Electrocardiographic examination.
4. Microscopic blood tests, giving complete cell count, in-
cluding red cell, white cell, and differential count.
5. Hemoglobin determination.
6. Wassermann test.
7. Coagulation tests.
8. Iso-agglutination test for transfusion.
9. Blood-cultures.
10. Examination for blood-sugar, uric acid, urea, choles-
terin, creatinin, chlorids.
IV. Examination of the condition of the ear, nose, throat, and
sinuses:
1. Transillumination of sinuses.
2. a;-Ray of sinuses.
3. Esophagoscopy.
4. Laryngoscopic examination.
5. Tests for hearing with lab}rrinthine examination.
6. Bdrdny chair tests.
SCIENCE AND ATTITUDES 109
V. Examination of the condition of the genito-urinary tract:
1. Urethral endoscopic examination.
2. Cystoscopic examination.
3. Ureteral catheterization.
4. Roentgenolpgic examination of kidneys, ureters, and
bladder.
5. Renal function test (phenolphthalein).
6. Urine analysis from one or both kidneys.
7. Examination for gonococci, tubercle bacilli.
8. Smears.
9. Examination for spirochetes by dark-field iUumination.
10. Gonorrhea complement-fixation test.
VI. Examination of the condition of the rectum and sigmoid colon :
1. Procto-sigmoido-colonoscopic examination.
2. Roentgenologic examination of bismuth enema.
VII. Examination of the condition of the nervous system:
1. Complete neurologic examination, including tests of
reflexes, co-ordination, and association tests.
2. Spinal puncture with examination of the spinal fluid in
(a) Wassermann test.
(6) Cytology.
(c) Globulin test.
(d) Cultural examination.
3. Roentgenologic examination of spine and cranium.
VIII. Examination of the condition of the endocrin system:
1. Carbohydrate tolerance test.
2. Roentgenologic examination of sella turcica and thymus
gland.
3. Goetsch therapeutic test.
IX. Examination of the condition of special parts by avray:
1. Teeth for pus sacs.
2. Joint conditions.
3. Bone conditions — especially for fractures.
4. Examination of the consistency of swellings.
X. There are other special tests, such as the great number of
skin tests for protein sensitization, total non-protein
nitrogen test of urine, Widal test used in typhoid
fever diagnosis, seminal fluid test, Lange's colloidal
gold test, microscopic tests of the histology and
pathology of tissue, type differentiation of the pneu-
mococcus, and rnflk examination (himian).
These examinations, I to X inclusive, are essentially
laboratory tests. In addition, the use that scientific
medicine makes of personal and family history, inspection,
110 PERSONAL HYGIENE APPLIED
palpation, percussion, ausculation, and mensuration in the
physical examination, is very great. With the aid given
by laboratory findings the personal observation of the
physician himself is corrected or verified.
The presence or absence of disease can only be deter-
mined by scientific methods. It is not possible that a
clairvoyant, mind-reader, or Christian Scientist can tell
whether or not the human body is diseased any more
successfully than a blacksmith can determine whether or
not a Swiss watch is in need of attention. Both groups
are able to detect whether or not the organism is per-
forming its function, but neither the Christian Scientist
nor the blacksmith, the chiropractor, nor the wheelwright
can determine what is the cause of the disturbance or the
proper method to pursue to correct the condition. In
these particular cases the only rational procedure is to
secure the services of a properly experienced watchmaker
in the case of the watch, and a properly experienced
physician in the case of the hmnan body.
That procedure is rational which bases its principles of
action upon the demonstrated facts of Hving processes.
Instruments of precision, such as the microscope, the
a;-ray, the chemical laboratory, and the technlc of the
scientific method, bring to the study of man, both in
health and in disease, a record that can be proved by
others working with hke care and precision.
Man, the Organism. — It is important to remember
that to some the doctrine of the Christian Scientist repre-
sents the reaction against the materialism in so much of
our life today. Physicians as well as laymen need to re-
member that man is a unit of mind and body, and that it is
fallacious to think of him in his reactions and expressions
as purely physical or purely mental. Moreover, the
factors that enter into the production of health must be
completely evaluated. The psychical must be considered
as well as the physical. This does not mean that one is to
treat typhoid by mental rays and spiritual light, but it
does, mean that in the whole life of man he who would
SCIENCE AND ATTITUDES 111
attain health, and he who would restore health, must
know the forces that affect personality in its spiritual as-
pirations and be able to recognize the demands of the
mind and soul as well as those of the stomach and the
intestines. There is an element of t«ith in most of the
systems that attempt either to teach health or restore
health, but the mistake of the credulous lies in accepting
as a guidance for the whole of life a lantern, when an arc
Ught is available. It should be remembered, therefore,
that science cannot neglect the mind of the individual in
dealing with the body (the physician must treat the
patient and not the disease) ; the mental healers in ridicu-
lous fashion neglect the body and its nature.
This influence of the mind over the body is one of the
most admirable relations, and yet in the hands of char-
latans, pseudoscientists, and others this fact is used with
pernicious results. It is known that persons suffering
from hopeless maladies are especially susceptible to the
suggestion that comes from any new treatment with
glowing promises. This psychic element in cancer, for
example, has been well described by Weil:
"It is indeed veiy remarkable that a patient that has been con-
si^ed to death as a victim of a hopeless malady shoiild regain his
spirits and his appetite, when he is again confronted with the hope
of a cure and of the eradication of his disease. It is a phenomenon
well known to ever^ student of the disease that a large proportion
of cases responds m just this manner to any treatment that is
offered them. Osier has described a case of cancer of the stomach
in which the mere visit to a consultant of sanguine temperament,
though poor judgment, whose assurance to the patient that there
was no possibiUty of cancer, resulted in a disappearance of all
symptoms and a gain of 18 pounds in weight. It is this psychic
influence which has occasionally deluded the honest student of
cancer cure, and which has also so generously played into the hands
of the dishonest."
The science of health includes not only the physical but
also the mental. As a science it has definite and accurate
provisions for the attaiimient of health. The laws must
be obeyed. They demand appUcation in the lives of men
and women and are most serviceable when guided by
112 PERSONAL HYGIENE APPLIED
ideals and made a part of life by habituation. A life that
is guided by the highest ideals ia applying the scientific
knowledge of the laws of health is the best illustration of
artistic living.
To live most andia serve best may with more success be
achieved in this combination of ideals with science than
in any other way.
The following chapters will present the essential laws of
hygiene and conditions for health; the hygienic facts will
be of service in so far as they are used.
CHAPTER VI
HYGIENE OF THE MUSCULAR AND SKELETAL
SYSTEMS
I. Place op Movement in Human Development.
II. SlGNIHCANCE OF MOVEMENT AND CONSCIOUSNESS.
III. Habits op Muscular Activity Characteristic op Dip-
PERENT Stages op Human Development.
IV. Beneficial Effects op Rational Exercise:
General Effects.
V. Injurious Effects op the Sedbntary Life:
1. The Heaxt.
2. The Lungs.
3. The Muscles.
VI. Adaptation op Exercise:
1. To Age-;-Exercise for Adults.
2. Adaptation to Sex.
3. Adaptation to Occupation.
4. Adaptation to Climate.
5. Adaptation to the Individual.
VII. Relative Value op Dipperent Activities:
1. Play, Games, Sports, and Athletics.
2. Dancing.
3. Formal Gjonnastics and Calisthenics.
4.. Setting-up Drill.
VIII. Habits op Exercise.
IX. All the Factors in Health Important.
HYGIENE OF THE SKELETON
I. The Matter op Posture:
1. Value of Good Posture.
2. Four Important Positions.
II. Prevention op Common Skeletal Defohmities:
1. Curvature of the Spine.
2. Shoulder Braces.
3. Weak, Deformed, and Flat-feet.
III. Causes op Foot Weakness and Deformity.
IV. Points op a Good Shoe.
V. Flat-pbet.
VI. Exercise for Weak or Fallen Abcheb.
VII. Perils op Maturity.
8 113
114 PERSONAL HYGIENE APPLIED
HYGIENE OF THE MUSCULAR SYSTEM
Place of Movement in Human Development. — ^We have
seen that the simpler forms of life were concerned almost
entirely with the processes of getting food and reproducing
their Idnd. In the very simple types these functions were
carried on without any directive force. Food came mainly
from the surrounding media and was taken in by a process
of absorption. Reproduction as a process was very sim-
ple. It consisted in the adult dividing and producing two
where there was only one before.
The lowest worm-like animals gave apparently the first
appearance of a muscular system and there followed soon
after this a skeleton. Mollusks developed an external
covering which limited locomotion, and it was not until
the bony parts became elaborated as an internal skeleton
that locomotion as seen in mammals came into prominence.
The vertebral skeleton opened up tremendous possibiUties
because great masses of muscles could thus be used, and,
in addition, there came increased opportunity for the ner-
vous system in a rapidly changing environment. It is very
important for us to learn this fact of evolution and develop-
ment, because in our own training of the human being we
should aline our methods with the methods used by nature
in developing man and thus work in harmony with nature's
laws. The increased efiiciency of the nervous system
that followed the increased power of the organs of loco-
motion means for us today that we should emphasize and
develop the muscles and skeleton before we attempt any
serious training of the nervous system. Moreover, we can
expect the nervous system to work most effectively if the
muscular system is well organized and in good condition,
and if the skeletal system is in such posture as to maintain
proper functioning. It is an interesting and important
fact that the attitude of the mind and the functioning
of the brain are controlled and modified by the posi-
tion of the body as a whole and by its several parts;
and the use of the nervous system, as pointed out by
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 115
James,* to insure that every sensory stimulus shall result
in a muscular or motor response suited to the emergency,
shows the mutual reliance of these two systems upon each
other.
Significance of Movement and Consciousness. — It is
very interesting that the story of development of higher
forms of life in the animal and plant kingdoms associates,
in general, in the former, consciousness and movement,
and in the latter, unconsciousness and immobiUty.'' For
the animal a muscular system made movement possible
and locomotion gave opportunity for new and changing
situations. The stimulation of the sensory part of the
nervous system was tremendous and called forth increased
neural activity. Consciousness has in evolution, therefore,
been associated very definitely with movement.
It is significant in this connection to note that modern
psychology is affirming this biologic fact in its statement
that sensation is never complete until the centrally in-
itiated impulse is expressed outward in a motor way and
is returned with the significance of the act rounding out
the circle and completing the circuit.
Moreover, the meaning of motor training must be
viewed in this newer light. The training of the hand in
kinesthetic sense, the training of trunk and legs, means an
awakening of consciouness with reference to the physical
world that is extremely valuable.
In contrast with this interesting development in the
animal world there should be noted the characteristic im-
mobihty of the higher plants and its accompanying un-
consciousness.
Consciousness and movement have been associated in
evolution; consciousness and movement are to be associ-
ated now because of the history of man. This means
definitely — does it not? — ^that intelligence will not develop
'James, William: Psychology, Henry Holt & Co., New York,
1900, pp. 370^72.
* There are some exceptions, notably the Drosera (Sundews) and
the Dionsea (Venus' fly-trap).
116 PERSONAL HYGIENE APPLIED
fully in the sedentary and immobile individual. The
brain has evolved concomitantly with vigorous activity
of the muscular system.^ This does not mean that one
can hope to attain briUiance of intellect by gaining in-
creasing power to lift heavy dumbbells. Mental power
is gained and conserved by an intelligent care and pro-
vision for the physical activities of the body. The law
of mental growth follows closely the law of physical
growth.
Habits of Muscular Activity Characteristic of Different
Stages of Human Development. — The muscular move-
ments of the newborn babe are very limited in type and
in ampUtude, and as they increase in number and range
up to adolescence, there is one characteristic manifesta-
tion. The movements of the child are large movements
and the control over the trunk is more accurate and comes
earUer than the control over hands and feet. The reason
for this is to be found in the order of development of these
muscles. The first muscles to appear in animal Ufe were
the muscles of the trunk; muscles of the upper and lower
extremities came much later. The trunk muscles are,
therefore, older, and in each individual of the race of man
they develop first and are followed by the muscles that
accomplish fine co-ordinations. Moreover, it will be re-
called that the vital organs of Ufe developed in correlation
with the trunk muscles. This fact has tremendous con-
notation in ordering our fives with reference to the develop-
ment of strong vital organs.
After adolescence the increased power of the individual
to perform fine co-ordinations with the hand goes along
with the increased power to co-ordinate the activities of
the brain. The changes that have come in man's civiUzed
' Beyer, H. G. : American Physical Education Review, June, 1900,
p. 149; June, 1901, p. 181. Report of the Royal Commission on
Secondary Education, 1905, London. Hastings, W. W. : American
Physical Education Review, March, 1900, p. 53. Porter, W. T.:
Transactions of the Academy of Science of St. Louis, 1893 and 1894.
Christopher, W. S.: Annual Report of the Board of Education of
Chicago, 1898-1899.
HYGIENE OF MtTSCtTLAR AND SKELETAL SYSTEMS 117
environment require the use of the smaller muscles of the
body. These changes threaten his vitality because they
eliminate very largely the fimdamental muscles that are
so important in maintaining the health and strength of
the circulatory, respiratory, digestive, excretory, and
nervous systems. Moreover, these changes have added to
the ease with which man can obtain a liveUhood because
of the ever-increasing use of machinery requiring only
the pushing of a button for operation. In short, the hfe
of man in the factory and even to some extent on the farm
is more and more becoming what it has been for the clerk
for many years — sl sedentary life. Such alterations in
the hfe of man bring advantages in many ways, but
unless their limitations are understood and controlled,
both by the individual and the community the result will
be definitely a loss of vitality to the nation. We can
never put the nation back to spinning-wheels for the
women and flails for the men.
Since the life of many civihzed men is and will be in the
future a life in work of sedentary type, effort should be
made to understand this fact and then to work out types
of activity that will provide the margin of motor activity
that man requires to maintain his own health and that of
the race. Professor Hetherington^ has outhned in valuable
form (Table II, page 118) what is needed from five to
eighteen years.
After twenty years of age an hour should be given daily
to motor recreation involving the use of the large muscles
of the body. Anything less than that for most individuals
will result in physical deterioration. We are unable to
state the ideal degree of muscular development needed
by man in different avocations. Theoretically, the lawyer,
the doctor, the merchant require a less vigorous muscula-
ture than the farmer, mechanic, or day laborer. In
reality, this may not be true when viewed in terms of
' Hetherington, Clark W. : American Physical Education Review,
May, 1917; University of California Publications, vol. v, No. 2,
July 30, 1914.
118
PEBSONAL HYGIENE APPLIED
TABLE
II
Distribution
OF Activities" BY Age FBRlobS^
Total
,„ Average
Big
Doing
Ago
Waking Hours
Muscle
Manual
Linguistic
Automatic
Notbinif
0-1
1
9-
■■•
2
10-
3
11-
i"
2"
f
4
12
2
2-i
5
12-i
4-i
2-i
2-i
2-
6
12-J
4-J
2-
2-i
2- ■
7
13
5
3-
2+
2-;
8
13-i
5-i
3-
2-i
2
?+
9
13-i
6
3- .
2+
2
10
14-
6
3-
2-i
2+
11
14-
5-*
3- ■
2-i
2
12
14+
5
4
3
2
13
14-i+
4-i
4
3-i
2-i
14
15
4+
4-i
3-:
2-
?+
15
15-J
4-
4-i
4
2-
16
15-S
3-i
4-J
4-i
2-
17
16-
3+
4-i
4-i
3- •
18
16
2-4
5-i
5-
3
19
16
2
5-i
5
3
20
16
2
5-i
5-i
3
The school years, from 5 to 16, are the strategic years for growth
and development. The child requires muscle activities from four to
six hours in this period. (By courtesy of Clark W. Hetherington.)
fullest health and most satisfying happiness. Certainly,
all men require a minimum physical development which
would enable them to participate with pleasure in many
forms of motor recreation. The narrow view that con-
ceives man as giving all to vocation and only a pittance to
recreation for "exercise" constricts the range and scope of
human happiness.
This minimum physical development should provide
for all:
1. Strength of trunk muscles to maintain an upright
posture and to prevent any ptosis of vital organs.
2. Strength of back and leg and feet muscles to produce:
(a) Ease and elasticity of gait.
(b) Power for walking, running, and jumping.
3. Strength of arm and shoulder muscles sufficient to
swing with reasonable skill a golf club, axe or
racquet, to throw a ball, to row a boat or to paddle
HYGIENE OF MUSfULAR AND SKELETAL SYSTEMS 119
a canoe, to pull a rope, to control a horse, and to
swim. Strength and skill should be sufficient to
permit one to enjoy and to take satisfaction in
such activities.
Such a minimvun, though generally stated, would pro-
vide power for enjoyable motor activity. It would insure
against the ptoses of adult Hfe. It would tend to main-
tain at normal the vital organs of the body.'
Beneficial Effects of Rational Exercise. — By rational
exercise is meant exercise that is suited to the individual's
need. What is desirable activity for one person may be
unwholesome for another. Suitability of exercise is de-"
termined by the following:
1. The exercise for general effects should be natural.
Through a long evolution man has developed a
physical body in response to certain activities and
needs. This body so developed will function best
if exercised in movements similar in type to the
activities that produced the body of man. Walk-
ing, nmning, jumping, Hfting, throwing, striking,
hanging, and climbing are natural types.
2. The exercise for special effects may be artificial, that
is, designed to produce particular muscle action
without reference to evolutionary prototypes.
Thus, special corrective exercises for feet, spine,
abdomen, chest, back,*or other part of the body
may be needed.
3. Whether natural or artificial, rational exercise will
not produce soreness or stiffness. The idea that
an exercise must hurt in order to be effective is
similar to the idea that a medicine must have a
disagreeable taste and an unpleasant odor in
order to be potent. That exercise is most scien-
tific which produces increasing amounts of fatigue
substances, causing increased resistance to fatigue,
but at no time resulting in soreness and stiffness.
' Friedman, H. M.: Muscular Development, etc., Journal Ameri-
can Me4ic»l Association, March 9, 1912, pp. 685-690,
120 PERSONAL HYGIENE APPLIED
With these brief reservations in mind the beneficial
effects of rational exercise may be stated. They are:
1. Increased circulation through the part (as in special
corrective work) or through the entire body.
This circulatory activity carries food to the tis-
sues, removes waste, distributes the endocrin se-
cretions, and equaUzes the water and heat content
of the body.
2. Increased respiration that gives increased oxygena-
tion of the blood, increased elimination of carbon
dioxid, and increased oxygen supply to the tissues.
These values are dependent upon body activity
and do not flow from the respiratory movement
itself.
3. Increased elimination of waste through kidneys,
lungs, intestines, and, to some extent, skin.
4. Increased metabohc changes. Digestion is improved,
assimilation accelerated, and nutrition in general
heightened.
6. Increased neural activity, resulting in part from the
increased circulation and ehmination, and in part
from the awakened kinesthetic senses.
General Effects. — In vigorous activity there is an in-
crease in the force and rate of the heart, the respirations
are increased in depth and frequency, perspiration be-
comes more marked, and more waste is eliminated. There
is in this heightened activity of the body systems a more
or less complete change in the liquids of the body. Com-
bustion of chemical compounds in the cells releases new
energy; old accumulations of waste are removed and all
the mechanisms for action are put in tune. Even reflective
states are assisted by exercise, although if carried to the
point of fatigue, mental activity afterward is slowed down.
The scientific use of exercise involves the selection of
forms and the extent of action that will favor best the
particular somatic result desired. The teacher or leader
of physical education must be awake to all the possibiUties
here, and not prescribe exercise without careful determina-
HYGIENE OF MXJSCULAB AND SKELETAL SYSTEMS 121
tion not only of the individual's condition but also of the
program and duties and responsibiUties that are to be
met after the exercise is finished.
Exercise stimulates growth.' Numerous observations
confirm this statement. For the growing child this is
essential. Contrariwise, overindulgence in athletic sport
may so deplete the body of vitaUty that growth is retarded.
Some of the most significant illustrations in the high
school confirm this, notably overtrained athletes.
Exercise is most popularly known for its development
of muscles. More significant is its power to develop the
organs of the vital systems. In this achievement, exercise
stands alone as the only agent. It must be remembered,
though, that only certain types of exercise achieve this
result: types involving the use ot the fundamental
muscles. German and Swedish gymnastics and other
formal systems that seek certain postural, localized,
and static effects are not valuable in this sense, though
for special conditions they may have a certain limited
use.
The body should be as sacred as a temple. Too often
bodies are mere shells, wrecks that serve to house minds
that have developed enormous receptive power, but
minds lacking in power of initiative, wanting in force,
direction, and enthusiasm. Persons of such unfortunate
equipment do not have that quahty of health that would
enable them to live most and to serve best.
Injurious Effects of the Sedentary Life. — ^A life of
sedentary living brings with it some real dangers to the
vital organs of life. It must be remembered that for the
best functioning of the whole man the physical and the
psychical must be provided for, not only because a fuller
life can be lived in that way but also because without the
physical the very basis of the psychic is lost. It is not
unusual to see an individual unduly neglectful of his
physical life so that he can advance in his vocation.
iHall, G. S.: Adolescence, D. Appleton & Co., New York, X911,
pp. 1-237.
122 PERSONAL HYGIENE APPLIED
More of health is traded for the rewards of sedentary-
work than is biologically desirable.
The Heart. — One of the first organs to feel the loss in
strength is the heart. It must be remembered that the
heart is strengthened by the exercise of the skeletal muscles
of the body.i The only way in which a weak heart is to
be made strong is by gradual and increasing amounts of
physical work of the skeletal muscles. The college or
high school boy or girl who seeks to escape the activities
of the physical education program because his or her
heart is weak and irregular is foregoing the only means of
obtaining a strong and regular heart. The persons who
are unable to run a city block or climb a hill because of
palpitation of the heart muscle, are the ones who are
handicapped not only as regards this particular type of
activity but also by the deficiency of the circulation to
the entire body for twenty-four hours out of each day.
The number of people who are just below par because of
heart weakness experience inefficiency and debility as
compared with efficiency and strength. Instances may
readily be cited of individuals who have done and are
doing fine and excellent work with impaired hearts. The
evidence is not complete. Its consummation would tell of
breakdowns under extra heavy pressure, of times of
lowered power, and of an almost constant fear that by
"overdoing" a break would come. The surest and best
way to condition oneself for the doing of a high type of
work is to make sure so far as possible of a strong and
efiicient heart and circulatory system.
The Lungs. — Other organs that feel the loss of active
exercise are the lungs. The function of the Ivmgs, in part,
is to bring oxygen into the blood in response to the needs
of the body. During increased activity, when great
amounts of oxygen are needed, the lungs respond by fre-
quent and deep respirations. The venous blood in the
lung capillaries is exposed to air of a high oxygen content.
1 Tyler, G. M. : Growth and Education, Houghton MiiBin Co.,
Boston, 1907, Chap. II,
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 123
There is no provision for the storing up in the lungs or in
the body of oxygen for some future needs of the body.
Oxygen bums (oxidizes) food materials as soon as it
reaches the cells. Persons who hve sluggish lives use the
lungs relatively little because natural respiratory activity
is automatically controlled by the needs of the body.
This defect cannot be overcome by such a makeshift as
"breathing exercises," because oxygen is only deUvered to
the cells in accordance with their needs. The only rational
way to provide adequate oxygenation for the cellular
materials of the body is by engaging in big muscle activity
that results in deeper breathing without any control or
direction on the part of the performer.
The Musdes. — ^As might be expected, the muscles of the
body suffer in a direct way from the lack of activity. This
is of little importance for health pmrposes as regards the
muscles of the face; it is supremely important as regards
the muscles of the trunk. The abdominal muscles play
an important part in the maintenance of an upright
posture and a slackness and weakness of these muscles
results in a weak standing position. A weak posture
shows an exceedingly unattractive body, and, in addition,
has serious effect upon the position and functioning of the
abdominal organs.
Adaptation of Exercise. — ^Exerqise should be adapted to
age, sex, occupation, climate, and the individual himself.
To Age. — In speaking of exercises for infants, Holt'
says:
"This is no less important in infancy than in later childhood.
An infant gets his exercise in the lusty cry which foUows the cool
sponge of the bath, in kicking his legs about, waving his anns, etc.
By these means pulmonary expansion and muscular development
are increased and the general nutrition promoted. An infant's
clothing should be such as not to interfere with his exercise. Con-
finement of the legs should not be permitted. In hospital practice
I have often had a chance to observe the bad results which follow
when very young infants are allowed to lie in the cribs nearly all
' Holt, L. E. : Diseases of Infancy and Childhood, D. Appleton &
Co., New York, 1911, p. 7.
124 PERSONAL HTGIENE APPLIED
the time. Little by little the vital processes flag, the cry becomes
feeble, the weight is first stationary, then there is a steady loss.
The appetite fails so that food is at first taken without relish, then
at times altogether refused; later vomiting ensues and other symp-
toms of indigestion. This in many cases is the beginning of a steady
downward course which goes on until a condition of hopeless ma-
rasmus is reached. . . . Infants who are old enough to creep or
stand iisually take sufficient exercise unless they are restrained. At
this age they should be allowed to do what they are eager to do.
Every facility should be afforded for using their muscles. Exercise
may be encouraged by placing upon the floor in a warm room a
mattress or a thick "comfortable, and allowing the infant to roll
and tumble upon it at will. A large bed may answer the same
purpose."
In the recommendations of Holt may be seen the prin-
ciples which may effectively govern all children in the
matter of exercise. There should not be undue restraint.
The young child will run and play like all the young of
animal hfe if it is not interfered with by certain conven-
tions and social burdens placed upon the child by a
thoughtless parent. The child who walks in the park with
a nurse in order to advertise the social position of the
parents, or is not permitted to play because of the danger
of soiling kid gloves or fine dresses, is in serious danger.
Such a child needs to be saved from his parents. It
should be remembered that the child of the wealthy
suffers just as severely, if not so frequently, as the child of
the poor man from lack of nourishment of the body cells.
The difference is that the rich child has plenty of oppor-
tunity for food, but lacks the capacity for digestion and
assimilation; the poor child could digest and assimilate if
adequate food were available.
In speaking of exercise for older children Dr. Holt^
says:
"In older children every form of outdoor exercise should be en-
couraged — ^ball, tennis and all running games, horseback riding, the
bicycle, tricycle, swimming, coasting, and skating. Up to the
eleventh year no difference need be made in the exercise of the two
sexes. Companionship is a necessity. Children brought up alone
are at a great disadvantage in this respect, and are not likely to get
as much exercise as they require. The amount of exercise allowed
' Holt, L. E.: Loo. cit., pp. 7, 8.
HYGIENE OF MUSCULAK AND SKELETAL SYSTEMS 125
delicate children should be regulated with some degree of care.
It may be carried to the point of moderate muscular fatigue, but
never to muscular exhaustion. The latter is particularly likely to
be the case in competitive games.
"Exercise should have reference to the symmetrical development
of the whole body. In prescribing it the specific needs of the in-
dividual child should be considered. By carefully regulated exer-
cises very much may be done to check such deformities as round
shoulders and slight lateral curvatures of the spine, and also to de-
velop narrow chests and feeble thoracic muscles. For purposes like
these gymnastics are exceedingly valuable to supplement out-of-
door exercise, but they can never take their place.
It is important to point out here that Dr. Holt is speak-
ing of the child with physical defect when he recommends
symmetric development. There is no reason to believe
that he means the symmetry in body development that
was sought so earnestly a few years ago by specialists in
anthropometry. The child that is allowed to participate
in all vigorous games will develop symmetrically enough
to satisfy all except those who make symmetry a fetish to
be worshiped.
During the period of adolescence, when the body is
growing rapidly and the vital organs are embarrassed to
keep up the supply of energy for the rapidly growing
body, it is important not to carry the exercise to extreme
lengths. It should be remembered that in children the
one quality that should not be tested is endurance. Many
instances are on record of high school athletes being
"burned out" by too intensive participation in scholastic
sport. Exercise should be used to build strength and
power in the youth, not to waste them.
Exercise for Adults. — Adults in general suffer from lack
of exercise. The vocational interests of the majority of
men and practically all women tend to center in sedentary
activity. The adult has not carried on his interest in
motor activities because of two defects in his training:
1. The formal calisthenic training of school days offered
no satisfying states and hence no habituation to
exercise that would make for continuance after
school days.
126 PERSONAL HYGIENE APPLIED
2. The athletic games and sports learned in school were
so highly organized and required such expensive
and elaborate equipment that they were not pur-
sued.
That exercise is most serviceable for adults that uses
the large muscles of the body in forms of activity which are
pleasant, enjoyable, producing satisfaction, and that lead
to habits of exercise. The most favorable forms to secure
this state of affairs are swimming, hiking, camping with
its varied activities, golf, tennis, skating, and coasting.
To these should be added horseback riding, hunting,
fishing, and gardening.
After thirty years of age the adult may engage in
activities requiring moderate endurance; he is less well
adapted for speed effort. He is beginning to lose his
elasticity and should never be tested in severe competition,
although golf, swimming, hiking, and skating may be
pursued to their limits.
The perils of middle age are a gradual deterioration of
muscle power with sagging of structures, notably the ab-
dominal organs, that gradually lose their abiUty to
function properly. These perils are to be overcome by
daily physical activity. There is no short cut; no easy
way out.
Adaptation to Sex. — There should not be any marked
distinction in the type of exercise of the boy and girl up
to and including the eleventh year. After that the change
made should be in hne with the teaching of biology as
regards the difference in the sex characters and physical
make-up dependent upon those characters. At one time
the girl was regarded as a being unsuited for play and
physical training. The Victorian period of Enghsh litera-
ture shows us a girl who was interested chiefly in being
unweU and ministered to as a weak sister. In America
this type of girl is occasionally seen, but there is a healthy
indication of more interest on the part of the girl and her
parents in securing a vigorous foundation for the girl as
well as the boy. It should be kept clearly in mind that
HYGIENE OP MUSCULAR AND SKELETAL SYSTEMS 127
both the girl and the boy are dependent equally upon the
muscular system for the proper development and func-
tioning of the vital organs of life. In both, the heart, the
lungs, the digestive organs, and the nervous system must
all rely upon the activity of the muscular system for
efficient functioning.
The boy and girl both need vigorous exercise, but there
are some fundamental differences between the body of the
boy and that of the girl which determine the kind and
extent of the activity to be followed. In the first place,
the skeletal framework of the girl presents some im-
portant differences. The bones are lighter. The pelvis is
much broader, which gives to the thigh bones a marked
obliquity. The width of the pelvis interferes with the
running ability of the girl; in aU movements of the lower
extremities, either in walking or running, there is a lateral
sway of the pelvis; and the extent of this oscillation de-
termines the speed of the individual in getting over the
ground. Because of this one factor of body construction
the girl is unable to run as fast or as far as the boy. It is
this sort of biologic evidence that one must understand
and respect, because one wiU not approve for the girl the
kind of tasks held up to the boy. There are some people
who feel that the girl should attempt to do the same
physical feats of which the boy is capable. Such theory is
distinctly contrary to the teaching of nature, and if one
desires to progress one must remember to act in harmony
with nature's laws and not contrary to them. It should
be stated, therefore, that it is important to develop
standards of performance of the girl that will be her
standards. Girls should not seek to do the events in
which the boys excel because they are boys' events, but
rather they should try to excel in performances belonging
pecuharly to women. There is no feehng here that girls
are inferior to boys; it is meant that girls are different.
There is need to provide for girls types of activity that are
suited to their needs, on the one hand, and in harmony
with their powers on the other.
128
PEHSONAL HYGIENE APPLIED
2.
For Immature Girls
Condemned:
Pole vaulting.
Running more than 100 yards.
Weight throwing.
Doubtful:
Basket ball.
Field hookey.
The following activities' are classified for mature and
immature girls:
For Mature Girls
1. Condemned:
Broad jump.
High jumi> (in competition).
Pole vaulting.
2. Doubtful:
High jump.
Running more than 100
yards in competition.
Weight throwing.
3. Safe:
Archery.
Ball throwing.
Basketball (women's rules).
Climbing.
Coasting.
Dancing.
Field hockey.
Golf.
Horseback riding (cross and
side saddle).
Indoor baseball.
Low hurdles (not in com-
petition).
Paddling.
Rowing.
Running (not in competi-
tion).
Skating.
Skiing.
Snowshoeing.
Swimming.
Tennis.
Walking.
4. Especially beneficial and suit-
able:
Dancing.
Paddling.
Rowing.
Running.
Swimming.
Walking.
3. Safe:
Archery.
Ball tmowing.
Broad and high jump (not in
competition).
Climbmg.
Dancing.
Horseback riding (cross sad-
dle).
Low hurdles.
Paddling.
Rowing.
Running (not in intense com-
petition).
Skating.
Swimming.
Tennis.
Walking.
Especially beneficial and suit-
able:
Climbing.
Dancing.
Jumping (in moderation).
Running (in moderation).
Skating.
Swimming.
Walking.
5. Best loved, most commonly practised, and with greatest primitive
appeal: Dancing (greatest unanimity of opinion in this
answer).
» Prom Healthful Schools, by Ayres, Williams and Wood, Hough-
ton Mifflin and Co., Boston, 1916.
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 129
Adaptation to Occupation. — When it is recalled that ex-
ercise is of value because of its effects upon the vital proc-
esses of life, it will be clear that the exercise necessary for
health will vary in accordance with the activity of the
person. The ditch digger at the end of a day's work does
not need activity that will strengthen his heart and induce
perspiration. He may, however, need activity of a kind
that will have an exhilarating effect upon his nervous
system. The clerk in a store engaged in sitting behind a
counter and selling buttons does require effective stimula-
tion of the lungs, heart, and skeletal muscles, and especially
out of doors. In thinking of the adaptation of exercise to
occupation it is important to remember that health is
something more than the ability to eat and sleep. Health
of the muscles and heart is important, but health of the
nervous system must not be neglected. Exercise that is
distasteful or uninteresting is not only of small value, but
it may be positively injurious. For students in college as
well as pupils in school, for clerks in stores as well as
workers in the factory, the selection of exercise must be
made on a basis of the person's occupation, and thus
supply the margin of activity necessary to keep the entire
body healthy and strong, a ready and wilHng servant of
the mind. What this margin shall be varies with the
vocation. But for all there is a minimum which will
provide for strength and vigor of the vital organs and
will keep the muscles in sufficient tone and strength to
secure pleasure and satisfaction from motor activity.
The individual with weak and flabby muscles cannot
enjoy physical activity. The importance of joy in phys-
ical activity caimot be overestimated.
Adaptation to Climate. — Climate rather naturally makes
its own adaptation of the individual in the matter of
exercise. Persons who live for any length of time in the
South gradually develop a distaste for exertion of a
physical kind."^ In the North there is quite naturally an
1 Huntington, E.: Civilization and Climate, Yale University-
Press, 1915, Chap. III.
130 PERSONAL HYGIENE APPLIED
inclination even in winter for vigorous outdoor life.
Nature should be followed here. The winter time is the
most important time to carry on outdoor activities.
Vigorous walking, outdoor games, skating, coasting —
these are the things to do. It is because of the limitations
imposed by the weather that people live such unhygienic
lives in the winter. For many it is a period of semi-
hibernation. Because of this, and the resulting accumula-
tion of waste materials, so many feel the need of a "tonic"
in the spring. It is important to state here that the best
tonic in the spring, especially after an inactive winter, is
out-of-door exercise with a rather careful limitation of the
diet. This point will be taken up later in more detail.
Adaptation to the Individual. — It may be stated that all
persons without serious disease need the gsneral effects
of daily exercise. These may be secured by walking (not
stroUing aimlessly, but walking a distance of 2 miles in
at least thirty minutes), hiking, swimming, playing games
such as golf, tennis, baseball, handball, and other sports.
The cardiac patient may need restricted and graduated
work; the tuberculous person may need absolute rest.
Such cases need the care and advice that a skilled phys-
ician can give.
Relative Value of Different Activities. — Not all exercise
is wholesome. Some varieties are more desirable than
others. The advocates of certain "systems" propose that
it is only necessary to follow their method to secure health
and happiness, if not hfe eternal itself. The virtue of
their systems is hkely to be greater the more they satisfy
the needs of man as revealed by man's nature and develop-
ment. On the contrary, many claim virtue because of
certain "special" exercises which the founders "dis-
covered." A consideration of the relative value of types
is therefore important.
Play, Games, Sports, and Athletics. — Play forms seen in
games, athletics, and aquatic and land sports afford the
best type of exercise. They are the best for man because
they are identical with or similar to the forms used by
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 131
man in evolving from lower forms to his present position
in the biologic scale. Man's body works best when
exercised in movements very hke the movements that
produced his body. These activities as types, contrasted
with caUsthenics, are so much more satisfying because of
the interest and mental exhilaration that comes in play
forms.
Dancing. — Folk and natural dances are excellent forms
of exercise. Women are finding great satisfaction also in
certain rhythmic forms that have advanced beyond the
old esthetic technic.
Social dancing is wholesome exercise, natural in the
form of movement, and physiologically valuable exercise
if practised in a sanitary environment. Unfortunately,
the late hours, the bad ventilation that so often accom-
pany the social dance introduce factors that need to be
controlled.
From another standpoint the modern social dance is
open to serious criticism because it is frequently hcentious,
and often immoral, and tends by its indirect influences to
a lowering of standards and to a debasing of fine human
relationships. The social dance involves fundamentally
the romantic position; it is often erotic in character.
Hence it should be controlled by the finest and most
accepted standards that wiU help boys and girls to fine
forms of expression.
The young man or young woman who is interested in
living most and in serving best ought to be concerned not
only with the possession of splendid purpose but also in
the expression of the finest and best in personality. It is
not possible to "jazz" through an evening, cheek to cheek,
body close to body, without arousing emotions and im-
pulses that are biologic, natural and worthwhile, but
emotions and impulses so strong and impelling that they
lead frequently to undesirable, unsocial, and immoral
forms of expression.
Formal Gymnastics and Calisthenics. — Exercises of this
type are less valuable than games, sports, and athletics.
132 PERSONAL HYGIENE APPLIED
They are useful in special cases to correct special defects.
Their apphcation to life is so Umited that lengthy dis-
cussion is unnecessary.
Setting-up Drill. — It ought to be possible for all persons
to live in such a way that the activities of work or the
activities of play provided all that was essential in phys-
iologic results to keep the muscles in tone, the heart
strong, and the different organic systems in good con-
dition. There is here, as elsewhere in human hfe, con-
siderable difference between the ought and the is. We are
confronted with the fact that a very large number of
people, especially professional and business men and
women, follow pursuits that are strictly sedentary, and
not conducive, under present social organization, to
adequate participation in motor recreation. For these
persons a setting-up drill taken every morning before the
bath will be of real value in assisting to maintain the
body in good physical condition. The following descrip-
tion of the exercises appeared first in the Teachers Col-
lege Record which has kindly given permission to repro-
duce in part the author's original article:
"In presenting a series of setting-up exercises it is important to
emphasize certain limitations. It does not represent a complete
system of physical education, nor may it be considered in all oases
to provide everything that is necessary to maintain health. At
best it is only a substitute for more wholesome exercise out-of-doors
in the form of games and recreative sports. The following points,
therefore, should be noted :
1. There is no short cut, no royal road, no easy way to health.
The development and preservation of physical vigor require intelli-
gent care of the body and scrupulous regard for the laws of health.
One cannot with safety and assurance contract a few muscles,
breathe deeply a few times, and obtain organic strength. In addi-
tion to exercise other factors must be considered, such as a healthful
attitude of mind, the choice of proper recreation, the intelligent
selection of food, the adjustment of work and play, and the care of
the body functions. All are as important as exercise. It ought to
be unnecessary to say that one cannot misuse the mind and body,
and then breathe a few times, take a pill, and remain vigorous.
2. Health exercises as a rule have been devised to produce effects
which could be felt by the person taking them. The idea that an
exercise must be felt in order to be valuable is similar to the idea
that medicine must have a nasty taste and a mysterious color in
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 133
order to be potent. On the contrary, the most desirable sort of
physical training will not prod ace soreness and wUl in no way strain
the muscles.
3. Exercises usually offered to the public are based upon the
artificial and unnatural movements of the Swedish or German
systems. It should be appreciated more generally that the move-
ments which man has made in developing from the lower forms of
life into the human being that he now is are more suited to his needs
than movements which are wholly unrelated to his phylogenetic
inheritance.
4. Many of the exercises often proposed are distinctly harmful.
For example, the human being should not bend the trunk backward
(except in corrective gymnastics where the support is controlled),
and breathing exercises which have no relation to physiologic needs
of the body are often injurious.
The exercises that follow are natural movements; hence they are
offered with the belief that they will be of some value to the sedentary
worker in school or office. They will serve to provide some activity
of a natural kind, and should be supplemented with as much whole-
some out-of-door exercise as is necessary to provide that "margin
of motor activity" essential to individual health.
They do not represent a complete system of body building.
They are not devised to meet the play requirement of children nor
the reactive needs of adults. They will set up the body, but they
will not restore a damaged heart, nor bring strength to a paralyzed
muscle. They will help, however, in securing good posture; but
they wiU not cure a crooked back nor remove fat from the abdomen
and deposit it on the shoulders.
These exercises should be performed on arising in the morning
and should be followed by the morning bath. They are devised
to produce wholesome effects upon circulation and respiration, and
they will aid digestion and ehmination. Since they are devised to
secure an upMft of the body in all the movements, the accent should
be upward. In addition, the trunk muscles are vigorously worked
and the correct use of the foot is favored.
The necessity of supplementing these movements with out-of-
door exercises must again be emphasized. Such activities as walk-
ing, hiking, tennis, swimming, coasting, skating, horseback riding,
canoeing, golf, dancing, athletic sports and games are suggested,
but the extent of participation in them must be determined by the
needs, capacities, and hmitations of the individual.
The following description should be carefully noted and the pic-
tures studied in learning the exercises.
Standing (Fig. 5)
The standing exercise (Fig. 5) is used to help in achieving a good
standing posture. Much of the posture work in the schools is bad
on account of the rigid and unnatural position attained. The body
is too frequently put into such a posture that the relation of parts
prevents quick and controlled action. One should seek to attain
in standing an erect position without rigidity, thus insuring health-
134
PERSONAL HYGIENE APPLIED
ful functioning of abdominal organs, proper use of joints, and effi-
cient use of the musculature of the body.
Exercise :
Stand with the feet parallel to each other and 6 to 8 inches
apart. Place one toot (either one) 3 to 4 inches in front of the
other. Have weight on both feet disposed to their outer edges.
This position of the feet produces balance, pivot, and control.
Push tlie tnnik upward and lift the abdominal wall ujjward.
Retain a feeling of relaxation in the shouklers, but secvu'e a sensa-
tion of extension and li'ngthening of the boily without contracting
or tensing the muscles (Fig. 5).
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 135
Guides in Pbefobmancb:
1. Avoid rigidity.
2. Secure straightening of the spine, but keep the shoulder
muscles relaxed.
3. Keep the weight off the heels.
4. Pull the abdominal wall upward and keep the lower half of
the abdominal waU constantly flattened.
Command :
For individ^ual performance of the exercises no commands are
required. Directions are given, however, for use in group instruc-
tion where commands are necessary.
The commands have two parts separated by a pause. The
length of the pause should vary according to the needs of the
group and the exercise. The first part of the command is pre-
paratory; the second is executive. These parts should be spoken
in such a way as to convey in the voice the manner of action
expected.
The command for this exercise is : Class — Stand!
Stretching (Figs. 5 and 6)
This is a natural movement that straightens the spine, lifts the
chest, and overcomes the sagging of the abdominal muscles so com-
monly seen in adults.
Exercise :
On the command One! push the arms easily upward and rise on
the toes as far as possible. Reach up as far as possible as if trying
to get an object from a high place (Fig. 6).
On Two! let the arms sink and the heels touch the floor, but
retain as long as possible the sensation of extension (Fig. 5). Do
not let the "body droop. The development of the proper muscle
sensation is important.
Guides in Performance:
1. Avoid tenseness and rigidity.
2. Do riot bend backward;- , ^
3. Avoid angular nxovemesnt^of the arms. Do not swing them
up; push them up. ' »
4. Perform with a feeling of Relaxation rather than contraction.
5. Repeat the movement ten times. (In the beginning, two or
three times is sufficient for aU the movements which are to be
repeated.)
6. Do not execute the movement rhythmically, for in rhythmical
exercises it is more difficult to get the correct form at the end of
the movement. The form in this movement is important.
Command :
1. Ready for Stretching — Stand! (Take the position in Fig. 5.)
2. Stretching— One! (Fig. 6) Two! (Fig. 5).
136
PERSONAL HYGIENE APPLIED
Throwing (Figs. 7 and 8)
This is a natural movement used by man in throwing a ball at
an object. In learning movements that involve complex co-ordina-
tions, do not think of the "end" of the movement, but keep clearly in
mind the "means" to that end. Follow closely the directions for
arm, leg, and trunk movement, and the co-ordination will come.
This movement is a powerful trunk exercise. It uses the back
and side muscles and brings into plaj' the large muscles of both arms
and both legs.
The first part of the movement (Fig. 7) corresponds to the second
part (Fig. S) in position of trunk and legs. If the arms in Fig. 7
were placed in the position .shown in Fig. 8, the similarity in the two
parts of the movement would be instantly apparent.
HYGIENE OF MUSCULAB AND SKELETAL SYSTEMS 137
Exercise :
Stand with feet about 24 inches apart and with the left foot
about 6 inches in front of the right. On One! clasp hands hghtly,
waist high as shown in Fig. 7, shift weight to the right foot, bend
the right knee, draw both hands to the right, twist the trunk to the
right, and turn the head to the right. The left leg is straight
and relaxed and the left heel is off the floor. The trunk is in-
cUned forward (Fig. 7).
On Two! throw with the right hand, twisting the trunk sharply
to the left. The left knee is bent and the right knee is straight
with the heel off the floor. Notice that the body forms a straight
hne from head to right heel (Fig. 8). The weight has been
transferred to the left leg. The right arm is forward and the left
arm back (Fig. 8). The force of the throw turns the body in
Fig. 8 a greater distance than in Fig. 7, and so the left foot is
turned in the direction of the throw.
Guides in Performance:
1. Avoid angles and sharp tensions in the movement.
2. Make all movements flowing, smooth, and harmonious.
3. Avoid conscious contractions. Do not try to contract the
muscles. Perform the movement and the muscles will contract to
carry out your desires.
4. Repeat the exercise ten times. At first separate it into two
parts. After it is learned make it continuous, and change from the
position in Fig. 7 to that in Fig. 8 and back to the position in Fig. 7
without interruption.
5. After strength and power are developed, the movement may
be performed rhythmically twenty times.
Command :
1. Ready for Throwing — Stand! (Stand with feet about 24
inches apart and with the left foot about 6 inches in front of the
right.)
2. Throwing — One! Two!
3* To command the rhythmical throwing, set the rhythm that
is desired. Then command. Throwing in Rhythm — Begin! Count
1, 2, 1, 2, to mark the rhythm.
4. To halt the group, command, Class — Halt! inserted in the
series of 1, 2.
5. Class — Stand! Standing position as given in Standing exer-
cise is taken.
Lifting (Figs. 9, 10, and 11)
This is a natural movement used in lifting an object from one
side of the body to the other, or from a low level to a higher one.
It is an exercise of the back and legs and may be made very vigor-
ous by reaching low and hfting high.
The movement as given has two phases: low lifting and high
lifting.
138
PERSONAL HYGIENE APPLIED
Exercise of Low Lifting:
On command One! bend the right knee and reach with arms to
the right of the right foot about 12 inches from the fioor (P'ig. 9).
The left leg is straight, the back is flat, and the movement occurs
in the hip- and knee- joints. On Two! transfer the weight to tlie
left foot and lift the object secured in conmiand One! to the left
and mto the same relative position as in l''ig. 9. Tlien the lel't
knee \A ill be bent, the right leg straight, and the arms will be to
the left of the left foot about 12 inches from the floor.
Exercise of High Lifting:
On One! assume the position as shown in Fig. 10. The hands
reach the floor and there is greater bending in the right knee and
hip joints. The back remains flat and tlie left leg is essentially in
the same position as shown in Fig. 9.
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 139
On Tioo! lift the object to the left and place it high above the
head (Fig. 11). Vigorous muscular extension should occur in this
part of the movement while the weight is being shifted to the left
foot and the right leg is relaxed with the right heel off the ground.
Guides in Performance:
1. Avoid tenseness in the movement, seek smoothness and con-
stantlj' adjust the body in the different parts of the exercise by
comparing the movement with the illustration.
2. Secure uplift of the body in the high lifting and get the com-
plete extension that would come in placing a box on a high shelf.
(In Fig. 11 the upward pull of the trunk is indicated in the ver-
tical folds of the shirt.)
3. Repeat each lift ten times.
140 PERSONAL HYGIENE APPLIED
Command .
1. Ready for Lifting — Stand! (Stand with feet 24 to 28 inches
apart, parallel and with the weight disposed to their outer edges.)
2. Low Lifting — One! Two!
_ 3. High Lifting— One! Two! Start the high lifting part of the
time on the left and part of the time on the right.
Climbing (Figs. 5 and 12)
CUmbing has always played a prominent part in the history of
man. Our arboreal ancestors excelled in it and our children today
at an early age seek to recapitulate their racial history in the same
action. This movement is a powerful exercise for the legs and se-
cures strong contraction of the abdominal muscles. As shown in
Fig. 12, it represents reaching upward and grasping an object, as a
Umb of a tree or ladder rung and pulling up one leg to obtain sup-
port preparatory to pushing up the body. The arm movement is
identical with the Stretching exercise.
Exercise :
On One! reach upward with the arms, raise the right -knee
forward and push the body upward on the ball of the left foot.
Secure vigorous stretching upward. This is to be the accented part
of the movement (Fig. 12). On Two! return to standing position
(Fig. 5).
Guides in Peefokmance:
1. Be careful not to droop on Two! Keep the erect position as
shown in Fig. 5.
2. Accent the count One!
3. The movement may be performed rhythmically, but the
rhythm should be slow and the accent always on the upward
movement.
Command :
1. Ready for Climbing — Stand! (Fig. 5).
2. Climbing— One! (Fig. 12) Two! (Fig. 5).
Walking (Figs. 5 and 13)
The walking movement represents a natural exercise performed
with movement of the opposite arm and leg. The act should be
executed with the feet parallel and with the weight on their outer
edges. The illustration (Fig. 13) exaggerates the natural move-
ment in some of its phases, but should be practised as shown (Fig.
13) to secure the freedom in walking that is desired. Walking can
be something more than a means of progression. Smooth arm move-
ment and vigorous leg action will bring exhilaration into an act that
is frequently rendered difficult by improper habits and clothing.
Exercise :
On One! raise the left knee forward and swing the right arm
forward. The body remains poised on the ball of the right foot
(Fig. 13). On Two! reverse the position of arms and legs.
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 141
Guides in Performance:
1. Keep the accent upward.
2. In walking avoid the pounding of the heels on the floor. The
heels strike first always, but the accent of the movement should
be upward and forward, never downward.
3. This movement is not to be confused with the aimless
strolling that is seen so frequently.
4. The rhythmical and continuous walk i.s used as soon as the
idea of the arm and leg movement is comprehended.
Command :
1. Ready for Walking — Stand! (Fig. .5).
2. Walking— One! (Fig. 13) Two! (Fig. 13).
3. Walking in Rhythm — Begin! See directions for commanding
a rhythmical exercise in Throwing.
142 PERSONAL HYGIENE APPLIED
Running (Figs. 6 and 14)
This is a natural exercise performed on the balls of the feet with
vigorous thrusting upward of the knees and free dnd vigorous swing-
ing of the arms (Fig. 14). It will be noticed that the right arm is
forward when the left knee is forward. This opposition in walking
and running is a fundamental compensation in the movement of
the body to secure proper balance, direction, and control. This
exercise vigorously stimulates the circulatory and respiratory
systems, and will aid in improving all the functions of the organs
supplying the body with energy. It should be possible for one to
run and enjoy the movement (Fig. 14).
Exercise :
On One! swing the right arm forward and thrust the left knee
upward and forward at the same time pushing the body upward
on the ball of the right foot.
On Two! reverse the position of the arms and legs and push the
body up on the ball of the left foot.
Guides in Performance:
1. Run a few times at first. After power and endurance are
developed, the run should be continued for several minutes.
2. Accent the upward movement. Do not strike the floor hard
on the down stroke.
3. After the co-ordination is learned, the run should be executed
in rhythm.
Command :
1. Ready for Running — Stand! (Fig. 5).
2. Running— One! (Fig. 14) Two! (Fig. 14).
3. Running in Rhythm — Begin! See directions for rhythmical
movements in Throwing.
Jumping (Figs. 15 and 16)
To clear an obstacle or grasp an object above one's standing
reach one resorts to jumping. This is therefore a natural move-
ment and it should be performed naturally. The first part of the
movement (Fig. 15) uses the muscles of the entire body, and in the
second part (Fig. 16) the body is thrown into the air by the vigor-
ous contraction of leg, back, and arm muscles. In the continuous
jump the landing position, shown in Fig. 15, serves as the start for
the next jump. At first the movement should be practised without
the jump.
Exercise :
On One' bend the knee- and hip-joints and incline the body
forward (Fig. 5). Swing the arms downward and backward
elevating the heels slightly. Note that the trunk is inchned and
not held in the upright and unnatural position sought in some gym-
nastic systems. On Two! swing arms forward and upward, and
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 143
spring into the air (Fig. 16). The landing follows as a result of
the movement and should assume the position shown in Fig. .1.5.
Guides in Performance:
1. Before trying the jump the movement of preparation
(Fig. 1.5) should be practised until the muscles are strong enough
to jump without straining them.
2. At first only make one jump (Fig. 16). Land with the knees
bent and the heels off the groimd.
3. Secure lightness in the movement and avoid landing heavily.
4. After the strength of the legs has been developed, continuous
jumping should be performed. Gradually increase the number
of jumps from one to five or si.\.
144 personal hygiene applied
Command :
1. Preparation for Jumping — One! (Fig. 15) Two! (Pig. 5).
This movement should be performed six to ten times each day
until the muscles are strong enough to make the jump.
2. Jumping— One! (Fig. 15) Two! (Fig. 16) Three! (Fig. 5).
On completing the jump, the body assumes the position shown in
Fig. 15 and then comes into the standing position shown in Fig. 5.
3. Jumping in Series — One! (Fig. 15) Jump! (Fig. 16)
Jump! Jump!
The command Jump! is used as soon as the landing is made and
is repeated as often as desired. At first not more than two jumps
in series should be made; later a series of six and in some cases
more may be used.
Habits of Exercise. — It is well known that one cannot
build up in school days a store of health that will last for
the rest of Ufe. The star football player in college deteri-
orates rapidly after school days unless he continues his
physical activity in some form.
College men and women ought to develop during
school days a skiU in and love for some sport, game, or
physical activity which they will foUow after school days
are over. Activities lending themselves to such habitu-
ation are swimming, tennis, handball, and walking. To
enjoy a "hike," to get out in the open spaces, to hunt, to
fish, to ride horseback, to row a boat, to chop wood, to
play golf, to grow things in the garden are health-produc-
ing activities. Habituation to physical activity is one of
the goals that should be set not only for every college man
and woman, but for all persons in the formative periods of
school life.
All the Factors in Health Important. — In any health-
building program care must be taken not to attribute to
exercise more than belongs to it. In focusing on exercise
there is a danger of neglecting other important health
measures without which the greatest health cannot be
attained. There are many individuals who live physically
active lives, but who are lacking in vitality and vigor.
Other important considerations in a health-building
program are care of the body as regards bathing, eating,
sleeping, ehminating, dressing, and forms of recreation.
There must be also appreciated in this connection the
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 145
influence of mental states on physical health. Without
stating at this time the psychology of related mental and
physical states it should be noted that mental reactions to
situations are important modifiers of organic processes.
We need, therefore, in the statement of the health needs
of the individual something more than playgrounds,
gymnasia, and tm-nverein. We need the first two cer-
tainly, but in co-operation with these we need more
hygiene in the schools, better sanitation in the schools,
more opportunity for wholesome recreation for adults, and
less transmission of communicable diseases^; we need in-
struction in the schools that wiU not only enable the child
to develop into an industrially or professionally intelUgent
man or woman but also a chance for that child to develop
the characteristics that will make him or her a good
parent. It is coming to be appreciated that home eco-
nomics may be very valuable for the training of the girl;
it is to be recognized that certain phases of the conduct
and organization of the home may very well be given to
boys. Both boys and girls need instruction in the home
training and care of children. It is rather interesting that
babies have been bom into civilized homes for several
years, and in that time a certain body of information has
been developed with reference to the training of children.
Nevertheless, we allow young people to be educated in the
schools and marry and bear children without giving them
any scientific knowledge that would enable them to do
the best that was possible for them to do. Of course, in-
numerable clinics are provided in the large cities for the
curing of infants after they have disease, but the intelligent
and wise thing to do would be to instruct prospective
parents at a time when they could be taught with some
chance of preventing and correcting the intolerable con-
ditions that at present prevail in the care and training of
children.
* Annual Report of the United States Interdepartmental Social
Hygiene Board. Reprint, activities 1919-1912, June 30, 1921,
Washington, D. C.
10
146 PERSONAL HYGIENE APPLIED
A broad view of the health of the individual will include
much more than exercise in a program that aims to
achieve fineness in living and in service. It is the limited
view that produces the queer anomaUes seen at times in
large cities when members of athletic club or turnverein
will go to the gymnasiiun to engage in exercises ostensibly
for the pm-pose of health, and will go out from the place
and violate all the laws of health. There is need for an
understanding of all the factors that enter into the pro-
duction of health, and such conviction concerning human
duty that the knowledge wiU be translated into effective
action.
HYGffiNE OF THE SKELETON
The Matter of Posture. — The bones of the skeleton are
for the purpose of protection to certain parts of the body,
for points of attachment for muscles, and for support to
organs and structures. In order that the child develop
in the proper way it is necessary that the bones of the
skeleton retain the shape and position in the body which
will enable them to perform these functions. There is
great importance, therefore, in the maintenance of the
correct position of the bony parts of the body. This is of
immense significance especially in childhood because the
period of childhood determines the shape and position of
the body in adult life. Correct posture modifies body
movement and conditions the development of the vital
organs, so that it should be sought at all times. It is very
much worth while to acquire correct motor habits, on the
one hand, and strong and sound organs on the other.
The correct upright position of the body does not call
for an erectness that is sometimes asked for in gymnastics.
It calls for an erectness in which the general line of the
body is straight, the head poised on top of the chest, and
not projecting forth at an angle like a gargoyle on the
cathedral Notre Dame, the abdomen flat and contracted,
and the weight placed so that the body can be moved
readily in any direction.
HYGIENE OF MUSCULAB AND SKELETAL SYSTEMS 147
Correct posture of the body cannot be defined adequately.
A definition is incapable of expressing all that must be
sought in the body from head to foot, but one can acquire
appreciation of what is desirable by being guided by the
best in hving and art forms that express in good posture,
elevated, optimistic, and happy states of mind. Such a
form as the Winged Victory shows good posture. The
reason for its excellence lies in the thought back of the
motor expression.
Posture is an expression of the mental and physical
state; also, posture may modify and control mental states.
It is possible by assuming an erect posture, by giving an
appearance and expression of joyfulness, cheer and op-
timism, to replace a depressing mood with the opposite
emotional state. The cultivation of a happy, cheerful,
optimistic nature more readily achieves results when
efforts are also made to walk with an elastic, springy
step, to hold the head erect and the abdomen flat.
Individuals taking too httle exercise are not infre-
quently equipped with such weak muscles that it is im-
possible for the parts of the body to be held in their proper
position. Too frequently college girls and other young
women who have neglected their physical training and
games present bodies so miserably weak that the effort to
stand erect is muscularly so fatiguing that the upright
position is never held in an habitual way. These weak
sisters try to cover their infirm and ineffective bodies by
masking it behind a pose or a slouch that may happen at
the time to be in style; but only the thoughtless are fooled.
Such posture is essentially the posture of a frail body. It
represents a body that is unable to do the work and meet
the responsibilities that come with adult life, with mar-
riage, and motherhood. Such girls, instead of possessing
an attraction, unfortunately own a body that is relatively
less able to express and receive happiness, to work and
achieve results, to serve and receive service.
Value of Good Posture. — ^Although it is exceedingly
difficult to define good posture, it is not at all difficult to
148 PERSONAL HYGIENE APPLIED
realize the advantage of a posture in which the parts of
the body at naechanical advantage and the body as a
whole are responsive to the needs of the environment. The
values flowing from such a posture are several:
1. Hygienic value: The erect, straight, vibrant body
has its organs properly suspended so that bodily
functions are more complete and perfect.
2. Economic value: Good posture pays. It speaks of
the spirit within the body. The young man or
woman seeking a business position portrays his or
her mental energy and alertness by the way he or
she stands and walks.
3. Social value: Despite the influence of pernicious and
siUy styles, it may be said that personal attractive-
ness is more properly measured by a splendid
carriage of the body rather than by a "debutante
slouch."
4. Spiritual value: The spirit is uplifted with a physical
uplift of the trunk. The glory of the rising sun is
never seen by one walking with protruding head
and abdomen and flat-feet.
Four Important Positions. — There are four positions of
the body that are important because of their influence on
health and happiness. Sitting, lying, standing, and
walking are such common postures that they influence
greatly bodily activity. If correctly performed, the in-
fluence is good; if done badly, the result is inefficiency
and frequently ill health.
We sit more than our ancestors did. Much sitting has
caused weakness of trunk muscles, and much bad sitting
has resulted in abnormalities of the trunk itself. One
should sit in a chair so that the trunk is straight. Bending
the body forward should occur at the hip-joint. To pre-
vent bad trunk position it is helpful to sit far back in the
chair. Chairs that are too high or too deep prevent
proper sitting.
In reclining, relaxation of all muscles should occur.
Complete relaxation is not possible in lying on the back.
H7GIENE OF MUSCULAR AND SKELETAL SYSTEMS 149
It is generally agreed that lying on the right side* (or
partially on the face) is more desirable than lying on the
back, because it favors muscular relaxation and makes
less pressure on the heart.
Standing is very tiresome and fatigues one more than
walking. This is due to the slowing of the circulation in
the legs. This fatigue cannot be overcome except by
activity, but it can be lessened by a posture which facili-
tates the blood flow. The body should be balanced on the
balls of the feet with the weight on the outer side. Keeping
the weight poised and the abdominal muscles flat will
assist the return of venous blood as well as contributing
markedly to general well being.
It has been said that walking is a lost art. It is true
that people walk less frequently today than formerly,
but the growing interest in walking is a most hopeful
sign for health. In walking the weight should be carried
on the outer side of the feet, and the feet should be used
in a parallel position so that the toe will point directly
forward. Toeing out and throwing the weight on the
inner side of the foot are productive of arch trouble.
But in addition to these mechanical points in walking
it is important to note that the way we walk depends very
largely upon the way we think and feel. That drab serious-
ness that clothes so many of us with its colorless mantle
affects even our walk. Cabot,^ with wonderful spirit,
writes:
"What is this melancholy and crestfallen line of persons, whom I
see moving along Beacon Street or Commonwealth Avenue toward
the heart of the city, a little before 9, in the crisp and frosty morn-
ing. So mechanical and spiritless is their gait as they plod along
that one might fancy them members of the sad, exploited proletariat,
crushed by overwork, exhausted by want of sleep. In fact, they
are prosperous bankers and lawyers on their way to business, and
the only trouble with them is that they have just lapsed into being
' Other factors, such as lighting, ventilation^ or noise, may more
readily determine whether the sleeping position shall be right or
left side. Other things being equal, the right side is preferable.
2 Cabot, R. C. : What Men Live By, Houghton MiflSin Co., Boston,
1914, p. 93.
150 PpBSONAL HYGIENE APPLIED
serious and serious only. It has never occurred to them that walk-
ing could be anything better than a means of sober progression.
Poetry in walking? Don't suggest that to practical men. They'll
think you a dangerous character."
Prevention of Common Skeletal Deformities. — ^The
skeleton may develop deformities due to improper posture,
lack of sufficient food of the proper kind, unusual loads
imposed upon the bony parts, either as severe strain in
occupation or as increased weight, sequels of disease, or
the actual process of a destructive disease itself. The
common deformities relate to the spine and to the feet.
Curvature of the Spine. — There are two main types of
abnormal curvature of the spine: one from front to
back; the other from side to side. The former results
in round shoulders (kyphosis) or hollow back (lordosis);
the latter in lateral curvature (scoliosis) of a mild or
severe grade.
Round shoulders and hollow back are largely the result
of poor posture in work and play, incorrect adjustments of
the parts of the body. They can be corrected by proper
exercises and the wUl to overcome faulty habits.
Lateral curvature frequently follows infantile paralysis,
and the mild cases of this disease probably provide a
large number of the scoUoses seen. Other causes which
have been suggested are carrying of books on one arm,
standing on one foot, and writing at a desk of improper
height. Curvatures of a postural kind can readily be
corrected by corrective gymnastics if the individual is
interested to overcome the defect; those resulting from
disease are more difficult to control.
Shoulder Braces. — Many parents are led to suppose that
shoulder braces are effective means for correction of round
shoulders. This is absolutely wrong. The wearing of
braces is distinctly harmful in that they do the work that
the back muscles should do, and hence allow these muscles
to become stiU weaker and less effective agents of body
control. In the growing period of childhood postural de-
formities more frequently occur. They should receive
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 151
attention at that time. This should be in the form of cor-
rective exercises prescribed by physician or medical
gymnast who knows the problem. It is very important to
select some one whose personahty will arouse and hold
the interest of the child in striving to overcome the de-
fective condition.
Weak, Deformed, and Flat-feet. — The normal human
foot is constructed of bones arranged in such fashion that
a long arch is made on the inner aspect of the foot, and a
transverse one in the region of the ball of the foot. These
arches are sustained by ligaments of the foot and by
muscles of the foot and leg. The entire mechanical
structure of the foot indicates its use to be as follows:
1. The foot in action should be placed on the ground
with the line of direction parallel to the line of
movement. The toes should point forward then,
and neither be turned outward nor inward.
2. The weight of the body shotdd be carried forward
from the heel to the ball of the foot with its dis-
position always to the outer part of the foot.
3. In walking the heel should strike the ground first,
and the weight then be transferred to the toes.
Every step should produce elevation of the body
on the ball of the foot.
Causes of Foot Weakness and Deformity. — The cause
of most foot troubles is improper shoes. Shoes too narrow,
too short, of improper lines, with high heels, are especially
condemned. Many young people permit the shoes sales-
man to make the foot fit the shoe. The principle to be
applied is that the shoe must fit the foot.
Points of a Good Shoe. — The style today may be high
tops or low oxfords, ties or buttons, military heel, or the
extreme French. These are incidental and meaningless
for those who see straight and refuse to get their values
mixed. The thoughtless, the careless, the vain will run
after the baubles of style and be handicapped in action
and in freedom of movement. Others, seeing real values,
will look for the following in choosing a shoe;
152 PERSONAL HYGIENE APPLIED
1. An approximately straight inner line from heel to
toe. Some feet show an inflare and some an out-
flare. There are shoes to fit these types. Most
feet show a straight inner line and, as a rule, the
straight line test for shoes should be applied.
2. Front part of the shoe shall be as broad as the foot
for which it is designed.
3. The heel shall not be over 1 J inches high and shall
be as broad on its wearing surface as the human
heel.
4. The shoe should fit snugly around the arch and
instep of the foot and loosely over the toes.
5. Patent leather shoes should not be chosen because
they do not allow free ventilation of the feet.
Rubber heels are distinctly valuable for city wear.
The human body developed its structure and fimctions
with reference to an agricultural type of hfe. While ad-
justments may be going on in the body fitting it to city
conditions, such as hard floors and pavements, it is never-
theless good hygiene to use an appliance such as the
rubber heel to reUeve the body of jar as much as possible.
The rehef of fatigue and the increased sense of elasticity are
values significant enough to warrant the use of rubber heels.
Flat-feet. — Many causes may contribute to produce
flat-foot. This unfortunate condition should have the
care of an expert in such matters. Modification in occupa-
tion, reduction of weight, change in maimer of walking, use
of orthopedic shoes — ^aU may be necessary to effect a cure.
Exercises for Weak or Fallen Arches. — If the long arch
of the. foot is weak, if pain is beginning, the following pro-
cedure is important:
1. Examine the shoe to see if it is at fault. If so,
correct.
2. Note whether an increase in weight has occurred. If
so, reduce.
3. If occupation involves standing for long periods, try
to adjust by sitting at work and begin walking
every day.
HYGIENE OF MUSCULAR AND SKELETAL SYSTEMS 153
4. In walking note as follows:
(a) Keep weight always on outer side of foot.
(6) Keep feet parallel in walking. Do not turn
feet outward.
(c) Let the heel hit the ground first and then
transfer the weight forward along the outer
edge of foot to the ball.
(d) Push off strongly with the toes and do not let
the leg swing entirely from the hip.
5. Practice daily the following exercises:
(a) Lie on the back and flex and extend the ankles
as far as possible, laying most stress on the
flexion. (Bring toes up toward knees.)
(b) With the ankle flexed as far as possible practice
bending the toes down toward the sole of
the foot in an effort to grasp the sole.
(c) Sit on a chair or edge of the bed and try
grasping and holding a lead pencil with the
toes.
(d) With the legs extended and together try to
turn the foot inward so as to see the sole of
the foot.
(e) Practice these exercises every evening before
going to bed. Begin first with a ten-minute
period and increase to thirty minutes if not
fatigued.
If the arch condition is not corrected by the above pro-
cedure, see an orthopedic stirgeon at once.
Disturbance in the arch in the front part of the foot
requires a pad for support. This should be supplied by an
orthopedic surgeon.
Perils of Maturity.^ — The joints and ligaments of the
body suffer from two deficiencies in mature years:
1. Increase in body weight without a corresponding
increase in supporting strength.
2. Decrease in tone of the ligaments due to general loss
in body tone accompanying the sedentary life.
These conditions are to be combated by keeping the
154 PERSONAL HYGIENE APPLIED
weight at the desired average for the height, and by im-
provement of strength and tonicity of ligaments by ex-
ercise, outdoor air, rest, and recreation. To maintain the
body at a level of efficiency that will make possible the
best work and the largest happiness requires expenditure
of time in care of the body and its use in motor activities.
To give this time from vocation is often difficult; to achieve
efficiency in any other way is impossible.
CHAPTER VII
HYGIENE OF NUTRITION
I. SotmcEs OF Energy.
II. Digestion, Assimilation, and Nutrition.
III. Basal Metabolism.
IV. Caloric Values op Different Articles of Food.
V. Classification of Food:
1. Food to Yield Energy:
(o) Carbohydrates.
(b) Fats.
2. Food to Build Tissue.
3. Composition of Vegetable and Animal Proteins.
4. Food to Regulate Body Processes.
VI. How Vitamins Affect Nutrition and Growth.
VII. Foods and Vitamins.
VIII. Destruction of Vitamins:
1. The Story of Vitamin A.
2. The Story of Vitamin B.
3. The Story of Vitamin C.
IX. Mineral Salts as a Dietary Essential.
X. Composition op the Body in Terms op its Elements.
XI. The Role op Mineral Salts in Food.
XII. The Mineral Salts and Body Reaction.
XIII. The Hygiene op Nutrition:
1. Wise Choice of Food:
(a) Food Values and Body Needs.
(6) Food Digestibility.
(c) Food Poisons.
2. Correct Eating.
3. Regular Elvacuation.
XIV. Causes of Indigestion.
XV. Fads and Fallacies in Diet:
1. Vegetarianism.
2. Hot Water Fad.
3. Raw Food Fad.
4. No-breakfast Fad.
5. Sour Milk Fad.
XVI. Food Adulteration.
XVII. Alcohol:
1. Alcohol and Length of Life.
2. Alcohol and EfRciency.
XVIII. Coffee, Cocoa, Tea.
155
166 PERSONAL HYGIENE APPLIED
Sources of Energy ,-^The sources of human energy were
discussed in Chapter IV. Ultimately, we say that energy
comes from food. Sherman' says: "The activities on
which the life of the body depends involve a continuous
expenditure of energy and the constant exchange of
material." This continuous expenditure of energy is de-
pendent upon food taken into the body, and this food
serves not only to provide the known chemical compounds
which directly release energy but also it provides sub-
stances serving to stimulate and promote growth and to
regulate body processes. Health, as evidenced in activity
or in growth of the body, is seen to be dependent upon not
merely chemical compounds that will produce upon di-
gestion so many heat units. Normal growth, normal
work, and power of normal reproduction wiU be seen to
be due to other substances in food that do not yield
calories, but serve as regulators, organizers, and stimulators
of bodily activity. The old emphasis upon the caloric
yield has beeii broadened to include other important
factors in determining man's dietary. The chief functions
of food then are, as Sherman'' suggests, "(1) To yield
energy, (2) to build tissue, (3) to regulate body processes."
Digestion, Assimilation, and Nutrition. — The rough
masses of food are made available for use in the body by a
physiochemic change produced when food is brought in
contact with various juices of the ahmentary tract. By
this change chemical units are separated out to be used
in growth of the organism, in the maintenance of the life
activities, and repair of parts. These units are taken up
by the tissues; they are assimilated into the cells where
they will serve. The final result is good nutrition of the
organism if sufficient energy has been supplied for action
and if a normal body has been secured through a proper
supply of building and regulating material.
Basal Metabolism. — The foods taken into the body are
the source then of energy either for action or for tissue
' Sherman, H. C. : Chemistry of Food and Nutrition, The Mao-
millan Co., New York, 1920, p. xi. 2 Ibid.
HYGIENE OP NUTRITION
157
building. They are made available for release of energy
by a series of chemical changes that occur in digestion and
later in assimilation in the tissues. Chemical changes
occur when energy substances are burned in the body.
In these chemical changes, known as metabolism, there is
always a production of heat, sometimes apparently as a
by-product of the change itself, and again as the chief end
or aim of the process. At all events, heat is constantly
being produced in the human body, and as energy in its
simple form we may think of energy release as heat pro-
duction. It has long been known that the production of
heat in the body varied with many factors, but in recent
years efforts have been directed to determine what is
normal heat production, so that a standard would be
available by which abnormahties could be judged. The
heat production of an individual has been called its basal
metaboUsm. The basal metabolism is controlled by the
activity of the organs, muscles, and blood, and in part by
body weight and body surface area. There is some rela-
tionship between body weight and body area, but pro-
toplasmic activity of body cells is more significant in ex-
plaining basal metabolism. The heat produced by the
body is an indication of the metaboUc activity of the
tissues. DuBois has shown that the basal metaboUsm of
boys is 25 per cent, greater than that of adults. His figures
follow:
Basal Metabolism of Boys, Men and Women
Age in years.
Calories per hour per square meter.
Subjects.
Meeh.
DuBoia
(height-weight).
Boys
12-13
20-50
20-50
60-60
50-60
77-83
45.7
34.7
32.3
30.8
28.7
49.9
Men
39.7
Women
36.9
Men
35.2
32.7
Men
35.1
158 PERSONAL HYGIENE APPLIED
This table shows that boys before adolescence have a
high rate of metabolism,^ that men have a higher rate
than women, and that with advancing age the furnace
fires cool down and oxidation is no longer so intense.
Heat is lost from the body by conduction and radiation;
by evaporation of water from lungs and skin; and by warm-
ing the food ingested and the air breathed. The loss by
conduction and radiation and by evaporation are the sig-
nificant losses. Individuals inadequately clothed for cold
weather require that the body bum its food at an increased
rate to keep up its basal metabolism. The observation by
Lavoisier on this point has been abundantly confirmed.
Caloric Values of Different Articles of Food. — ^When
food is burned in the body heat is produced. The ability
of the food to produce heat renders it valuable to the body,
and hence food is measured in terms of its heat-producing
power. This is called its caloric value, or its power to
produce units of heat in the body.
The caloric^ value of food-stuffs has meant very little to
most persons because the gram is usually chosen as the
unit of measurement. Tables of common articles of diet
giving the caloric value, protein, fat and carbohydrate
values, in relation to well-known units of service, such as
sUce, teaspoonful, tablespoonful, etc., can be found in
some of the technical books on dietetics. The most
serviceable in this respect is "Feeding the Family," by
Mary S. Rose. Another excellent little book is "Food
Values," by Edwin Locke.
Classification of Food. — Foods vary widely in their
chemical composition. They also vary, therefore, in the
service they give to the animal economy. It has been
customary to classify food in terms of the food elements
in diilerent varieties of food, but the newer knowledge of
' Lack of appreciation of the fact that children in the "growing
years" have a high basal metaboUsm is the cause of much under-
nutrition.
' 1 gram of protein yields 4 calories.
1 gram of fat yields _ 9 calories.
1 gram of carbohydrate yields 4 calories.
HYGIENE OF NUTRITION 159
nutrition has emphasized certain food factors that are
essential for maintenance and growth. A functional
classification is to be preferred because of this fact, and
also because of the hygienic imphcations involved. We
shall discuss food, therefore, with respect to:
1. Its power to yield energy.
2. Its power to build tissue.
3. Its power to regulate body processes.
It should be noted that some examples of food combine
all of these characteristics. Thus, milk and eggs possess
the above powers. Good human milk alone is entirely
adequate for infants. Many different foods are both
yielders of energy and builders of tissue. Many possess
the power to regulate body processes. Combinations are
essential to secure the three values in the proper pro-
portion.
Food to Yield Energy. — Foods contain three classes of
chemical compounds known as carbohydrates, fats, and
proteins. The first two are in daily life the main sources
of energy. These compounds are widely distributed in
food supplies.' Meats contain both fats and proteins;
eggs have nearly equal amounts of fats and proteins;
milk jrields carbohydrates, fats, and proteins in almost
equal amounts; most cereals contain all three and never
less than two (fat insignificant in amount) ; most nuts are
rich in protein and fat; and vegetables with few exceptions
contain all three, with the carbohydrates in largest amount.
The food-stuffs economical for energy are the carbohy-
drates and fats.
(a) Carbohydrates. — ^The carbohydrates include the sim-
ple sugars and the starches that by digestive processes are
changed into sugars. After digestion the sugars are taken
' There are no special system foods. The nervous system is de-
pendent upon the same food sources for its energy that supply the
other systems of the body. The term "brain food" or "nerve food"
is a misnomer. (See Fig. 17.) Sanatogen has been advertised ex-
tensively as a "nerve food and tonic." It is not so regarded among
scientific people.
160 PERSONAL HYGIENE APPLIED
by the circulation to the Uver, where they are stored in the
form of glycogen. As sugar is needed in the body the
supply in the Uver is drawn upon, and thus in the hours
between meals carbohydrate is always available for energy.
The combustion of carbohydrates may foUow one of
several possible courses, but it leads eventually to carbon
dioxid and water. The rate of combustion depends upon
the activity of the body. Oxygen is necessary for this
S ANATOGE N
SANATOGEN CONSISTS OF 95% CASEIN (DRIED MILK CURD)
AND 5% GLYCEROPHOSPHATES. IT IS ADVERTISED UNDER
RIDICULOUSLY EXAGGERATED CLAIMS AS A "FOOD-TONIC."
WHAT SI.OO WILL BUY IN FOOD ENERGY
Sanatogen
Eggs (54e. dz.) IBSigS"'1
Milk (16c. qt) mmjs^^mm
Bread aec.ib.t ita^i5s»w^ag^saBi.,jiiiim
Sugar (18c. lb.) i
Rice (16c. lb.) I
Beans (lOctb.) HHa^^^SS
There Is more food energy In 2 cents worth of Beans (at 10c. lb.) than
In One Dollar's worth of Sanatogen.
Fig. 17. — ^Energy is obtained more surely from wholesome food
than from special patented preparations. (By courtesy of the
American Medical Association.)
combustion, and unless some unusual condition impede,
the supply of oxygen will be maintained suflScient for body
needs. If the carbohydrate is abundant, it may result in
the saving of fat for the time, so that the fat of the diet
will be stored in the body tissues.
It is well known also that fat may be formed from carbo-
hydrate. Numerous experiments have demonstrated this
fact. The evidence of a practical kind is given by those
HYGIENE OF NUTRITION 161
people of overweight proportions who partake freely of
carbohydrate foods, such as potatoes, candy, cereals, and
bread.
(b) Fats. — The fats are widely distributed in nature and
occur in both the animal and vegetable kingdoms. They
are represented in milk, cream, butter, nuts, olive oil, and
other vegetable oils. After digestion of food containing
fats the end-products of the change pass into the circula-
tion and thence into the tissues. They may be burned at
once to produce energy, stored as glycogen for use as fuel
at a later time, or bound in chemical combination to
produce tissue fat. Some of the fat enters into combina-
tion with proteins, phosphorus, and other substances to
form complex compounds (e. g., lecithin) found especially
in the nervous system.
For the Hberation of energy fat is burned and yields
finally carbon dioxid and water. This energy production
is high. While 1 gram of carbohydrate yields about 4
calories, 1 gram of fat yields about 9. We recognize,
therefore, that fat is a food of high fuel value and useful
primarily as a source of energy.
Food to Build Tissue. — Proteins are of importance
chiefly as tissue builders and are the only available source
of nitrogen. They are found in animal and plant tissues.
More complex in chemijcal structure than the carbohy-
drates and fats, they have at last yielded to scientific
methods, so that their terminal digestion units, called
amino-acids, are well known. Not all proteins are alike
in the amino-acids yielded, and the amino-acids them-
selves vary greatly in their ability to build tissue. Osbom,
McCollima, and others have shown that certain proteins
obtained from wheat (ghadin), rye (gliadin), pea (legumin),
barley (hordein), maize (zein), and kidney bean (phaseolin)
may maintain life, but are not sufficient to promote growth.
The growth proteins of value are from milk (casein),
hemp seed (edestin), wheat (glutein), maize (glutelin),
and squash seed (globulin). Such experiments would in-
dicate the importance for growing children of milk, whole
n
162 PEBSONAL HYGIENE APPLIED
wheat, and unprocessed corn, to mention the foods in the
above group commonly used.
The relative value of meat and vegetable proteins for
growth and life processes in general has not been finally
determined. Certain results have been secured by careful
feeding experiments, but more remains to be done before
a final statement can be made. The animal proteins, if
milk and eggs are included, and of course they should be,
are distinctly superior as sources of nitrogen for the body.
The proteins of vegetables as they occur in the ordinary
diet are not so easily digested and utihzed as the meat
proteins. For growth purposes McCollum' says: "These
(muscle tissue proteins) are distinctly better than those of
the seeds with which investigations have been conducted."
Sherman* notes : "Hoobler has shown that milk is the best
form of food protein for the production of human milk and
the protection of the body protein of the nursing mother."
Protein is the only food containing nitrogen and nitrogen
is essential for life. The body is continually using nitrogen
in its metabolic activities, and the amount used can be
determined by measuring the amount of nitrogen in the
waste eliminated. If the nitrogen of the food and the
nitrogen of body waste are determined, it is possible to
compute the nitrogen intake and output. If the output
exceeds the intake, it means that the body is burning its
own protein to supply its needs. By reducing the intake
to the minimum where output and intake balance we
reach a point of equilibrium known in chemistry as
"nitrogen equihbrium." It has been held that meat
proteins were more usable in the body. Burton-Opitz'
states that, to secure nitrogen equihbrium, "we need 30
grams of the proteins of meat, 31 grams of the proteins of
milk, 54 grams of the proteins of beans, 76 grams of the
proteins of bread, 102 grams of the proteins of corn." On
• McCollum, E. V. : Newer Knowledge of Nutrition, The Mac-
millan Co., New York, p. 77.
i* Sherman, H. C: Loc. cit., p. 226.
» Burton-Opitz, R.: Text-book of Physiology, W. B. Saunders
Co., PhUadelphia, 1920, p. 1057.
HYGIENE OF NUTRITION
163
the other hand, Sherman' has shown recently that nitrogen
equiUbrium can be maintained on a diet of cereal grains
of 35 to 45 grains of protein per man of 70 kilograms per
day. "An allowance of 1 gram of protein per kilogram of
body weight per day provides a margin of safety of from
50 to 100 per cent, above the minimum actually required
to maintain equilibrium." For palatability's sake meat
protein is superior to vegetable protein, but for health's
sake it is probably wise counsel to say that the protein
allowance per day should not exceed 100 grams, and that
meat in contributing to that maximum should not be used
more often than once a day.
The diet in Germany during the war failed miserably in
maintaining health and was inadequate for work of
physical or mental kind. Lusk^ reports a table presented
by Rubner showing the rationed foods as planned and as
actually provided:
German Diet During the World War
As planned:
Amount.
Protein,
grams.
Cal-
ories.
Amount,
grams.
As actually provided;
Protein,
grams.
Cal-
ories.
Bread
Potatoes
Butter and mai
garine
Mflk
Meat
Eggs (per piece) . .
Sugar
Cereals
2Z1.0 gm.
710.0 gm.
18.0 gm.
200.0 C.C.
70.0 gm.
0.3 gm.
32.0 gm.
17.2
14.9
6.8
10.7
4.2
688
710
140
111
158
53
125
271.0
357.0
11.4
36.0
0.07
26.0
9.8
17.2
7.5
4.5
1.0
0.9
688
341
89
78
13
104
31
Totals.
53.8
1985
31.1
1344
1 Sherman, H. C. : The Protein Requirement of Maintenance in
Man, Proceedings National Academy Sciences, pp. 38-40, January,
1920.
' Lusk, Graham: Physiological Effect of Undernutrition, Physio-
logical Reviews, October, 1921, pp. 523-552.
164 PERSONAL HYGIENE APPLIED
"The exclusion of animal foods from the diet made it
monotonous, and for many it was not better than the
fare of prisoners sixty or seventy years before." More-
over, as Lusk later says, "The mixed diet of peace time
showed a loss of 10 per cent, of nitrogen, while the coarse
vegetarian war diet showed that 20 or even 50^ per cent,
of the nitrogen of the diet could not be absorbed."
The present evidence would seem to indicate the value
of animal proteins for growing children. For adults, when
growth is not important, the proteins must be judged not
as to source, but as to composition.
Composition of Vegetable and Animal Proteins. —
Although there is conflicting evidence and opinion as
regards the relative value of animal and vegetable protein,
there is general agreement that the sources differ markedly
in composition. This difference lies chiefly in the amount
of nucleoprotein available. This is of importance because
nucleoprotein is the source of the purin bases, complex
products of protein metabolism, and substances directly
related to the production of gout and probably related to
the efficiency and health of the kidneys.
In writing of the purins Rose^ says: "These purins are
not nutritious, but are gradually transformed in the body
to uric acid, to be carried off as waste in the urine. Persons
inclined to gout have difficulty in getting rid of uric acid, and
the more meat they eat, the more uric acid tends to accumu-
late in the system, circulating in the blood and depositing
in the joints. If protein is taken in moderation and chiefly
from eggs, milk, cheese, bread, and nuts, which contain no
purins, dangers of this difiiculty may be avoided. . . . For
' This would apparently lower the protein intake below 16 grams.
War diets in some areas of Germany under observation by American
officers showed a total calorie yield of 1200 to 2000. This lowering
of the protein intake and the caloric value of the diet was not in-
compatible with life because the basal metabolism was probably
reduced. But there was noticed a very great susceptibility to in-
fections. Patients in hospitals and welfare institutions died in
great numbers.
" Rose, M. S. : Feeding the Family, The Macmillan Co., New York,
1919, p. 68,
HYGIENE OF NUTKITION 165
persons of indoor sedentary life a very liberal use of meat
is certainly undesirable. Even athletes, for whom meat
was once thought especially necessary, have demon-
strated the possibility of reducing their daily consumption
to one-sixth the amount which the training table pre-
viously provided, with an actual increase in their capacity
for endurance."
The following foods are practically purin free: milk,
eggs, cheese, sugars, breadstufls made with white flour,
fruits, nuts, rice, potatoes, all root vegetables, most green
vegetables (spinach and asparagus excepted), fats, and
oils. The foods of high purin are: sweetbreads, kidney,
roe, liver, and sardines. Those fairly high in purin are:
beef, veal, mutton, pork, chicken, turkey, goose and other
game, fish (cod excepted), spinach, asparagus, peas, and
beans.
Food to Regulate Body Processes. — Mendel and Osborn'
reported their results on feeding different proteins. They
showed that rats require for normal growth certain of the
17 amino-acids which are the structural units of all pro-
teins. Now, no matter what combination of foods they
used, the animals failed to grow unless there were present
in the diet two things: "one present in butter-fat and
absent in lard; another present in milk, but which was not
protein, fat, carbohydrate, or mineral. These x and y of
Mendel's experiments were noted in papers published
simultaneously with Funk's announcement of Vitamin in
1911."^ McCoUum, working along similar Unes, gave the
names "fat-soluble A" and "water-soluble B" to these
substances. Lately a third substance has been discovered,
water-soluble C. The three types are usually designated
by physiologic chemists as Adtamin A, B, and C.
How Vitamins Affect Nutrition and Growth. — Numerous
experiments by Osborn, Mendel, Funk, Vedder, Takaki,
McCoUmn, and his co-workers definitely prove that
' Mendel and Osborn: Feeding Experiments with Isolated Food
Substances, Carnegie Institute, Washington, Publication No. 156.
^ Sherman, H. C: Loc. cit., p. 226.
166 PERSONAL HYGIENE APPLIED
nutrition and growth are profoundly affected by the
vitamins of food. Not only do specific diseases develop if
the vitamins are absent, but malnutrition of all grades
occurs when the vitamins are not in sufficient amount.
Scmvy and beriberi have lately been termed deficiency
diseases because of being caused by a diet deficient in
vitamin, C in the former and B in the latter. McCollum*
gives numerous illustrations of the damage done by a diet
in which the vitamin element is deficient. Eddy" says
that rickets which were formerly considered to be due to
a lack of calcium salts has been stated by McCollum to be
due to a deficiency of any two of four factors — quaUty of
protein, mineral salts, fat-soluble A, and water-soluble B.
Marasmus has shown some evidence of connection with
the A and B vitamins and scurvy has been finked with the
C vitamin. It should be noted that while the vitamin
content is extremely important in the diets of growing
children, it is to be noted that adults will secure all the
vitamin they require from the usual mixed diet. Ordinary
fresh foods are the simplest, cheapest, and richest sources
of vitamins. The commercialization of the interest in
vitamins would lead persons to beUeve that vitamin
tablets, yeast, and other preparations are essential to
health.
Foods and Vitamins.— The following (Table III),
adapted from Eddy,' gives the vitamin factor present in
different foods used by man:
1 McCollum, E. V. : Loc. cit., entire book; McCollum and Davis,
Journal Biological Chemistry, 1915, vol. 23, 231 ; McCollum, Simonds,
and Pitz, American Journal Physiology, 1916, vol. 41, 333, 361; Mc-
Collum, Journal American Medical Association, May 12, 1917,
pp. 1579-1586.
' Eddy, W. H.: Vitamines and Babies, Teachers College Record,
p. 103, March, 1920.
' Eddy, W. H. : The Vitamin Manual, Williams and Wilkins Co.,
Baltimore, 1921, pp. 59-61.
HTGIENE OP NUTBITION
167
TABLE III
Relative Amounts op Vitamins in Food-stuffs
Food-stuffs.
Meats:
Beef heart
Brains
Codfish
Fish roe..
Herring
Kidney
Lean muscle
Liver
Pancreas
TTiyinus (sweetbreads) .
Cabbage, fresh. .
Carrots
Cauliflower
Celery
Chard
Lettuce. .......
Onions
Parsnips
Peas, fresh
Potatoes
Potatoes, sweet.
Spinach
Cereah:
Barley
Bread (white)
Bread (whole meal) .
Maize (com)
Oats
Rice, polished
Rice (whole grain) .
Other seeds:
Beans, kidney.
Beans, navy. .
Peanuts
Peas, dry
FruUs:
Apples ....
Bananas. . .
Grapefruit.
+
+ +
+
+
+ +
+ +
+
+++
+++
++
?
+++
++
?
++
+
+++
+
+
+ yellow
white
+
+
+
+7
+
+++
4-
+ +
++
+ +
+
+ + +
+++
+++
+++
+++
++
++
+++
+++
++
+++
++
+++
+++
■+?
+++
+++
+++
+++
+++
+++
++
++
++
+
+++
"C."
?
+?
?
7
7
+7
+7
++++
+ +
+ +
?
?
+++ +
++ +
+ + +
+ +
?
+++
?
++
++
+++
168
PEHSONAL HYGIENE APPLIED
Food-s tuffs.
Fruits {Continued).
Grape juice
Grapes
Lemons
Limes
Granges
Pears
Raisins
Tomatoes
Oils and fats:
Beef fat
Butter
Codliver oil
Com oil
Egg yolk fat
Lard
Oleo, animal
Oleo, vegetable
Olive oil
Nuts:
Almonds
Brazil nut
Cocoanut
English walnuts
Filbert
Dairy products:
Butter
Cheese
Condensed milk
Cream
Eggs
Milk, powder (skimmed)
Milk, powder (whole) . . .
Milk, whole
Miscellaneous:
Honey
Yeast, brewers'
Yeast cakes
"A."
+ +
+
+ + + +
+ + + +
+ + + +
0?
+
+
++++
++
++
+++
++++
+
+++
+++
"B."
+
+
+++
++
+++
++
+
+++
+++
+++
+++
+++
+++
+
+
+
++
+++
+++
+++
++
++++
++
"C."
+
+
++++
++
++++
++
+
++++
?
?
+?
+?
++
Destruction of Vitamins. — Since most foods reach the
table changed in form from that of their natm-al state,
either through cooking, cannin|, pasteurization, or oth^r
HYGIENE OP NUTRITION 169
chemical or physical method, it is important to know to
what extent vitamin is changed or lost by such procedures.
The Story of Vitamin A. — The "A" vitamin is affected
as follows: Eddy' says, "Heat alone is of very limited
effect, but where sources are heated in the presence of
oxygen, destruction of the vitamin may be very rapid.
. . . Cooking of vegetables will not, as a rule, result in
appreciable destruction of this factor. . . . The many
lard substitutes now in use must in general be considered
'A' vitamin free regardless of the content of the 'A' in the
fats from which they are derived, unless they have been
made by blending instead of hydrogenation."
The question of heating the vitamin has not been
settled because the factors vary markedly. Sherman,
MacLeod, and Kramer state that "dry heating at a tem-
perature of 100° C. with free access of air only very slowly
destroyed fat-soluble vitamin." They go on to say: "The
results thus far obtained emphasize the importance of
taking fuU account of the time as well as the temperature
of heating, and of the initial concentration of vitamin in
the food as well as the opportunity for pre-vious storage of
the vitamin by the test animal."
The Story of Vitamin B. — The vitamin B will not be
appreciably affected in ordinary cooking temperatures if
alkali is not used. Therefore, the canning or preserving
of food by the addition of bicarbonate of soda at the time
of preparation is detrimental to the B vitamin. The use
of soda in the cooking of vegetables "to soften the vegetable
and accelerate the cooking" is destructive of vitamin B.
The Story of Vitamin C- — The C vitamin is more sen-
sititve than A or B. "Temperatures above 50° C," says
Eddy,'' "are usually destructive, although the time factor
is ejctremely important as well as the reaction. Hess, for
example, has foimd that the temperature used to pas-
teurize milk continued for some time is more destructive
lEddy, W. H.: The Vitamin Manual, Williams & Wilkins Co.,
Baltimore, 1921, pp. 63, 64.
2 Ibid., p. 68.
170 PERSONAL HYGIENE APPLIED
to vitamin than boiling water temperature continued for
only a few minutes. The extent to which orange juice and
tomato juice resist high temperatures indicates the pro-
tective action of acids to be considerable."
The cooking of cabbage destroys about 90 per cent, of
its vitamin C. If acid or alkaU is added to vegetables in
cooking, most of the vitamin is lost.
Dehydration of vegetables destroys, in most instances,
the C vitamin. Hess' suggests that dehydration was "the
greatest cause of scurvy in the Central Empires" during
the World War.
Young fresh vegetables contain more C vitamin than
old ones. These considerations all indicate the need for
man to secure fresh natural food products so far as possi-
ble; to avoid those that have been treated chemically and
in other ways. As regards milk, it is unquestionably
better to use pasteurized milk in which the vitamin A has
been decreased and to make up this deficiency in other
foods, than to court tuberculosis and dysentery by the
use of raw milk. It is probably Utopian to ever expect
that city children may receive, generally, clean raw milk.
The care of milch cows and the gathering of milk present
openings in our pubUc health armor that are best cared for
by pasteurization.
Mineral Salts as a Dietary Essential. — The mineral
salts occupy a very important place in the dietary. They
are not burned to produce heat, but they do help to build
tissue and in regulating body processes. They are to be
considered as a constituent of food of prime importance.
Thus Sherman,'' in speaking of "mineral metaboUsm" and
the functions of salts, says that they serve in three ways:
"(1) As bone constituents, giving rigidity and relative penna-
nence to the skeletal tissues.
"(2) As essential elements of the organic compounds which are
the chief solid constituents of the soft tissues (muscles,
blood-cells, etc.).
^Hess, A. F.: Newer Aspects of Some Nutritional Disorders,
Journal American Medical Association, March 12, 1921,
2 Sherman, H. C: Loo. cit., p. 236,
HYGIENE OF NUTRITION 171
"(3) As soluble salts (electrolytes) held in solution in the fluids
of the body, ^ving these fluids their characteristic influ-
ence upon the elasticity and irritability of muscle and
nerve, supplying^ the material for the acidity or alldlinity
of the digestive juices and other secretions, and yet main-
taining the neutrality or slight alkalescence of the internal
fluids as well as their osmotic pressure and solvent power."
Composition of the Body in Terms of its Elements. —
Sherman^ gives the elementary composition of the human
body as follows:
Per cent.
Oxygen, about 65
Carbon, about 18
Hydrogen, about 10
Nitrogen, about 3
Calcium, about 2
Phosphorus, about 1
Potassium, about 0.35
Sulphur, about 0.25
Sodium, about 0. 15
Chlorin, about 0. 15
Magnesium, about 0.05
Iron, about ^ 0.004
lodin ■
Fluorin
Silicon
Very minute
quantities
The Role of Mineral Salts in Food.— The presence or
absence of salts essential to body metabolism is an im-
portant matter. The correct understandiag of the possi-
bility of foods supplying these essentials wUi help to cor-
rect the rather prevalent notion that these valuable in-
gredients are only to be seciired by taking "patent med-
icines," extravagantly advertised and claiming unwar-
ranted values.
Carbon, hydrogen, and oxygen are always found in the
three food-stuffs, so that these elements are abundant.
Available nitrogen is found only in protein, and this ex-
plains why health caimot be maintained on a diet of only
carbohydrates and fats.
Sodium, potassium, and magnesium are supplied in
sufficient amounts in food without any care in the selection
for this purpose. The amoimt of sodium chlorid added to
'Sherman, H. C: Loc. cit., p. 234.
172 PERSONAL HYGIENE APPLIED
food is much more than sufficient for the body needs;
potassium and magnesium are fairly abundant in meat
(muscle) and in vegetables, so that an ordinary mixed
diet with some roughage will contain sufficient amounts
of these substances. Calcium, relatively large in the salt
content of the body, is quite irregularly distributed among
staple food articles. Milk, however, contains it in abun-
dance, and if sufficient milk is used this element will be
provided adequately. The calcium needs of the body
must be provided, especially in infancy and childhood and
during pregnancy. Lusk' emphasizes the importance of
calcium during pregnancy, especially during the last ten
weeks. Sherman,'' in speaking of the requirements, says,
"... It would seem that the food of a family should
furnish at least 0.67 gram of calcium or 0.9 to 1.0 gram
of calcium oxid per man per day." And later he' says,
"Apparently the American dietary is more often deficient
in calcium than in any other element; certainly more
attention should be paid to the choice of such foods as will
increase the calcium content of the dietary. The use of
more milk and vegetables with less meat and sugar will
accomplish this and usually improve the diet in other
directions as well." It is important at this point to re-
member that McCollum says that milk and leaf vegetables
will correct the dietary deficiencies of other foods in re-
spect to vitamins. The importance of milk as an article of
food is seen to be very great. The most practical means of
securing an adequate calcium supply is to use milk freely.
It is important to note that the "milling" of grain re-
moves a large amount of calcium. White flour, polished
rice, and new process commeal are very poor in calcium.
The fruits and vegetables are quite rich in calcium, es-
pecially prunes, oranges, carrots, and cabbage. The
sulphur content will be adequately provided if the protein
supply is sufficient. The sulphur needs are about 1 gram
• Lusk, G. : The Science of Nutrition, W. B. Saunders, 3d edition,
1919, pp. 389, 390.
2 Sherman, H. C: Loo. cit., p. 267.
• Ibid., p. 268.
HYGIENE OF NUTBITION 173
per day, and if about 100 grams of protein are used ade-
quate sulphur wiU be secured.
On the other hand, phosphorus may not be found in
sufficient amount in dietaries, and since, like calcium, it
represents an important part of the body structure, there
should be care to avoid a deficiency. Phosphorus is
present in the human body chiefly in bones, milk, brain,
nerve, and sexual tissue, and is essential in all body cells.
The phosphorus requirement is given by Sherman^ as
"1.44 grams (3.30 grams P2OB) corresponding to a 'protein
standard' of 75 grams." The evidence from many sources^
indicates that organic phosphorus compounds are of no
more value as food than are the inorganic phosphates.
This evidence is significant because of its bearing upon the
blatant claim of manufacturers who offer organic phos-
phates in patent medicines as "tonics, restorers, and
strengtheners." Food should be chosen that would provide
this necessary element. (See Table IV.^)
White flour is very poor as a source of phosphorus be-
cause miUing has removed the salt which is deposited in
the outer shell of the kernel.
The significance of an adequate phosphorus content of
the blood is very great in children and especially in the
first years of life. Occurrence of a depleted phosphorus
content in the blood of a young child ahnost always means
rickets.' The phosphorus content of our food supply
should not be treated lightly. The teaching of health
workers everywhere in educating parents to the full
meaning of proper food for the baby and growing child is
being constantly revised. It will be increasingly important
1 Shennan, H. C. : Loc. cit., p. 255.
' Forbes and Keith: Ohio Agricultural Experiment Station Tech-
nical Bulletin, No. 6, p. 357. McColIum, Halper and Drescher,
Journal Biological Chemistry 1912, p. 219. Marshall, Journal
American Medical Association 1915, p. 573. Sherman, Nettler, and
Sinclair, United States Department of Agriculture, Office Experiment
Station Bulletin 227, 1910.
'Rowland, J., and Kramer B.: American Journal Diseases of
Children, August, 1921. Jones, M. R., and Nye, L. L., Journal
Biological Chemistry, July, 1921. Von Meysenburg, L., and Mc-
.Cann, G. F., Journal Biological Chemistry, August, 1931.
174
PBBSONAL HYGIENE APPLIED
that it emphasize not only food values but also the quality
of the food consumed.
TABLE IV
Amounts op Phosphobus and Calcium in 100-Calobie Portions
OF Some Common Food Materials
Phos-
phoric
Calcium
Food material.
Measures of portion.
oxid,
grams.
grams.
Buttennilk
1| cups
0.61
0.415
Codfish, fresh
5 ounces (imcooked)
0.60
Celery
4 cups IJ-inch pieces
2i cups (cooked)
5 ounces (uncooked)
0.54
54
Spinach
0.54
0.37
Haddock, fresh, ..
0.50
Lettuce
2 large heads
0.47
Cauliflower
i medium head
0.45
0.55
Beef, lean
2-J ounces (uncooked)
0.42
0.009
Cheese, cottage. . .
5^ tablespoonfuls «
0.40
Asparagus
20 stalks
0.39
Cheese, hard
11-inch cube
0.329
0.25
Beans, dried
i cup (uncooked)
0.326
0.063
Milk
f cup
4 cups 1-inch pieces
303
239
Rhubarb
0.30
Turmps
2 cups i-inch cubes
2i cups 1-inch pieces
292
Beans, string
0.284
0.177
Cabbage
5 cups (shredded)
2 yolks
28
214
Egg yolk
0.27
Tomatoes
If cups (cooked)
2 tablespoonfuls (imcooked)
0.257
0.087
Peas, dried
0.25
Eggs
U eggs
3 to 4 medium
24
006
Onions
0.24
0.12
Peas, fresh
f cup
0.24
Oatmeal
1 cup (cooked)
^cup
21fi
no'i
Corn, green
0.21
Bread, graham. . .
2sUces
0.19
EAspberries
1| cups
1 me< ium
0.18
Potatoes ........
0.166
0.019
Peanuts
2 dozen singles
0.16
Carrots
3 to 4 medium
0.168
Blackberries
1| cups
0.13
Strawberries
1 j cups
0.13
Figs
U large
1 cup
0.089
0.083
Lemon juice
Beets
006
Peas, fresh
1 cup
0.032i
Raisms
i cup
4 to 5 prunes
02
Prunes
0.02
HYGIENE OF NUTRITION
175
Table IV, modified from Rose/ gives the amoimt of
calcium and phosphorus in 100-calorie portions of some
common food materials.
The iron content of the human body is small, but its
importance is very great. The loss of iron from the blood
results in a condition known as anemia, also chlorosis.
Sherman sets^ as the desirable standard "15 milligrams of
food iron per man per day." Woman during pregnancy
and at the menstrual period would require more, perhaps
about 18 milligrams. Table V, from Rose,' gives the
iron content in grams of food rich in iron:
TABLE V
Amounts of Iron in 100-Calorib Pobtions op Some Common
Food Materials
Food xnaterial.
Measures of portion.
lion, grams.
Spinach
2J cups (cooked)
21 cups 1-inch pieces
5 cups (shredded)
2i ounces (uncooked)
4 cups i-iuch pieces
2 yolks
If cups
i cup (uncooked)
Heggs
If cups (cooked)
3 to 4 medium
2 tablespoonfuls (uncooked)
1 medium
2 to 4 medium
2 cups |-inch cubes
2 slices
1 large bunch
3 to 4 medium
J cup
If large
1 cup cooked
4 to 5 prunes
tcup
2 slices
0.0133
Beans, string
0.0038
Cabbage
0.0035
Beef, lean
0.0032
Celery
0.0027
Eec volk
0.0023
0.0023
Beans, dried
0.0020
Ecffs
0.0019
0.0017
Carrots .
0.0016
0.0015
0.0015
Beets
0.0013
0.0013
Bread, sraham
0.0013
Grapes
0.0013
0.0011
I{,aigiiis
0.0010
Figs
0.0010
Oatmeal
0.0009
0.0009
Milk
0.00034
Bread, white
0.0003
> Rose, M.S.: Feeding the Family, The Macmillan Co., New York,
1919, pp. 22, 24, 25,
'Sherman, H. C: Loc. cit^j
'Rose, M. S.: Loc. cit., p. 23
290.
176 PERSONAL HYGIENE APPLIED
Sherman sets 15 milligrams of food iron per day as a
minimum. The above portions give the iron content in
grams. Fifteen milligrams expressed in grams would be
0.015 gram. It follows, therefore, that the minimum would
be satisfied by providing adequate portions of the above.
In order to supply suflScient iron foods should be selected
with some consideration of the amounts of iron present.
Iron is especially available in meat, milk, eggs, whole
wheat flour, spinach, and beans. A diet containing green
vegetables liberally, whole wheat bread, fruits, and some
meat wiU supply sufficient iron.
"Does man need medicinal iron?" has often been asked.
Numerous laboratory experiments extending since 1854
provides today the opinion that food will provide all that
is needed of iron compounds for the body. It has been
claimed that in anemia inorganic iron may act as a stim-
ulus to the body, but recent experiments by Whipple and
Robscheit* do not indicate any such effects. The best
medical opinion holds that hemoglobin (the iron compound
of the blood) is derived from the organic iron compounds
of the food. The justification for patent medicine prepara-
tions of iron is lacking; intelligent and rational procedure
in anemia and chlorosis^ would be to provide adequate
iron in the diet, to secure outdoor exercise, and remove
any of the causes favoring the disease. The eating of
highly "milled" flours and predigested and refined food
substances does not make for adequate iron metabohsm
in the body.
A recent addition to the "eat more" campaigns heralds
the value of raisins as purveyors of iron. It may be seri-
ously questioned if one should eat large amounts of raisins
because of the large amount of indigestible material they
contain. The claim for iron content is an exceedingly
brave one in view of the data in Table V. (See also Fig.
' Whipple, G. H., and Robscheit, F. S. : Iron and Arsenic as In-
fluencing Blood Regeneration, etc., Archives of Internal Medicine,
May, 1921, vol. 27, p. 591.
' There is some evidence that medicinal iron is useful in chlorosis.
But even here the management is more important than the medicine.
HYGIENE OF NUTRITION
177
18.) Thus H figs give as much and one medium-sized
potato gives more iron than i cup of raisins. For health
purposes 2| cups of milk or a half-dozen prunes would be
more desirable than raisins, no matter how attractive the
box in which they were sold.
FOOD-IRON
Do Not Be Misled by
the Clelme of High Iron
Content for Certain
Advertised Food Products.
Many Foods Contain Iron.
Compare the Proportionate
Amounts of Food-Iron in
the Edible Portion of
Some of the Commoner
Food-Stuffs.
Fig. 18. — This table is based on the ash constituents of toed in
percentage of the edible portion. (By courtesy of the American
Medical Association.)
The Mineral Salts and Body Reaction. — ^The blood and
body fluids show alkaUne to litmus, but the hydroxyl ions
are not appreciably in excess of the hydrogen ions, and
for practical purposes they may be called neutral. The
normal metabolic changes in growth and action produce
acids which must be neutralized in order to keep the blood
18
178 PERSONAL HYGIENE APPLIED
and body fluids in the proper condition. The source of
the power to develop neutrahty lies in the food of the diet
and especially in the carbonates, phosphates, anunonia,
and proteins. Sherman,^ in speaking of the experiments of
Blatherwick, says, ". . . foods which have a preponder-
ance of base-forming elements lead to the formation of a
urine which is less acid, both as regards hydrogen ion
concentration and titration acidity, while the ammonia
content of the mine is diminished and the carbon dioxid
tension of the alveolar air, indicative of reserve alkaUnity,
is increased."
The foods containing base-forming elements are chiefly
milk, vegetables, and fruits. It has been previously noted
that these foods are also valuable, especiaUy for their
salts of calcium and iron, and for their vitamins.
The Hygiene of Nutrition. — ^By voluntary act it is
quite impossible to control intestinal peristalsis, to direct
the flow of bile, or to favor the absorption of digested food
elements from the alimentary canal. The hygiene of
nutrition, however, is not dependent upon such control.
All that is essential in the nourishment of the body and in
the economy of processes relates to factors that are con-
trollable. They may be stated to be: to choose food
wisely; to eat correctly, and to evacuate regularly.
Wise Choice of Food. — Choosing food wisely involves a
knowledge of the fimctions of food, its power to build
tissue, to yield energy, and to regulate body processes.
In addition, food values in terms of calories and with
reference to man's needs, food digestibility, and food
poisons are important matters to consider in the choice of
food. The functions of food have been presented. There
remain the caloric values and the body's need, food digesti-
biUty, and idiosyncrasies of people toward different foods.
(o) Food Values and Body Needs. — Lusk^ says, "One
can say that in the United States there is no protein, or
'Sherman, H. C: Ijoc. cit., p. 281.
' Lusk, G. : Journal American Medical Association, June 22, 1915,
p. 171.
HYGIENE OF NUTRITION
179
salt, or vitamin deficiency in the habitual diet, and there
is plenty of roughage in the form of cabbage, sauerkraut,
and other vegetable foods available to him who desires it."
Sherman,* however, in analyzing 150 American dietaries,
says with reference to the iron content, "Apparently,
therefore, the typical American dietary does not contain
any such surplus of iron as would justify the practice of
leaving the supply of this element entirely to chance."
Experts differ on these points. The rational procedure
in such a situation is for the individual with adequate
knowledge to make sure that the best available is selected.
This means frequently not eating more food, but choosing
wisely less food. For although the past tendency has been
to set standards for diets, it should be noted that it is
quite impossible to plan a single diet that will be adequate
for all. At best certain principles may be stated:
The protein and energy factors of the diet should be
modified in accordance with the needs of the organism as
regards growth, work, and body weight. Thus Atwater^
recommends:
standards for
Protan,
grams.
Fuel values,
calories.
Man at hard muscular work
150
125
100
90
4150
Man at moderately active muscular work . .
Man at sedentary or woman with moderately
active work
3400
2700
Man without muscular exercise or woman
■ at light moderate work
2460
While European experts place the protein requirement
higher, the tendency of chemists in America has been to
constantly set a lower standard. Chittenden' in particular
has set the standard much lower, and holds that 50 grams
a day is sufficient for body needs. From a survey of
' Sherman, H. C. : Loc. cit., p. 303.
^Atwater: United States Depa
Bulletin No. 142, 15tb Annual Report Agricultural Experiment
^Atwater: United States Department of Agriculture, .Farmers
Station, Storrs, Connecticut, 1903.
" Chittenden: Physiological Economy in Nutrition, pp. 61, 127,
180 PERSONAL HYGIENE APPLIED
nximerous experiments Sherman' reports, "the apparent
protein requirements as indicated by the data of individual
experiments ranges between the extremes of 20 and 79.2
grams, averaging 49.2 grams of protein per man of 70
kilograms per day. Thus the average falls well within the
range of Chittenden's estimate" (see Lusk's report on
German diets, p. 163). Shermatf found that nitrogen
equiUbrium was maintained with protein of 35 to 45 grams
from cereal grains. Providing a margin of safety, 70 to
80 grams of protein would seem adequate.
The energy requirements are related to the work of the
body. To maintain the body weight the fuel value of the
food must be sufficient for the needs of the body. If fat
is deposited, more fuel has been taken in than can be
burned ; hence the excess is stored. Fuel value of children's
dietaries should always be liberal to proAride for great
muscular activity and marked growth. Sherman' gives
the energy requirements of different ages as follows:
Under 1 year 45 calories per pound (about 900 calories)
1- 2 years 45-40 calories per pound (about 1000-1100 calories)
2- S years 40-36 calories per pound (about 1100-1500 calories)
6- 9 years 36-32 calories per pound (about 1600-1900 calories)
10-13 years 34r-27 calories per pound (about 2000-2700 calories)
14-17 years 30-32 calories per pound (about 2500-3400 calories)
18-25 years 25-18 calories per pound (about 3400-3800 calories)
30 years 2750 calories for man of 152 pounds
40 years 2500 calories for man of 154 pounds
60 years 2300 calories for man of 150 pounds
70 years 2000 calories for man of 134 pounds
80 years 1750 calories for man of 139 pounds
The above figures indicate that during the period of
growth a great increase in fuel is necessary; that a young
person, fourteen to seventeen years, may need more fuel
than one thirty years of age; and that as age increases the
fuel requirement decreases. Age is not a valuable in-
dication alone. Work done with reference to age is the
best guide. The "man of the house" living a sedentary
' Sherman, H. C: Loc. cit., p. 220.
' Sherman, H. C. : Proceedmgs National Academy of Sciences,
January, 1920, pp. 38-40.
' Sherman, H. C. : Loc. cit., p. 196.
HYGIENK OT NUTRITION
181
life may require less than the young boy only twelve years
of age.
It will thus be seen that while it is possible to calculate
from tables the caloric value of the diet for different in-
dividuals, it is unsafe to set absolute standards. In addi-
tion to caloric needs the child should correspond in weight
with the members of the age-height group in which he
falls; the adult needs to adjust diet to weight and also
to work. The danger of the child being malnourished and
of the adult being too well nourished is so important that
tables (Table VI) are given to indicate what the weight
should be for different individuals.
(fe) Food Digestibility. — It is not possible to be guided in
the choice of food only by the caloric yield any more than
by its salt or vitamin content. All the factors are im-
portant. Thus certain foods are easy and others difficult
to digest; while for some persons foods may be entirely
unsuited, and to others entirely unwholesome. This
problem of feeding the human being is one that requires
care, attention, and reasonable intelligence.
The digestibility of foods has been expressed in terms of
coefficients of digestibility, by which is indicated the per-
centage of the food available for men as determined by
the relation between the constituents of the food con-
siuned and the corresponding constituent of the waste
material from the alimentary tract. Atwater has com-
puted the coefficients of digestibiUty of the main classes of
food on a simple mixed diet as follows:
Percentage Digestibility
OP Food
Food.
Protein,
per cent.
Fat.
per cent.
Carbohy-
drates,
per cent.
Animal foods
97
85
78
83
85
92
95
90
90
90
90
95
98
Cereals and breadstuffs
Dried legumes
98
97
Vegetables
95
Fruits
90
Total of average mixed diet. . . .
98
TABLE VI
HEIGHT AND WEIGHT TABLES
BOYS
Height
5
«
7
S
9
to
11
12
13
14
15
16
17
IS
Inchra
Yre
Yre
Yta
Yre
Yre
Yre
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
39
3B
36
37
40
37
38
39
41
39
40
41
42
41
42
43
44
43
43
44
46
46
44
45
46
46
47
45
47
47
48
48
49
46
48
49
BO
60
51
47
51
62
52
S3
64
48
63
M
66
65
56
67
49
S5
66
67
68
58
69
SO
58
60
62
69
61
63
6U
62
64
60
63
66
61
64
67
62
65
68
51
62
63
66
69
67
70
73
.77
68
71
74
78
81
84
87
91
69
72
75
79
82
86
88
92
70
73
76
80
83
86
89
93
71
74
77
81
84
87
90
94
78
82
85
88
92
97
86
90
91
99
91
96
101
97
102
64
55
56
67
68
69
60
61
95
100
105
97
102
107
113
99.
104
109
116
102
.106
111
117
104
109
114
118
106
111
115
119
108
113
117
120
110
62
116
119
63
64
122
65
120
125
130
134
138
122
126
131
136
139
142
\tl
123
127
132
136
140
144
149
154
124
128
133
137
141
145
160
165
126
129
134
138
142
146
161
166
126
66
130
67
135
68
130
69
143
70
147
71
152
72
167.
MEN
19
20
21-22
23^24
26-29
30-34
36-39
40-44
4649
60.54'
55-69
Height
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yre.
Yw.
6 ft
107
112
110
116
114
118
118
121
122
124
126
128
.128
130
131
1.33
133
136
134
136
13S
6H. lin...,.
137
6tt. 2in
117
120
122
124
126
130
132
136
137
138
139
6ft. Sin
121
124
126
128
129
133
136
138
140
141
142
6 ft. 4 in
124
127
129
131
133
136
188
141
143
144
146
6 ft. 5 in
128
130
132
134
137
140
142
146
147
148
149
6ft. 6in
133
133
136
138
141
144
146
149
161
162
163
6tt. 7itt
136
137
140
142
145
148
160
l.W
155
156
158
6ft. Sin
140
141
143
146
149
162
166
168
160
161
16it
5ft. 9in
U4
146
147
160
163
16ft
160
163
165
166
IBS
6ft. 10 in
148
149
161
164
167
161
166
168
170
171
173
6ft.llin
163
164
156
159
173
166
170
174
176
177
178
Oft
168
163
160
165
162
167
166
170
172
178
176
182
180
. 186
182
188
183
190
184
6ft. lin
19)
6ft. 2 n
168
170
173
176
179
184
189
193
196
107
198
61t. 3in
173
176
178
181
184
190
196
200
202
3M
m
6 ft. 4 n
178
180
183
186
189
196
201
206
209
211
Hi.
6ft. 6in
183
186
188-
191
194
201
207
212
21S
217
To determine the weight for a given height and age, trace the
height line to the proper age column. (By courtesy of Dr. Thomas D.
Wood.)
182
TABLE VI
HEIGHT AND WEIGHT TABLES
GIRLS
Hms-ht
Inches
6
Yra
6
Yre
7
Yra
8
Yra
9
Yra
10
Yra
11
Yra.
12
Yra.
IS
Yra.
14
Yrs.
15
Yra.
16
Yra.
17
Yra.
18
Yra.
39
40
41
42
43
44
45
46
47
48
49
SO
34
3S
38
40
42
44
46
48
35
37
39
41
42
45
47
48
49
51
53
36
38
40
42
-43
45
47
49
50
52
54
66
59
62
43
44
46
48
50
51
53
55
57
60
63
66
68
49
SI
52
54
56
58
61
64
67
69
72
76
53
55
57
69
62
65
68
70
73
77
81
85
89
56
58
60
63
66
68
71
74
78
82
86
90
94
99
104
109
61
64
67
69
72
7S
79
83
87
91
95
101
106
111
115
117
119
70
73
76
80
84
88
93
97
102
107
112
117
119
121
124
m
129
77
81
86
89
94
99
104
109
113
118
120
122
126
128
131
134
138
86
90
95
100
106
111
115
119
122
124
127
130
133
136
140
145
91
96
102
108
113
117
120
123
126
128
132
135
138
142
147
98
104
109
114
118
121
124
127
129
133
136
139
143
148
51
52
53
54
65
56
57
53
59
60
106
61
111
62
lis
63
119
64
122
65
in
66
128
67
130
63
134
69
137
70
140
71
144
72
149
WOMEN
19
20
21-22
23-24
25-29
30*1
35-39
4(M4
45-49
50^
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
Yra.
4ft. lOin
98
102
108
110
113
116
119
123
126
129
4ft.- 11 in
103
107
109
112
115
118
121
126
128
131
6ft
109
113
112
115
113
110
lis
118
117
119.
121
12U
122
123
125
127
129
130
132
133
136
6ft. lin
6ft. 2in
116
IIR
119
120
124
127
132
J35
138
6ft. 3in
120
121
122
\n
124
127
130
136
138
141
5ft. 4m
123
124
125
126
128
131
134
138
141
144
8.ft. 5ui
126
127
128
129
131
IM
VM
142
145
148
...:..
6ft. 6m
129
1,10
131
133
136
138
142
146
149
152
6ft. 7m
131
133
135
137
139
142
146
150
153
166
6ft. Sin
135
137
139
141
143
146
150
154
157
161
6ft. 9m
13«
14(1
142
145
147
15U
154
158
161
165
6ft. 10 in
141
143
145
148
151
154
157
161
161
169
6ft.llin
145
147
149
151
164
1,M
160
164
168
173
.^
6(t ,
190
152
154
156
158
161
163
167
171
176
To determine the weight for a given height and age, trace the
height line to the proper age column. (By courtesy of Dr. Thomas D.
Wood.)
183
184 PERSONAL HTGIENE APPLIED
Digestibility of food should not be confused with ease
of digestion nor rapidity of digestion. Food that stays a
long time in the stomach is said to be difficult of digestion,
but this refers only to rate of digestion and not to the
yield of the food elements finally. There seems to be
little relation between ease or rapidity of digestion and
the percentage or coefficient of digestibility of food. There
is a difference, however, in foods as regards the length of
time given to gastric digestion. Sherman* states the
following concerning the movement of food materials
through the stomach:
"Ordinarily, when each is fed separately, protein food
stays longer in the stomach than carbohydrate, fat longer
than protein, and mixtures of fat and protein leave the
stomach more slowly than either alone. This is probably
because fat tends to retard both the motility of the stomach
and the secretion of the acid gastric juice. In general, the
softer or more fluid the fat, the more rapidly it will leave
the stomach; also emulsified fats tend to pass on more
promptly than fat of the same kind taken in larger masses."
Hawk^ and his associates have conducted a series of ex-
periments on gastric digestion. Some of the conclusions of
this work are given below:
Whole boiled, creamed, mashed (with and without milk
and butter), baked (with and without butter), potato
salad, French, German and plain fried potatoes, and
potato chips "left the stomach in moderate time or one
and a half to two and a half hours for rapid type individuals
and two to three and a half hours for the slow type.
Fried potatoes left the stomach as rapidly as potatoes
prepared in other ways. Sweet potatoes remained longer
in the stomach than white potatoes cooked in the same
ways."
Pickled red beets left the stomach more rapidly than
' Sherman, H. C. : Loc. cit., p. 87.
= Hawk, P. B., and associates: The Gastric Response to Foods,
American Journal of Physiology, vol. 51, No. 2, March 1, 1920, pp.
332-349,
HYGIENE OF NUTRITION 185
boiled red beets, although the latter left in one to two
hours. Carrots, parsnips, and turnips, boiled, left the
stomach in one and a half to three hours.
"In general, raw vegetables low in protein, as carrots,
celery, tomatoes, cabbage, lettuce, and cucumber, leave
the stomach rapidly — ^and without great change."
In studying the effect of water, tea, coffee, and cocoa
upon digestion in the stomach the following conclusions
were made by Hawk^ and his associates:
"Evacuation of the stomach was not appreciably de-
layed by the drinking of 1 Uter of cold water, cold or hot
tea, hot coffee, either plain, with cream, or cream and
sugar. The addition of sugar alone to coffee delayed
evacuation.
"Cocoa in 1 liter quantities markedly delayed evacu-
ation."
Results from the study' of candies show: "Candies
depress secretion and delay evacuation in proportion to
their sugar content and the amount of them ingested.
This tendency is influenced, however, by flavoring sub-
stances, and particularly by added food ingredients, such
as milk, eggs, or chocolate, which stimulate gastric se-
cretion. "Candies should be eaten not before but after
meals. Hard candies which must be sucked are prefer-
able to cream candies for children."
A study of the digestion in the stomach of puddings,
pies, and cakes gives an average time for puddings of two
hours; pies, two hours and twenty-four minutes; cakes,
three hours. Pies were digested more rapidly than cakes.
"The addition of 50 grams of ice-cream to a small piece of
pie did not increase the burden of the stomach to any
marked extent."
(c) Food Poisons. — Food that is for others entirely
'Hawk, P. B., and associates: Gastric Kesponse to Foods,
American Journal of Physiology, vol. 52, No. 1, May, 1920, pp..
28-53
>Ibid., vol. 53, No. 1, August, 1921, pp. 65-88,
186 PERSONAL HYGIENE APPLIED
wholesome becomes for some persons a distinct poison.
That means that those persons have an idiosyncrasy for
that particular food. Many people develop fads and fears
as regards certain foods, but a real food idiosyncrasy may
exist. Such reaction to food is called sensitization.
Sensitization to certain proteins is the most usual form
observed.
It is not so easy to explain the way in which sensitiza-
tion to food occurs, but the fact of being sensitive is well
known.^ Supposedly, the child is given too much of a
new food, which he has not as yet developed a capacity
to handle. There results a susceptibility which renders
the individual unable to care for that kind of food sub-
sequently. The phenomenon of sensitization is also
known to exist in certain disturbances of the respiratory
tract, e. g., certain forms of hay-fever are known to be
related to definite flower or vegetable proteins.
In medicine it is known that foreign proteins injected
into the blood may render the individual very sensitive
to the particular protein injected. This sometimes occurs
in the administration of antitoxin.
Correct Eating. — The eating of food has become today
a complex matter. It is not sufficient to provide for
proper energy needs, vitamins, and salts; to eat in such
fashion that digestion will be as thorough, rapid, and
orderly as possible is very desirable. It is, therefore, im-
portant to note those conditions that are associated with
the hygiene of eating.
1. Environment.
The quiet, clean, attractive dining place is a boon
to good eating. To avoid noisy, dirty places should
be the first thought in selecting a place to eat. The
dining-room should tend to produce repose, quiet,
freedom from hurry and rush. It is an expression of
an overwrought nervous system to desire an eating
place where the din of jazz rhythms vies with the
' Longcope, W. T. : Protein Hypersensitiveness, Journal American
Medical Association, November 12, 1921, p. 1535.
HYGIENE OF NUTRITION 187
screeching voices to be heard above the rattle and
crashing of dishes and cabaret singers. Digestion is
aided by an atmosphere of quiet and cahn.
In a study of the psychic influences on digestion of
food, Hawk* and his associates found as follows:
"Mixed meals consisting of nourishing ingredients,
but very unpleasantly prepared and served, gave
rise in the case of a phlegmatic individual to no
distinct delay, ... a more susceptible individual
showed a shght delay.
"Chinese preserved eggs, unpalatable to our sub-
jects in appearance, odor, taste, and belief in their
unwholesome character led to delayed acid response
and evacuation."
2. Condition of the individual.
One should come to the table rested. If fatiguing
work has been performed before mealtime, the
hygienic plan would provide a period of rest before
eating.
Moreover, the mind and spirits of the individual
should be cheerful and happy. Hawk reports that
anxiety and mental strain markedly delay gastric
digestion. The importance of avoiding emotional
states associated with worry is nowhere more pro-
nounced than in connection with this subject. If de-
pressing emotional conditions do control, it is best not
to eat at that time. One should replace such states
with a brave, cheerful attitude and the digestive
tract will be ready to do its work. Nervous in-
digestion is a sympton of bad mental hygiene.
3. The technic of eating.
If one comes to a dining-room that is quiet and
attractive, and is himself free from fatigue and from
depressing emotional states, one might eat almost
any food in usual amounts, either rapidly or slowly,
'Hawk, P. B., and associates: Gastric Response to Foods,
American Journal of Physiology, vol. 52, No. 1, May, 1920, pp.
1-11.
188 PERSONAL KYOIENE APPLIED
without experiencing any difficulty in digestion. All
may not be so indiscreet, however. Nor is it wise
for any one to so indulge his gastronomic instincts.
Reason must guide here. The secret in eating then,
is:
1. To eat slowly. It has been claimed that we should
chew each morsel of food thirty times. It is
surely a waste of energy to count our jaw move-
ments and unwise to concentrate our attention
too much on the process of eating. Food should
be enjoyed. The environment free from rush
and hurry will help us automatically to chew
food more — ^to eat slowly.
2. Not to wash food down the esophagus with drink.
If the food is well chewed this will not be neces-
sary. It is not unhygienic to drink water at
mealtimes if no food is in the mouth at the
time of drinking. Ice-water should not be
used. Milk that is cold should be drunk very
slowly.
Hawk found that cold water did not appreci-
ably delay digestion if taken during the meal.
The practice of drinking cold water at the be-
ginning is to be condemned. Many people
coming to the table hungry and thirsty commit
a hygienic sin here. The blood-vessels of the
stomach are dilated and the blood-supply is
abundant; the gastric glands are exceedingly
active in preparation for the food about to be
eaten — when suddenly a dash of cold water is
thrown into the stomach, constricting the
vessels and checking secretion. One should
always eat some warm food before drinking
cold water at meals.
3. Do not overeat. To stop before completely satis-
fied is good dietary advice. This means often
foregoing the attractive dessert, or omitting the
second helping of the favorite dish. A good
HYGIENE OF NUTBITION 189
plan is to take very small helpings. Eating
slowly will help to eat less; one is satisfied with
less when that taken is chewed thoroughly.
Regular Evacuation. — The hygiene of nutrition has been
grouped around the wise choice of food, correct eating,
and regular evacuation of the bowels, because all these
factors are closely related. The best food correctly eaten
will not nourish if waste material is not removed. Here
is indicated the essential interdependence between all
parts of the body. No one part can live to itseK alone.
All must function properly. Loss of efficiency in one
part affects all. More will be said upon this subject in
Chapter X; it is enough at this time to indicate its im-
portance and connection.
Causes of Indigestion. — Frequently indigestion occurs
because food is improperly cooked, but, as indicated
above, there are other factors. These may be grouped
together as the causes of indigestion:
1. Improper foods. This may refer to the choice of the
food or to the combination chosen.
2. Improper cooking of the food. Food to be cooked
should be cooked thoroughly, especially vegetables,
breads, and pastries.
3. Food idiosyncrasies. Examples are oysters, shell-
fish, fish, buckwheat cakes, strawberries, and
chocolate.
4. Physical fatigue. If tired, one should rest before
eating or eat very hghtly (better not eat at aU).
5. Worry and depressing emotional states.
6. Rapid eating. Important to avoid places that are
noisy. Freedom from a sense of hurry is essential
to correct eating.
7. Drinking cold water before eating warm food at
mealtime.
8. Overeating. Large amounts of food may affect only
slightly the coefficient of digestibility, but they do
retard the ease and rapidity of digestion. Snyder
found, however, that protein was 7 per cent, and
190 PERSONAL HYGIENE APPLIED
fat 6 per cent, more completely absorbed in
medium amounts of oatmeal and milk when he
compared medium and large amoimts of this
ration.
9. Constipation. Lack of evacuation of the bowels is
frequently a cause of improper digestion of food.
10. Defective teeth. This cause may act by not per-
mitting thorough mastication; it also may be
effective through the disturbance of the condition
of the stomach due to the presence of pus material
from the teeth.'
11. Various diseases. Indigestion may be a sign of ap^
pendicitis. When the indigestion is prolonged it
may be a sign of gastric ulcer, and in an elderly
person, of cancer of the stomach.
Fads and Fallacies in Diet. — The individual who chooses
food thoughtfully and on a logical plan needs all the facts
available. Most food fads represent partial truths. They
are so usual and commonplace that to account for their
occurrence would be to write the story of human super-
stition. Several of the most common will be discussed.
Vegetarianism. — ^At times extremists of this fad take a
position of protest against the eating of animal flesh
because of a philosophy that is opposed to the taking of
animal life. In this position they may be accused of
sentimentaUsm or what you will, but essentially the one
defect of these people on this question is that they are not
intellectually honest. If honest they would have to hve
upon air alone. They are entirely wiUing to eat plants
which have Ufe. If their philosophic and biologic educa-
tion were as comprehensive as their sophistry they would
appreciate the common origin of plant and animal hfe,
and the essential integrity of the I'elan vital of Bergson, in
both animals and plants. However, they must Uve, and
since they are not philosophic, nor intellectually honest,
'It has not been determined whether the gastric disturbance
results from the swallowing of pus or from infection through tiie
circulation, or from both.
HYGIENE OF NUTRITION 191
they continue to choose eggs, milk, and cheese to supple-
ment their vegetarian diet of nuts, cereals, and vegetables.
Those who take the vegetarian r6le because of a belief
in the superior value of a non-meat diet have many argu-
ments that are interesting and worth investigating. Some
members of this group object to eating lamb, beef, or
pork because they believe that such foods are not whole-
some. Some say that all animals are diseased, that many
sick animals are killed for food, that serious disease often
follows eating animal food. These are partial statements
and are untrue. Some flesh is unwholesome (e. g., trichinosis
is a serious disease at times) ; meat inspection should rule
out the killing of sick animals just as it should eliminate
rotten fruit and vegetables from the markets. In general,
it is effective.
The question of the relative superiority of animal or
vegetable protein needs scientific information. The follow-
ing facts have been established by investigators and ex-
perience:
1. The protein of animal food is more completely util-
ized by the body than the protein of fruits, vege-
tables, dried legumes, cereals, or breadstuffs. The
coefl&cient of digestibility for animal food is 97
per cent.; for the vegetarian group it varies from
78 to 85 per cent. This difference is 12 to 19 per
cent. If one requires 100 grams of protein daily,
it is necessary to eat from 112 to 119 grams of
vegetarian protein to secure the same amount
that is available from 100 grams of animal food.
2. The body needs animal protein. This may be largely
supplied from milk and eggs.
3. The superior palatabiUty of meat proteins is generally
recognized.
4. Racial superiority may be definitely related to food
habits. It may be suggested that this has some
influence in the development to dominant positions
in the world of those races that are meat eating
as contrasted with the vegetarian groups. Sher-
192 PEHSONAL HYGlE>fE APPLIED
man, however, refers to these races as "not meat-
eating but cow-keeping races."
5. It should be noted, however, that it is a mistake to
eat too much meat. The limit is to be placed at
"meat once a day only." Excessive eating of
meat leaves a waste of protein that is not only
economically bad but also imdesirable because of
the strain upon kidneys^ which must remove the
end-products of protein metabolism. The purins
are more abundant in meat.
6. Pork is the least desirable of all meat. It is difficult
to digest. It should always be thoroughly cooked
to kill the trichina, if perchance the parasite is
present. Beef is valuable for its iron content as
well as protein. Lamb is tasty and easily digested.
Fowl and fish are very desirable forms of flesh
food. Lobster and scallops are quite difficult to
digest because of the toughness of the muscle.
There are probably few strict vegetarians. In reality,
those who pose as such are "no meat" advocates. They
eat animal foods, such as milk, cheese, and butter; other-
wise they could not stay well.
Hot Water Fad. — This fad is especially vicious. Hot
water before breakfast is helpful as a therapeutic measure
for some persons, but its general use for all is not in-
dicated. The ease with which people accept vague but
rather plausible proposals for water therapy speaks
vehemently of the sort of instruction given in physiology
in the schools. Internal bathing by a patented cascade,
hot water before meals, "water internally, externally, and
eternally" — ^these are but catch phrases of a fad that is
unscientific and pernicious.
Raw Food Fad. — The raw food fad has some justifica-
tion in proportion as it represents a reaction against bad
cooking. Improperly cooked vegetables are more difiicult
' Recent evidence of the influence of high protein diet on kidney
irritation is given by Squier, T. L., and Newburgh, L. H.: Renal
Irritation in Man from High Protein Diet, Archives of Internal
Medicine, July, 1921.
HYGIENE OP NUTRITION 193
to digest than raw vegetables because the stomach will
attempt to digest the former, but ignores and passes on
the latter. As a fad it is without scientific basis.
It has been generally held that fried foods are difficult
to digest, but Hawk found no appreciable difference in
time for digestion of fried potatoes as compared with
potatoes cooked in other ways. In general, fat stays a
long time in the stomach. If the food is fried in deep fat
or prevented by other methods from taking up much fat,
fried food is just as wholesome as other kinds.
There is a real health danger, especially from typhoid
fever, in eating certain uncooked foods (e. g., lettuce,
celery, and water-cress) that have been grown in soil
contaminated with sewage. Such uncooked food should
be washed carefully in many changes of water, because
the source is not usually known.
No-breakfast Fad. — It is not uncommon to find young
people, especially girls, developing the no-breakfast fad.
It should be stated that the body needs food in the morn-
ing to draw on for energy used in the day's activities.
The body needs are often cared for by these individuals in
two large meals. This is unwholesome, and it is more
desirable to distribute food eaten over three meals rather
than two. These individuals often show an aversion to
milk and eggs. It should be remembered that they may
like custards, creamed soups, oyster milk stews, eggnogs,
and other food dishes in which milk and eggs are used.
An egg is an egg, whether in a custard or in the chicken
house; it will serve the nutritive needs of the body, so far
as we know, as well in custard form as it will when boiled,
or poached, or scrambled. The same can be said for milk.
Sour Milk Fad. — The use of sour milk as a food was very
popular some years ago due to the values assigned by
Metchnikoff* to the change of the bacterial flora of the
intestine produced by sour milk. This procedure has been
very useful in the treatment of certain cases of intestinal
'Metchnikoff, E.: The Prolongation of Life, G. P. Putnam's
Sons, New York, 1908.
13
194 PERSONAL HYGIENE APPLIED
intoxication, but as a guide for the normal person it offers
nothing. Sour milk as a food is useful because it has the
same constituents as sweet milk.
Food Adulteration.— Before the passage of the Pure
Food and Drug Act about 50 per cent, of the food sold in
the United States was adulterated. The act defines
adulteration to be:
1. If any substance has been packed or mixed with it to
reduce or lower or injuriously affect its quaUty or
strength.
2. If any substance has been substituted wholly or in
part for the article.
3. If any valuable constituent of the article has been
wholly or in part abstracted.
4. If it is mixed, colored, powdered, coated, or stained in
any manner whereby damage or inferiority is con-
cealed.
5. If it contains any poisonous or other added dele-
terious ingredient which may render such article
injurious to health.
6. If it consists in whole or in part of a filthy, decom-
posed, or putrid animal or vegetable substance or
any portion of an animal unfit for food, whether
manufactured or not, or if it is the product of a
diseased animal or one that has died otherwise
than by slaughter.
The purpose of this act in terms of the definition of
adulteration is to protect the public in two ways:
1. To insitte the delivery of the article labeled. Thus,
an article labeled honey should contain honey and
not glucose, a common adulterant.
2. To prevent the use of deleterious substances. Thus,
it is important that bacteria or parasites be absent
and that injurious drugs have not been used to
cover up decomposition.
It is important to note the purpose of this act and help
in carrying out its provisions. Two points should be kept
in mind:
HYGIENE OP NUTBITION
195
1. Labels are frequently used which enable the manu-
facturer to be within the law, although in spirit he
is frankly violating it.
nMOUM^VEGEIULE
COMPOUND
THE ALCOHOl.
^IN THIB
FLASK OF
WHISKEY
1905
1910
1917
Before there was a National Food and Drugs Act
this nostrum was soid as a " Sure Cure for Fall-
ing of the Womb " and the " Greatest Remedy
In the World for All Diseases of the Kidneys".
No mention was made of the presence of alcoholl
Rg. 19. — ^Note the legal education of the above firm between
1905 and 1917, as evidenced by the labels. (By courtesy of the
American Medical Association.)
(a) Most patent medicines depend for their
success upon the presence of alcohol in
the mixture. The amount of alcohol
present must be stated, and it is — in
small letters in an inconspicuous place
(Fig. 19).
196
PEESONAL HYGIENE APPLIED
(b) Jellies, jams, and catsups are frequently
adulterated and the adulterant indicated
in small type. For the first two it is
usually glucose; for the last, benzoate of
soda.
2. It is not necessary to use chemicals to preserve or can
fresh wholesome food. Food, therefore, that has
been treated, indicates that the food was not in a
fresh state. We do not know whether the minute
amount of the chemical used is injurious or not,
but we do know that food in need of a preservative
is not wholesome food.
The following table, arranged from Broadhurst's' tab-
ulation, gives the common adulteration in foods:
Food substances.
Adulterant.
Remarks.
Candy-
Clay or "terra alba"
Cheese
Lard, bean meal, po-
tato, bread
Chocolate
Cocoa butter sub-
tracted
Cocoa
Starch, clay, brick
dust
Cocoa or chocolate
Cocoa shells
Coffee
Cereals, acorns, date
pits, red slate
Coffee (specials)
Caffein extracted
Condensed milk
Cane-sugar added to
Less suitable for in-
replace fats sub-
fants.
tracted
Cream
Gelatin
Figs
Worms and their
wastes
Flour
Talc, gypsum, alum.
Poisonous nitrogen
nitrogen peroxid
compounds do not
prevent passing as
%rst grade."
Gum-drops
ParaflSn
Honey
Glucose with pollen
Pollen is found in bee-
collected honey.
Jellies
Turnips, squash
Meat
Chemicals, such as
To bring back red color
saltpeter
to prevent caking.
'Broadhurst, J.: Personal and Community Hygiene,
Lippincott Co., Philadelphia, 1918, pp. 34, 35.
J. B.
HY6iENB OF NtlTBlfloN
m
Food substances.
Meat extracts
MUk
Milk (whole)
Molasses
Nuts and fruit
Oleomargarin
Olive oil
Oysters
Peas (green)
Salt (table)
Sausage
Sugar (cane)
Sugar (maple)
Tea
Adulteranl.
Plant extracts
Formaldehyd
Skimmed milk
Glucose
Whitened by sulphur
fumes
Coloring
Com oil, cottonseed oil
Fattened in water con-
taining sewage
Colored by copper sul-
phate
Starch
Cereals
Saccharin
Glucose
Once-used tea leaves
Remarks.
Though cheaper, some
plant extracts (i. «.,
yeast) add valuable
vitamins, yet they
are considered adul-
terants unless prop-
erly labeled.
To defer souring.
Lightens colors to
higher grade ap-
pearance.
Injurious sulphur com-
pounds retained by
fruits and kernels.
Sold as butter. Very
wholesome. Legal
restrictions now tend
to keep up the price
of both butter and
its substitutes.
A coal-tar product.
Sweet, but lacking in
food value.
Alcohol, a distinct protoplasmic poison, has been de-
fended in recent years because of its food value. There is
little educational propaganda today on the food or health
values of alcohol — such were shattered long ago. The
advocates of the use of alcohol have based their claims
not on scientific truths, but rather on pohtical "rights."
Personal liberty has been invoked as the shibboleth of
bootleggers, brewers, distillers, and aU those who make
money out of the trade. The old selfish reasons are again
presented, whereas the Prohibition amendment was passed
not to save man from himself, but to protect society. In
the same way and after the same fashion that cocain,
198 PEHSONAL HYGIENE APPLIED
opium, morphin, and other narcotics are controlled, so
alcohol has capitulated to an ideal of social responsibility.
This ideal is to be kept alive and intelligent by constant
contact with the scientific facts, so that it may always be
an intelligent idealism. To present these facts, even in
condensed form, is important.
Alcohol and Length of Life. — ^Evidence from insurance
and benevolent associations accumulates to the effect that
the steady use of alcohol increases mortality. This is true
for even moderate users. The "light wines and beer"
advocates are without scientific and statistical evidence to
support their plea of "harmlessness." Steady but mod-
erate drinkers show a group mortality of 86 per cent, in
excess of the average.*
Alcohol and Efficiency. — Experimental evidence of
scientific and acceptable kinds shows that alcohol tem-
porarily impairs memory, temporarily decreases the
efficiency of workers, and resistance to disease. It has
marked effect on bodily functions. This is especially to
be noted in the circulatory and nervous systems. It
increases the pulse-rate, but not the force of the heart,
and, actiQg as a depressant, which it really is, it lowers
blood-pressure. The classical work by Dodge and Bene-
dict* shows the impairment of neuromuscular acts and
gives the scientific background for the experience of em-
ployers as to its cause of accidents in industry.
The experiments of Stockhard' add a further indictment
of its use as a beverage. They show an injury of male
germ cells by alcohol to such a degree that offspring are
distinctly impaired. In this instance also the laboratory
has brought support to the opinion of numerous social
'Fisher, I., and Fisk, E. L.: How to Live, Funk and Wagnalls,
1921, p. 307. An extensive bibliography on alcohol is given in this
book, pp. 333-338.
2 Dodge, R., and Benedict, P. G.: The Psychological Effects of
Alcohol, The Carnegie Institution of Washington, 1916.
' Stockhard, C. R. : The Effect on the Offspring of Intoxicating
the Male Parent and the Transmission of the Defect to Subsequent
Generations, American Naturalist, 1913, xlvii, p. 641; American
Naturalist, 1916, 1, pp. 65-88.
HYGIENE OF NUTRITION 199
workers who have seen the effects of alcoholism in parent
and child.
Niimerous studies' bear out all the reasons advanced for
national prohibition and challenge those interested in
national as well as personal health and vitality to accord
to prohibition the same intelhgent support that is to be
given to laws controUing or prohibiting traffic in drugs,
women, or children.
Coffee, Cocoa, and Tea. — The use of coffee, cocoa, and
tea is so general that a dogmatic statement is antagonistic
to many persons, and the views concerning the effects of
such use so conflicting that a final statement at this time
is impossible. It is probably always true that whenever
statements vary widely the truth lies at some intermediate
point. As regards coffee, it is imquestionably true that
to some persons coffee is a poison, causing toxic eye con-
ditions, disordered digestion, and nervous disturbances.
On the other hand, some persons drink it without any
deleterious effects that are noticeable. The same may be
said for tea and cocoa. It is unwise to say that coffee or
tea will harm no one. It is fooUsh to condemn for all.
The path of health in this instance must be determined by
each seeker of a larger and more abundant life.
Some studies have been made. Lusk" notes: "Schum-
biu-g finds that coffee and tea have no recuperative power
over the muscles of a fatigued organism, except when
taken with other foods. Hillsten, exercising before break-
fast, finds that the effect of taking tea is almost negligible"
(in increasing muscle power). Again he' says: "When
theophyUin, caffein and theobromin, the methylated
purins found in tea, coffee, and cocoa, are ingested it has
been stated that they are not oxidized to uric acid, but
that they increase the purin bases in the urine. However,
Levinthal and Stanley Benedict have foimd the uric acid
' See the bibliography in How to Live, by Fisher and Fisk, pp.
333-338.
' Lusk, G. : The Science of Nutrition, W. B. Saunders Co., Phila-
delphia, 1919, p. 325.
•Ibid., p. 503,
200 PERSONAL HYGIENE APPLIED
elimination to increase in man after the ingestion of 1 to
1.5 gram of caffein daily,"
More recent investigations than those cited by Lusk
indicate a certain effect on digestion that is more in har-
mony with experience than anything that has been stated
heretofore empirically. Hawk"^ and his associates in a
series of excellent studies on the gastric response to food
studied the effect of tea, coffee, and cocoa (see page 185).
While not markedly interfering with digestion, tea and
coffee did not aid the process. Cocoa distinctly retarded
evacuation and the development of normal acid con-
ditions. It should be noted that fluids ingested were
taken with a uniform meal.
'Hawk, P. B., and associates: Gastric Response to Foods, XI;
The Influence of Tea, Coffee, and Cocoa upon Digestion, American
Journal of Physiology, vol. lii. No. 1, May, 1920.
CHAPTER VIII
HYGIENE OF THE RESPIRATORy SYSTEM
I. The Essentials of Respiration.
II. Desirable Temperatubb — ^Proper Methods of Heating:
1. A Valuable Experiment.
2. Equable Temperature.
III. Proper Humidity and Means to Secure it:
1. Effect of Wind on Metabolism.
2. Effect of Humidity on Metabolism.
IV. Air Movement and Means to Secure it.
V. Control op Dust and Dirt:
Influence of Mineral Dust in Air on Health.
VI. Bacteria in Air.
VII. The Value of Sunlight.
VIII. Nature's Plan for Respiration — ^the Respibatort Tract:
1. The Muscular Mechanism for Respiration.
2. Automatic Control.
IX. The Matter op Breathing Exercises.
X. Health op the Respiratory System.
XI. Colds.
XII. Tonsils.
XIII. Adenoids.
XIV. Hygiene op the Voice.
XV. Tuberculosis:
1. Cause of the Disease.
2. Predisposing Factors.
3. Prevention.
4. Treatment.
The Essentials of Respiration. — One of the interesting
aspects of the study of low forms of animal Ufe is respira-
tion. The very simple one-celled animals breathe without
a special respiratory apparatus. In studying such forms
it is determined that oxygen from the air passes directly
through the cell membrane of the animal and carbon
dioxid passes out. This records the primary fact that is
noticed in respiration in man: oxygen of the air is taken
up in the lungs and carbon dioxid is given out. This truth
SOI
202 PEBSONAL HYGIENE APPLIED
is made clear by a comparison of the composition of air,
both inspired (outdoor) -and expired:
Nitrogen.
Oxygen.
Carbon dioxid.
79
20
0.04
79
16
4
Inspired air
Expired air
The essential fact, then, in human breathing is the bring-
ing of air into the lungs so that oxygen may be taken from
it and carbon dioxid given to it.
This knowledge of the use made of oxygen of the air
and of the need of the body for the vital gas has been
known for a long time, but usually it has been interpreted
erroneously with reference to ventilation studies. Carbon
dioxid for many years has been considered the dangerous
element in bad air. Dr. Chaumont set the standard in
this respect in 1875 at 6 volumes per 10,000 as the Umit of
Adtiation. In America many of the states have laws that
require schoohooms to be so ventilated that not more
than 6 parts of carbon dioxid in 10,000 shall be allowed.
For many years this was the accepted standard, but by
many ventilation experiments it has been shown that
CO2 may be increased to 12 volumes without deleterious
effects. Furthermore, it has been demonstrated that
from a health standpoint the physical conditions of the
air are usually more important than the chemical, and
that control of air moisture, temperatiu:e, and motion are
generally more to be desired than control of the chemical
conditions as represented by CO2. For some time the
"badness" of inside air was attributed to an organic
poison. Weichart claimed to have isolated an organic
substance which was responsible, but his experiments have
not been confirmed. On the contrary, the evidence in-
dicates that vitiated air is produced by other factors.
From the studies of Hill, Fliigge, and more recently of
the New York State Commission on Ventilation,^ it has
been demonstrated that the "badness" in air in ordinary
' New York State Commission on Ventilation, Some Results of
the First Year's Work, American Joum^,! Public Health, vol. 5,
N9.3,
HYeiENE OP THE RESPIHATORY SYSTEM 203
buildings is not due to an organic poison, nor to excessive
amounts of carbon dioxid, but rather to:
1. Improper temperature, usually too high a tempera-
ture.
2. Improper humidity.
3. Lack of air movement.
On this point the New York State Commission on
Ventilation* says: "The following tentative conclusions
seem, however, to be indicated by the experiments of the
first year as outlined above:
"1. A very high room temperature, such as 86° F.
with 80 per cent, relative humidity, produces
shght, but distinct elevation of body tempera-
ture, an increase in the reclining heart rate, an
increase in the excess of standing over reclining
heart rate, a very shght lowering of systolic
blood-pressure, and a marked fall in the Cramp-
ton value.^
"2. A moderately high room temperature, 76° F. with
50 per cent, relative humidity, has all the effects
noted above, although, of course, in less degree
than the extreme temperature condition.
"3. Even the extreme room temperature of 86° F.
with 80 per cent, relative humidity shows no
effect upon rate of respiration, dead space in the
Ixmgs, acidosis of the blood, dissociation of
oxyhemoglobin, respiratory quotient, rate of heat
production, rate of digestion, carbohydrate or
protein metabolism, concentration of the lu'ine,
and skin sensitivity.
"4. The power to do either mental or physical work,
measured by the quantity and quahty of the
product by subjects doing their utmost, is not
at all diminished by a room temperature of 86° F.
with 80 per cent, relative humidity.
'Loc. cit.
2 Cramptxin value: This refers to a test of heart rate and blood-
pressure reaction described in Transactions, Fourth International
Congress on School Hygiene, vol. v, p. 555.
204 PERSONAL HTGIENE APPLIED
"6. On the other hand, the inclination to do physical
work, and the inclination to do mental work
are diminished by sufficiently high room tem-
peratures. So far as physical work is concerned
our tests show a decrease in actual work per-
formed, when the subject had a choice between
working or not working, of 15 per cent, under
the 75° F. condition and 37 per cent, under
the 86° F. condition as compared in each case
with 68° F.
"6. Stagnant air at the same temperature as fresh
air, even when it contains 20 or more parts of
carbon dioxid and all the organic and other
substances in the breathed air of occupied rooms,
has, so far, shown no effect on any of the physio-
logic responses listed above under 1 and 3,
nor on the power or incUnation to do physical
or mental work nor on the sensations of comfort
of the subjects breathing it.
"7. On the other hand, the appetite for food of sub-
jects exposed to such stagnant air may be
slightly reduced.
"8. These experiments seem to indicate that over-
heated rooms are not only uncomfortable, but
produce well-marked effects upon the heat-
regulating and circulatory systems of the body,
and materially reduce the incUnation of occu-
pants to do physical work. The most important
effects of 'bad air' are due to its high tempera-
ture, and the effects of even a. slightly elevated
room temperature, such as 75° F., are sufficiently
clear and important to warrant careful pre-
cautions against overheating.
"9. The chemical changes in the breathed air of occupied
rooms are of comparatively minor importance,
although the substances present in such air
may exert a slight decrease in the appetite for
food."
HYGIENE OF THE RESPIRATORY SYSTEM 205
While the work of the Commission is unfinished and
the studies on air movement and himiidity are not com-
pleted, it seems from present information available that
the results of these studies will emphasize the importance
of the physical factors in ventilation.
Desirable Temperature — ^Proper Methods of Heating.
— The desirable temperature for indoor air is 68° F.
It should never go below 66° nor above 70° F. The rela-
tion of temperature to humidity and its effect upon
health has been stated above. Huntington* shows that
temperature influences work done.
Every school room and every home should possess
a thermometer and a definite effort should be made to
keep the temperature constant and at the proper elevation.
When rooms are heated by stoves this is nearly impos-
sible. It is difficult with hot air furnaces. The best
methods of heating are with hot water or steam.
A Valuable Experiment. — A great deal of money has
been spent devising elaborate methods of ventilation.
Fan, plenum, exhaust, and combination systems guarantee
to provide so many cubic feet of air per minute. Devices
for humidifying the air and automatically regulating the
temperature have been added. All of these mechanical
methods of ventilation have yet to prove their value
in the face of the following experiment:
The Bureau of Child Hygiene,^ Department of Health,
New York City, conducted in 1916 and 1917 an experi-
ment to determine the relationship between the health
of school children and the methods of ventilation in
classrooms. The number of children under observation
in 1916 was 2541, and in 1916-17 the number was 2992.
The number of class rooms in the first series studied was
58; in the second, 76. Other important controls, such
as age, locality, nationahty, and season, were in evidence.
Obviously here was an experiment of scientific merit.
'■ Huntington, E. : Civilization and Climate, pp. 8&-110, Yale
University Press, New Haven, 1915.
* Baker, S. J. : Classroom Ventilation and Respiratory Diseases
Among School Children, American Journal Public Health, January,
1918, pp. 19-26.
206 PERSONAL HYGIENE APPLIED
"It was decided that three types of ventilation should
form the basis of the study:
Type A.
"These were the so-called cold, open-window classrooms,
ventilated by natural means. It was desirable to have the tem-
peiature kept at 50° F. This, however, was found to be im-
possible owing to variations in the weather, and it therefore
ranged from 50 to 60 degrees and occasionally higher.
Type B.
"These were moderate temperature classrooms, kept between
eO'i^and 70° P., averaging about 68° F. Ventilation was wholly
by open windows. Some rooms had gravity exhaust ducts, while
others did not. Window deflectors were used in only one room in
the 1916 study, while in the 1916-17 study window deflectors were
installed and used in all rooms.
TypeC.
"These rooms were of the same moderate temperature as Type
B, that is, averaging 68° F. Ventilation of the classrooms was by
the plenum, fan system installed in the buildings, the windows in.
these dlassrooms being kept closed."
Physicians and nurses conducted the experiment
during the winter and fall and late spring for a total
period of five months. The following results are immensely
valuable for those interested in health values in ventila-
tion.
It was found that in Type C classrooms -the rate of
absences from respiratory disease was 32 per cent, higher
than in Type B classrooms and 40 per cent, higher than
in Type A.
It was also found that in Type C classrooms the rate
of respiratory disease occurring among pupils in attendance
was 98 per cent, higher than in Type B classrooms and
70 per cent, higher than in Type A.
Mechanical methods of ventilation in the buildings
studied' must be charged, therefore, as favorable to the
development in the winter, fall, and spring of respiratory
diseases severe enough to keep children from school ta
' The experiment should be repeated in other places, under different
ventilation conditions. It should be noted that generally the
mechanical^ system of ventilation is administered more easily than
the open window system.
HYGIENE OF THE BESPIRATOKT SYSTEM 207
an extent of from 32 to 40 per cent, more than natural
ventilation, and of respiratory diseases not severe enough
to keep from school, to an extent of from 70 to 98 per
cent, more than nattiral ventilation by means of open
windows.
Equable Temperature. — Equable temperature is very
desirable. Sharp variations in temperatiure tax the heat-
regulating system of the body, and frequently cause
-disturbances of the gastro-intestinal tract. With many
persons a sense of bodily well being is very dependent
upon an even temperature. In this country southern
Florida and southern California afford the best illustra-
tions of equable climate. The effect of atmospheric
conditions upon fatigue and efficiency has been studied
by Winslow,' and his results show the need for careful
regulation of indoor temperature. A comparison of
infant mortality and temperature changes in Chicago
from 1907 to 1912 is shown in Fig. 20. Ward^ mentions
the following characteristics in climate as desirable for
health: Frequent moderate weather changes, fairly
marked annual and diurnal variation in temperature,
reasonable amount of cold dm-ing part of the year, variety
in amount of cloudiness, rainfall sufficient for grass and
crops. He would advise that extremes be avoided.
Proper Humidity and Means to Secure It. — ^Water is
always present in the atmosphere. While outdoor air
varies greatly in its water content in different places
and at different times of the year and day, the variation
between the amount of water vapor in indoor air and
outdoor air constitutes a prominent factor in the un-
wholesomeness of indoor air. The absolute amoimt of
water present in indoor air is not the entire statement
in this connection, but the amount of moisture that can
still be taken up at the prevailing temperature. Build-
• Winslow, C. E. A. : The Effect of Atmospheric Conditions upon
Fatigue and EflSciency, American Journal of Public Health, October,
1917, pp. 827-834.
> Ward, R. D. : Climate and Health, Scientific Monthly, April,
1921, p. 355.
208
PERSONAL HYGIENE APPLIED
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HYGIENE or THE RESPIRATORY SYSTEM
209
ings ventilated by open windows present little or no
difficulty because the outdoor humidity usually controls,
and no essential value is achieved by attempting to secure
indoor conditions different from outdoor. The problem
is chiefly one related to artificial systems of ventilation,
as in schools, and in a certain extent in modern homes,
where httle or no attention is given to ventilation by
means of windows.
The desirable humidity is often stated to be 60 per
cent, (relative). This does not provide against the
danger of excessive temperature with the resulting dry-
ness of the air. The relative humidity may remain at
60 per cent, and the air may be able to take up consider-
able water vapor, as indicated by the following table
from Rosenau':
Relation of Humidity and Temperature
Temperature '
Relative humidity.
Absolute humidity,
Grams of vapor that
per cent.
grams per cubic meter.
can still be taken up.
—20°
60
0.638
0.426
—10°
60
1.380
0.920
0°
60
2.924
1.950
10°
60
5.623
3.749
20°
60
10.298
6.866
30°
60
18.083
12.056
Note: To reduce degrees Centigrade to degrees Fahrenheit
multiply by f and add 32 degrees.
The unwholesomeness of most indoor air with reference
to its water content lies in its excessive dryness. With
the temperature correct, this danger may be lessened,
and it can be said that air at a temperature of 68° F.
and a relative humidity of 60 per cent, will usually be
satisfactory.
There is no method for determination of relative
humidity that will be found practicable in the home,
because it involves the use of an instrument that requires
' Rosenau, M. J. : Preventive Medicine and Hygiene, D. Appleton
& Co., New York, 1913, p. 608.
14
210
PERSONAL HYGIENE APPLIED
adjustment, reading, and interpretation by means of a
table. Therefore, the guide is to be a sense guide, de-
pendent upon an interpretation of dryness of the mucous
membranes, especially that of the nose.
In the school accurate determination may be made
and records kept, and the procedm-e may be made not
only contributory to general sanitary improvement but
also helpful in training in methods of hygiene. For this
purpose the sling psychrometer is used.
Excessive dryness in the air may be combated by:
1. Open window ventilation.
2. Liberal use of potted plants in the room.
3. Pans of water placed, where it will evaporate,
under or on radiators for steam and hot-water heating,
and in furnace chambers for hot air.
Excessive dryness of the air causes absorption of water
from the body, especially from the mucous membranes.
Man's body is about 58.5 per cent, water, so that the
water loss in this way may well be a serious matter.
The loss of moisture from exposed membranes interferes
with their normal functioning.
Effect of Wind on Metabolism. — ^Wind and humidity
have pronounced influences on metaboUsm. Wolpert's
experiment as quoted by Lusk' gave the following results:
Inpltjencb op Wind on Metabolism
IN Man
Calm.
Wind — 1 meter
Wind— 8 metera
per second.
per second.
Temperature
Grams COj
Grams COi
Grama COj
per hour.
per hour.
per hour.
2°
29.8
lO'-lS"
25.1
28.3
30.0
15°-20''
24.1
30.1
20°-25°
25.0
28.0
25''-30°
25.3
22.2
24.4
SO'-SS"
23.7
21.6
35''-40°
21.2
22.2
22.1
' Lusk, G. : The Science of Nutrition, W. B. Saunders Co., Phila-
delphia, 1919, p. 146.
HYGIENE OF THE RESPIRATORY SYSTEM
211
Thus it would appear that the metabolism would be
more marked with a breeze moving about 15 miles an
hour (8 meters per second) at a temperature of 59° to
63° F. than with a temperature of 35° F. in a calm. The
scientific basis for many hygienic practices in clothing
the body is given in this experiment. The body is easily
chilled in a wind due to loss of body heat by rapid evapo-
ration.
Effed of Humidity on Metabolism. — The work of Wol-
pert was conducted on a thin man clad in summer clothes.
Rubner, working with a fat man wearing clothes, obtains,
according to Lusk,* the following results:
Influence op Tempehatuhe and Humtoity on the Metabolism
OF A Fat Man
Humidity,
30 per cent.
Humidity,
so per cent.
Tempera-
CO: in grams
HjO evaporated
COi in grams
HjO evaporated
per hour.
per hour.
per liour.
per hour.
20°
33.7
56
30.7
17
28°-30°
36.9*
134
44.5t
170
319 sweat
36''-37''
42.6t
204
149 sweat
46.7§
186
2559 sweat
* Body temperature rose 0.1 degree,
t Body temperature rose 0.0 "
j Body temperature rose 0.4 "
§ Body temperature rose 0.9 "
Note:
20° C. = 68° F.
28-30° C. = 82- 91° F.
36-37° C. = 97-100° F.
On a hot, humid day the heat lost from the body is
by evaporation of water. This is retarded by the hiunidity.
Hiunidity by preventing the evaporation of perspiration
on a hot day results in depression of the body. This is
due to the exhaustive elimination of perspiration which
by non-evaporation is prevented from cooling the body.
If the temperatm-e is moderate the heat loss may take
place through radiation and conduction, so that perspira-
i Lusk, G. : Loc. cit., p. 147.
212 PEBSONAL HYGIENE APPLIED
tion is not so excessive. Lusk' comments upon this effect
of humidity and temperature as follows:
"It is also interesting to note that prostrations from
the heat occur in New York with 66 per cent, humidity
and a temperature of 31.5° C.'' (2.30 p. m., August 24,
1905)."
Air Movement and Means to Secure It. — It has been
found that many of the ill effects of bad ventilation can
be avoided by keeping the air of the room in motion.
HiU, in England, and Fliigge, in Germany, demonstrated
that air movement was an essential element in well-
ventilated rooms. In still air the body becomes sur-
rounded by a jacket of warm moist air which produces
the famiUar symptoms of a vitiated air, even with the
CO2 content well below 6 volumes.
Movement of air in rooms is very desirable and should
be secured. This may most readily be accompUshed
by opening windows. Many persons do not know how
to open windows. If the room seems badly ventilated,
some one who doesn't know how may open the windows
widely so that those near the windows are suddenly
chilled. It usually happens that some one in the group
near the windows replies by tightly closing them. Both
err. To secure air movement the windows should be
opened a small space only and preferably at top and
bottom, but top at least.
Air movement may be supplemented by an electric fan.
The fear that some persons have for drafts is very
real, but it is often a developed fear, dependent upon
coddling of the body, and should be overcome by proper
dressing and bathing. Air in movement sufficient to
prevent unpleasant and unhealthful effects may be
secured without injury to health. The rate of movement
in relation to our perception as given by Rosenau' is as
follows:
' Lusk, G. : Loo. cit., p. 148. « About 89° F.
' Rosenau, M. J. : Preventive Medicine and Hygiene, D. Appleton
& Co., New York, 1913, p. 603; ibid., p. 626.
HYGIENE OF THE RESPIHATOKY SYSTEM 213
Air moving at 1.5 foot per second — 1.0 mile per hour — ^imper-
ceptible;
Air moving at 2.5 feet per second — 1.7 mile per hour — ^barely per-
ceptible;
Air moving at 3.5 feet per second — 2.3 miles per hour — draft.
The term "draft" is relative. To some persons a blowing
wind is not recognized as a draft; to others the slightest
air movement is a strong draft.
Control of Dust and Dirt. — ^Dust is a normal constituent
of the atmosphere and it serves a very useful purpose
as a focus for water vapor precipitation, as a disperser
of the sun's rays with decrease in the transparency of
the air. Dust particles are derived from the earth,
carbon particles in smoke, volcanoes, salt from sea spray,
interplanetary particles, mineral dust from certain occu-
pations, and organic dust, such as, "epithelial scales,
seed, spores, bacteria, pollen, plant cells, fluff of various
kinds, bites of insects, starch, pus-cells, algse, rotifers,
fragments of hair, feathers, and bits of tissue, fibers of
cotton, etc."i
The dust of great danger from a health viewpoint is
mineral dust from trades. The dust from the earth,
smoke, or refuse heaps is unpleasant, but mineral dust
is distinctly injmious.
Influence of Mineral Dust in Air on Health. — ^The
dust from mineral sources is injurious when present in
large amount and when, as is usually the case, the par-
ticles are sharp and cutting, thus serving to irritate
body tissues. Thus in coal mining, iron and steel trades,
stone cutting, and other dusty trades the dust is present
in large amounts and is extremely irritating. The lungs
are the chief organs to suffer and so definite is the injury
to the lungs that the affection resulting is named accord-
ing to the cause of the disease. Thus, anthracosis is
caused by coal dust; siderosis, by iron or steel dust,
and silicosis, by stone dust.
iRosenau, M. J.: Preventive Medicine and Hygiene, D. Appleton
& Co., New York, 1913, p. 603; ibid., p. 626.
214 PERSONAL HYGIENE APPUED
Kober and Hanson* have shown that the effect of
dust and fumes on the upper air passages may be marked.
"Dr. Collis, after examining thousands of grinders and
granite cutters and others exposed to inhalation of dust
in Sheffield, Aberdeen, and elsewhere, found, as a rule,
that the lining membrane in the interior of the nose
for a distance of f inch was smooth, dry, and pale colored;
the mucous membrane behind this was red and inflamed
and generally covered with dust, while the back of the
pharynx and pillars of the fauces were tolerant of the
touch of the spatula used to depress the tongue, having
lost their sensitiveness."
Bacteria in Air. — ^Bacteria in outdoor air do not con-
stitute a very serious danger, and, in fact, do not have
the importance that people usually attach to the matter.
Bacteria do not multiply in the air, and most of them
soon die, especially when exposed to sunshine. It may
be safely said, therefore, that bacteria coming in the air
directly from another person in the liquid spray from
coughs or sneezes are very dangerous, but if they are
not received directly from another person, the danger
is very small indeed. The expired air is practically free
from bacteria. In coughing, sneezing, talking, or other
forced respiratory movements, however, the expired
air contains bacteria. This indicates how droplet infec-
tion occurs.
The air has been considered in former times to be a
prolific source of disease. Malaria (bad air) and other
diseases, such as typhoid fever, yellow fever, and rheu-
matism, were supposed at one time to be communicated
by the air. The knowledge of these diseases today
rules out entirely, however, air as a factor in causation.
The advances in epidemiology show that bacteria in
outdoor air are usually harmless; in crowded places,
such as street cars, schoolrooms, and other closed and
* Kober, G. M., and Hanson, W. C: Diseases of Occupation and
Vocational Hygiene, P. Blakiston's Son & Co., Philadelphia, 1916,
p. 297.
HTGIENE OP THE BESPIRATOKY SYSTEM 215
poorly ventilated places, where human beings come in
close contact, the danger of disease transmission is very
real. The process, however, is that of direct contact
by means of a droplet or spray of infection from the
nose or mouth of another person.
The Value of Sunlight. — ^The value of sunlight in the
modem treatment of tuberculosis and rickets* illustrates
the saying of Pliny, the elder, who wrote "Sol est reme-
diorum maximum." The sun is the greatest cure for
many things. Its value in the maintenance of general
health is less appreciated than it should be. Part of
the splendid effects of an out-of-door hfe is due to the
sunshine. The ancients appreciated this fact more than
we moderns do, as shown by the helioses of the Greeks,
and the solaria of the Romans.
Civilized man in the temperate zone by taking on
clothing, by Uving so much indoors, protects himself
unduly from the sun's rays. On exposure to strong sun-
shine he shows a marked susceptibility to sunlight.
A careful and gradual exposure in the sximmertime
would generally result in improved fimction of the skin,
increased nutritive changes, enrichment of the blood,
particularly the hemoglobin content, and improved
nerve action. In the tropics man suffers from the exces-
sive simhght. Woodruff^ names excessive sunlight
as the cause of backwardness in these regions. One
unaccustomed to sunlight should avoid prolonged expos-
ure at first. Sunburn, headache, sleeplessness, and other
signs of discomfort following exposures to the sun indi-
cate too sudden or too prolonged periods. City persons
on vacations in the country frequently err in this regard.
Gradually increasing the amoimt of body surface exposed
' Hess, A. F. : Experimental Rickets in Rats, Journal of Biological
Chemistry, January, 1922, p. 77. McCollimi, E. V. : Is There More
Than One Kind of Rickets? American Journal of Diseases of
Children, February, 1922, p. 91.
» Woodruff, C. W.: The Effect of Tropical Light on White Men.
Clark, J. H. : The Physiological Action of Light, Physiological Re-
views, April, 1922, pp. 277-309,
216 PERSONAL HYGIENE APPLIED
and the time spent in the sunshine will bring valuable
results, if unfavorable signs are recognized and acted
upon accordingly.
Nattire's Plan for Respiration — ^the Respiratory Tract.
— The general plan provides that air be taken in through
the nose, where dust and dirt are in part removed and
the air properly warmed before passing on through the
trachea (windpipe) to the lungs. Nature in all mechan-
isms of the body provides a margin of safety, and that
principle is seen in the provision that air may be breathed
in through the mouth. This is an emergency entrance,
however, and is not adapted either in general structure
or function for respiration. Nose breathing alone is
justifiable and should be practised. Obstructions in the
nose in the forms of adenoids, growths, or deformities
should be removed to secure the free passage so essential
for proper breathing and vigorous health.
The Muscular Mechanism for Respiration. — Nature
has provided a muscular mechanism by which man may
increase the size of the chest cavity and allow air to rush
in. This mechanism allows for an increase from side to
side, from back to front, and from top to bottom. Fad-
dists, singers with special "systems," and fake "professors
of physical culture" at times advocate irrational and
wholly unscientific methods for using the chest caArity.
One extreme method of breathing is known as "abdomi-
nal." This method consists in pronounced use of the
diaphragm without the use of the intercostal muscles.
The natural method of respiration is one that calls into
action both diaphragm and intercostal mechanisms
in which the greatest expansion comes in the lower chest
and epigastrium. It has been asserted that the corseted
mature woman breathes with a costal type of respiration,
but that there is no fundamental difference between the
natural respiration of man and woman has been well
demonstrated. Children show, as a rule, an abdominal
type, but this type is lost in the pubertal changes that
come with adolescence, due to the increase in muscular
HYGIENE OF THE KESPIHATOKY SYSTEM 217
power and a change from the protuberant abdomen to
the flat type.
Automatic Control. — The rate and frequency of respira-
tion is controlled by a group of nerve cells, the respiratory
center in the medulla, acting in response to changes in
the blood. True it is that we can voluntarily breathe
deeper and faster, but clearly also, whether we do or
not voluntarily is not related to the physiologic require-
ments of the body. When running or engaged in feats
of speed, strength, or endurance the act of respiration
goes on without conscious direction, and because of this
essential automaticity, satisfying, as it does, the needs
of the body, an attempt of the voluntary or conscious
kind is unnecessary and unhygienic. Certainly at no
time or place does any individual know how fast or how
deep he must breathe to eUminate the carbon dioxid
produced by activity. The respiratory center does
know, however, and if iminterrupted it will under all
normal conditions carry out its demands and fulfil
its physiologic obligations.
"riie Matter of Breathing Exercises. — There is prob-
ably less clear thinking among physical educators on
the subject of breathing exercises than on any other
aspect of body training. Hall,* who marches in the
procession with those who give prominence to play and
games as contrasted with formal gymnastics, makes
the following absurd statement:
"Deep breathing, however caused, no doubt acts
against auto-intoxication, gives increased power to-
resist disease, is the root of endurance imder effort, and
is of great and hitherto unsuspected importance in de-
termining the level or intensity of life, one of the chief
variables with which the rate and completeness of normal
oxidation of the blood is correlated."
The above statement may well mean that respiratory
gymnastics in one's room before an open window, as
> Hall, G. S.: Adolescence, D. Appleton & Co., New York, 1904,
p. 102,
218 PEBSONAIi HYGIENE APPLIED
is customary with those who pursue this fad, will deter-
mine "the level or intensity of life" to the advantage
that "auto-intoxication" is done away with and "endur-
ance" is strengthened at the root. President Hall has
such a keen appreciation of the biologic values in life
that it is disconcerting to find him expressing such opinion.
It is important to point out that breathing exercises
in the home or following a period of gymnastics are
unscientific and not physiologic for the following reasons:
1. Oxygen cannot be stored up in the body. The
passage of oxygen from the air-chambers of the
lungs to the blood and thence to the tissue is
dependent upon the need of the body cells for
oxygen. If physical activity is increased, oxygen is
required, and hence respiration is increased in rate
and depth. Burton-Opitz* says in this connection:
"The relation between the quantities of O absorbed and
COi liberated during a given period of time is designated
as the respiratory quotient.
"The rate and depth of the respiratory movements do
not appreciably change the relationship of the O and COi.
"The general arrangement of the intracellular material
constitutes the principal factor in the determination of the
manner in which the dysoxidizable f ood-stu5s combine with
oxygen. On this account there is imparted to the oxida-
tions definite specificity and a limit is set to them in con-
formity with the requirements of the different tissues.
Conseguenliy, the magnUtide of the oxidation is regvlated by
the tissue itself and not by the amount of oxygen actually
available."
There is abundant physiologic evidence to show that
the arterial blood is in a state of almost complete satura-
tion and that this normal state is possible with an oxygen
tension of little more than 30 mm. Hg., although the
normal tension is at least 100 mm. Hg. In short, that
natural respiration amply safeguards the needs of the
tissues. Moreover, as Burton-Opitz says:
"But even if this gas (os^gen) is supplied in pure form so that its
pressure is increased five tmies, namely, from 152 nmi. Hg. to 760
' Burton-Opitz, R. : A Text-book of Physiology, W. B. Saunders
Co., Philadelphia, 1920, pp. 507, 611, 514, 516, 517,
HYGIENE OF THE BESPIBATOBT SYSTEM 219
m.m. Hg., no considerable variation in the consumption of oxygen
and output of carbon dioxid resiilts."
2. By respiratory exercises the proportion of oxygen
to carbon dioxid in the lungs and blood can be
temporarily increased, but only at the expense
of the physiologic equilibrium of the body. An
illustration of this disturbance may be seen by
breathing deeply and rapidly for one or two
minutes. The nausea, headache, disturbance in
vision, and other sensory manifestations indicate
the unhygienic effect of the procedure. Hender-
son's' experiments in this field have been especially
valuable in confirming this view.
Investigators have observed that spasms and mus-
cular twitchings may foUow voluntary over-
breathing. It may cause symptoms of tetany,
the factor being alkalosis, due to reducing the
amount of the blood carbon dioxid, and making
the blood more alkaline than normal.
3. The voluntary taking of oxygen regardless of the
needs of the body is unphysiologic and irrational.
The quantity of oxygen taken up by the cell is
conditioned by the needs of the cell. Pfluger's^
work on the combustion of living material showed
that. Barcroft' has sustained his position. The
respiratory center provided by nature to regulate
the oxygen supply in accordance with the body
needs is a better guide than any voluntary,
arbitrary, and empiric method. No individual
at any time knows how much oxygen is needed.
* Henderson, Y., and associates: The Influence of Forced Breath-
ing Upon the Circulation, The Journal of Pharmacology and Experi-
mental Therapeutics, April, 1918. The Time that the Breath Can
Be Held as an Index for Acidosis, Journal American Medical Associ-
ation, July 25, 1914. Haggard, H. W., and Henderson, Y.: How
Oxygen Deficiency Lowers the Blood Alkali, Journal of Biological
Chemistry, vol. xliii. No. 1, 1920.
' Pfluger: Ueber die physiologische Verbrennung in den lebendigen
Organismen, Pfluger's Arch., x, p. 350, 1875.
* Barcroft: The Respiratory Function of the Blood, Cambridge
University Press, London, 1914, p. 73.
220 PERSONAL HYGIENE APPLIED
4. The use of breathing exercises following a gym-
nastic lesson is unscientific' and should be dis-
continued. No teacher can tell the respiratory
needs of any one pupil; how futile to set a respira-
tory rate for 40 children when there is not
sufficient knowledge to guide intelligently, and
when respiratory needs vary tremendously in
different individuals.
5. The use of breathing exercises to increase the size
of the lungs and chest, unless used for corrective
or therapeutic purposes in individual and pre-
scribed-for cases, is unscientific and dangerous.
Lung development should be an expression of
increased respiratory need and should follow as a
response of the respiratory mechanism to the
need for oxygen by the tissues of the body. It
would be as irrational to develop a large heart
out of proportion to the rest of the body as it
is to develop large lungs without reference to
body needs.
6. The belief that breathing exercises and large lungs
were inimical to the development of pulmonary
tuberculosis is unfounded in fact. Tuberculosis
is related directly to personal habits, sanitation,
and sources of contagion. There is no char-
acteristic tuberculous chest except in the chronic
stages of the disease.
7. Since tuberculosis develops most frequently in the
apex, the less frequently used portion of the
lungs, it would seem to be dangerous to develop
a very large lung and thus produce a larger area
not used continually.^ A lung that is related
' Burton-Opitz has unpublished data clearly showing that the tidal
air is greater under conditions of maximum respirations with the
arms hanging easily at the sides than with the arm movements
usually emploj'ed in breathing exercises.
' Sewall, H., and Swezey, S. : American Review of Tuberculosis,
September, 1921, p. 547. Beasley, T. J. : Journal American Medical
Association, February, 25, 1922, p. 579.
HYGIENE OF THE RESPIRATORY SYSTEM 221
to the habits of exercise, life, and needs of the
individual is a better mechanical instrument
than one much larger in size and power and un-
related to the physiologic body requirements.
In the latter case it is reasonable to suppose
that such a lung would be more susceptible to
disease because of the larger unused area.
8. The evils aimed at in breathing exercises are to be
corrected by physical exercise that will not only pro-
duce increased respiratory action and gaseous inter-
change, but also will give additional hygienic effect.
Health of the Respiratory System. — Health of the
lungs and respiratory tract is dependent upon many
factors. The general health of the body, digestion, circu-
lation, and elimination are important factors. The air
breathed, the condition of the nose and throat, and the
matter of exercise in the open air are important. Specific
directions for avoiding tuberculosis will be given later,
but aside from this infection, and for the maintenance
of good condition in the pulmonary system, the following
points are to be noted:
1. Nose breathing is essential. The nares are con-
structed to warm cold air and to screen out frpm
the air dust and germs. If necessary, surgery
should be employed to free the nares from ade-
noids, spurs, growths, and other obstructions.
2. Cold bathing is invaluable to keep the tone of the
body and especially the tone of the mucous mem-
branes of the respiratory tract in good condition.
Numberless persons have freed themselves from
"colds" by a faithful habit of the morning cold
bath.
3. The best exercise for lung development is running
for boys, and dancing for girls in the open air.
La Grange recommends skipping for girls. Swim-
ming, mountain cUmbing, hiking, and outdoor
games are more important than any respiratory
gymnastics ever devised.
222 PERSONAL HYGIENE APPLIED
4. In the prevention of colds the following should be
noted in addition to cold bathing:
(1) Sufficient sleep in well ventilated room. If body is
well protected by bed clothing, there should be no
fear of drafts. A direct draft upon the head is un-
desirable.
(2) Avoid close, poorly ventilated rooms, and especially
those with high temperature.
(3) Avoid chilling the body. Keep the body warm when
riding or sitting quiet. When walking or exercising
there is no danger; the mistakes are made when
resting following the activity.
(4) Keep the general health at the best and highest level
possible.
Colds. — Colds are very common health disturbances
and because they are not liable to cause immediate
death they are regarded by many people as of no great
importance. Hutchinson suggests, however, that a
person's age is not dependent upon the number of years
that have passed over one's head, but upon the number
of colds that have passed through one's head. The best
medical opinion supports the view that colds, however
minor may be their temporary effect, are of enough
importance to warrant serious painstaking care to avoid
contracting them.
Colds are caused by bacteria which at times attack
the body in great force and cause marked disturbance,
with temperature, loss of appetite, and general feeling
of disability, or at times causing only a slight indispo-
sition for a day or two. The latter condition is probably
responsible for the phrase: "Oh, I only have a cold."
The variability in the severity of the condition is
due to a variation in two factors: the virulence or number
of invading bacteria and the resistence of the body to
the infection. The virulence or number of bacteria is
increased at times when there is an epidemic of colds.
At such times only the best resistance will prevail against
the infection. Therefore, it is always wise to avoid a
person who has a cold, and to isolate one's self when
HYGIENB OF THE RESPIRATOHT SYSTEM 223
one has a cold. The protection against the bacteria
then is by avoiding contact with those who are infected,
and by increasing or by maintaining body resistance.
The matter of resistance is of considerable importance.
We may understand the problem better by noting that
there is a dual aspect to the subject: resistance of local
parts, such as nose, throat, and accessory structures,
and resistance of the body in general.
Many persons are susceptible to colds because of
abnormality in the nose or throat. The common forms
are adenoids, enlarged tonsils, and nasal obstruction.
Nasal obstruction may be due to growths, to nasal in-
juries and septal deformities, or to abnormal develop-
ment of the teeth and palate in childhood. Adenoid
growth and tonsils are frequently the cause of colds in
children. All of these abnormahties increase the liability
to colds, and, in addition, render it more likely that serious
involvement of accessory structures will occur. Thus,
middle-ear disease, sinus trouble, and even the dreaded
mastoid infection may result. To increase the resistance
of local parts by having abnormalities corrected is the
reasonable thing to do.
If local parts are in good condition a cold can result
only if the invading bacteria overcome the general de-
fenses of the body. General defense is known as general
resistance also. It is upon personal hygiene that re-
sistance is largely dependent. Chilling the body, getting
the feet wet, dietary indiscretions, constipation, over-
work, loss of sleep, and other matters may lower the
resistance sufficiently to allow infection to occur. These
causes may need special attention.
Experiments upon animals show that chilling and
overeating do diminish the body's resistance to infection.
Rabbits which have been chilled subsequent to inocula-
tion with cold-producing bacteria show a higher rate
of mortality from the disease than animals similarly
inoculated, but not chilled. The old belief that drafts
cause colds is justified in this sense that they will congest
224 PERSONAL HYGIENE APPLIED
the mucous membranes and render the individual more
susceptible. This point needs examination though, be-
cause by rational health habits the skin may be trained
to adjust readily to all the usual variations in air move-
ment and temperature. This training is important.
Cold baths for those who can take them is the most
important single procedure for skin training. Those
not able to take the cold bath should wash the neck
and face with cold water every morning and splash
some cold water over the chest.
Getting the feet wet should be avoided whenever
possible. If it cannot be avoided, the changing of shoes
and stockings as soon as possible is, of course, impera-
tive. Standing out-of-doors in cold weather may re-
sult in chilhng of the body even though warmly clothed.
To avoid this one should — if to be out-of-doors is essential
at that time— continuously, contract the body muscles.
Rising on the toes, shifting the weight, contracting arm
and back muscles will be found efficacious.
Dietary indiscretions and constipation lower the
resistance to colds. Overeating is to be avoided for
this as well as for other good reasons. Constipation is
to be combated, of course, with every proper food, and
other natural means, such as exercise, plenty of water,
and regularity in evacuation. If these do not sufiice
to correct the condition, a physician should be consulted.
Avoidance of overwork and loss of sleep are important
for this as well as for other good reasons.
Shall a nasal douche be used? Are vaccines valuable
in preventing or treating colds? What home remedies
are recommended? These are common questions from
those who suffer from colds. In general, nasal douches
are not advisable. They should be used only on pre-
scription. The snuflBng of solutions into the nose is
dangerous, and may lead to middle-ear infection. For
the same reason care in blowing the nose should be taken
by closing one side completely and blowing through the
other, allowing the front opening to be unobstructed.
HYGIENE OF THE RESPlKATOEY SYSTEM 225
Vaccines have been recommended for sufferers from
continual colds, and in some cases the results have been
good. The procedure is not well enough established to
give it general approval.
The home treatment of a cold is, briefly: stimulate
the bowels by a laxative, preferably a salt, such as mag-
nesium sulphate or citrate of magnesia, and go to bed,
keeping the body warm. Ventilate the room thoroughly.
A hot foot bath for fifteen to twenty minutes is good
treatment, but the danger of catching cold after emerging
from the body bath is so great that, if used, it should be
supervised carefully.
If one has over 100 degrees of temperature a physician
should be called. The onset of other and more serious
diseases is marked at times by the symptoms of an
ordinary cold.
After a cold has passed one should not take on work
too early. Put the load on gradually. Learn from one
experience, and by improving the living routine make
succeeding infections, if not impossible, at least, exceed-
ingly difficult.
Tonsils. — ^The tonsils are glands placed on either side
of the opening from the mouth into the phajynx. In
childhood they probably serve to protect the individual
against respiratory diseases, but if normal they dis-
appear soon after puberty. As a matter of fact, the
prime purpose of the tonsils has never been determined.
If the tonsils become diseased, then the question is, not
what function do they have, but rather, how serious is the
infection, and what will happen if they are not removed.
There are many old-fashioned beliefs about the tonsils,
but they must give way before the clearly proved evi-
dence of tonsil complicity in heart and rheumatism
affections.
The entrance for the organisms causing valvular
disease of the heart or rheiunatism is Ada the tonsils
in many cases. This evidence has been available from
clinical experience; it has been corroborated by laboratory
15
226 PEBSONAL HYGIENE APPLIED
findings. The case is complete. Diseased tonsils are
dangerous to health!
The present-day operative procedure for the removal
of infected tonsils is correct. It is important to have
a skilled surgeon perform the operation. There is no
danger to be feared if the operation is in the hands of a
skilled performer. The removal of the tonsils enlarges
the throat-mouth cavity and increases the volume and
resonance of the voice.
Children have large tonsils. These glands decrease
in size with age. If not infected they will become very
small. The size of the tonsils is not an indication for
removal imless they cause obstruction. Real signs of
disease and infection wiU be sought by the reputable and
skilled surgeon before advising removal (see Chapter XIV).
Adenoids. — At the opening of the nasal cavities into
the upper part of the pharynx there occurs in children
a growth of lymphoid tissue, called adenoids. This
growth may become so extensive as to cause interference
with nasal breathing, obstruction of the eustachian
tube orifice, and hence interference with hearing. The
tonsils are to be removed not because they are large,
but because they are diseased; the adenoids are rarely
diseased, but are dangerous to health because of enlarge-
ment. The effects of adenoids are diminished physical
activity, lack of energy, vigor and vitality, and malnu-
trition. They constitute a serious health handicap for
the child. In addition, by causing mouth breathing,
they produce a lack of proper development of the bones
of the nose, cheek, and jaws. The operation is simple,
not dangerous, and should be advised and. followed if
indicated.
The Joint Committee on Health Problems in Educa-
tion' gives the following structural, functional, and general
effects of adenoids:
' Joint Committee on Health Problems in Education of the
National Council of Education, National Education Association and
the Council on Health, American Medical Association. Health
Essentials for Rural School Children, second edition, 1921.
HYGIENE OF THE RESPIRATORY SYSTEM 227
(o) Structural effects:
1. High arched palate.
2. Narrowing of upper jaw.
3. Deformity of chest, resulting from obstructed and im-
perfect breathing, shown by lateral depression of front
of chest and prominent sternum (breast bone).
4. Disturbed development of teeth and vocal organs.
5. Large tonsils in one-third of cases.
(b) Functional disturbances:
1. Mental:
(a) Disturbance in function of brain resulting in apro-
sechia nasalis, that is, difficulty in forming an
idea of anything new; stupidity; difficulty in re-
taining ideas; weakness of memory; inability to
turn thought on a definite subject; lack of power
of attention.
(6) Irritability, depression, and often disorderly conduct..
2. Deafness.
3. Defects in sense of smell and taste.
4. Defects in voice (nasal voice).
5. Chronic rhinopharyng^al catarrh, shown by a persistent
nasal discharge. Tms is often one of the first symptoms.
In very young children it is manifested by snuffles.
6. Obstruction of air passages resulting in breathing dis-
turbances, manifested by open mouth and great rest-
lessness at night, the child being forced to assume
various attitudes, such as sleeping on face, in order to
breathe better.
7. Reflex:
(a) Catarrhal spasm of lar3Tix, or croup.
(6) Headache.
(c) Intractable cough and hoarseness.
(d) Bronchial asthma.
(e) Enuresis (incontinence of urine).
(c) General effects:
1. Malnutrition and anemia.
2. Underdevelopment, physical and mental.
3. Predisposition to otitis media (middle-ear disease),
laryngjtis, colds of a remittant nature; increased sus-
ceptibility to disease infections, such as tuberculosis,
diphtheria, scarlet fever, etc.
Hygiene of the Voice. — Proper use and care of the
voice are very important. A pleasing voice is an asset
of real worth to a person. Children develop the voice
according to the voices heard most often. The influence
of parents and teachers upon voice formation in the
child is more powerful than any other factor in deter-
mining the quality of the voice. The child that hears
228 PERSONAL HYGIENE APPLIED
harsh, coarse speech will develop like vocal qualities,
and the child hearing soft resonant tones will speak
softly and resonantly if not prevented by defects in the
nose or throat, or by disturbances due to poor co-ordina-
tion in speech control. Adenoids, tonsils, abnormalities
of the palate, obstruction in the nose are the common
causes of poor vocal sounds. These conditions must be
remedied before improvement in speech is to be expected.
After abnormahties are corrected speech training may
be necessary to develop new co-ordinations and to re-
educate the muscles of the throat.
Training of the voice may be accomplished either by
teachers of oral expression or by teachers of singing.
Both forms of training are valuable if good methods are
followed. The methods of teaching the use of the voice
are indeed numerous. No principles can be stated that
win serve effectively in choosing proper teachers; results
alone can determine.
The care of the voice is more important to professional
singers and speakers, but for all persons the voice is so
useful, so much a part of hving, that certain rules of
hygiene should be noted and followed.
The voice responds to general bodily states. Weak-
ness and muscular flabbiness cannot support a good
voice. The voice takes on the quality of the body in
general as regards its health. A person in poor health
wiU suffer with fatigue of the voice, and under use there
wiU develop inflammatory conditions, leading frequently
to repeated colds in the larynx, called laryngitis. The
voice during an attack of laryngitis must not be used
more than is absolutely necessary. Singing at such
times is especially harmful. Perfect rest for the voice
is the best form of treatment for laryngitis.
A frequent cause of poor vocal production is poor
posture. A relaxed, drooping position of the trunk and
head allows the larynx to sink and results in poor tones.
The basis for good soimd production is an erect posture
with the abdomen well supported by muscular contrac-
HYGIENE OF THE RESPIRATORY SYSTEM 229
tion and the chest carried high. A strained position
is not desired, but one of erectness and balance.
Smoking causes irritation and thickening of the mucous
membrane of the throat and may result in a chronic
cough. Improper voice placement may so strain the
cords that the singing voice is entirely lost. The efforts
of altos to sing soprano, and of baritones to sing tenor
lead logically to disaster. The voice must be used properly
to serve adequately.
Tuberculosis. — ^A variety of disease processes may de-
velop in the respiratory system. Bronchitis, pneumonia,
pleurisy, empyema, and others are all important. Some
of these will be discussed briefly in Chapter XIII. Pul-
monary tuberculosis is so prevalent and its effects are
so disastrous at times, that it is important to describe
the disease at length, its mode of transmission, its pre-
vention, and its treatment.
Tuberculosis is an infection caused by the Bacillus tuber-
culosis. This bacterium may attack almost any organ
in the body. There may be tuberculosis of the lungs,
Uver, spleen, intestines, kidney, bones, brain, and other
structures. In children it is more commonly seen in
bone and gland infection; in adults it is more frequent in
the lungs.
The cold blooded animals are rarely affected. It
does not affect birds, and rarely horses, sheep, goats,
cats, and dogs. It is a common disease among cattle,
and its wide-spread prevalence among milch cows accounts
in part for many cases of the bovine type in man.
In man the disease is one of the most serious from an
economic and social point of view. It is estimated that
one-seventh of all deaths in England and one-ninth of all
deaths in the United States are due to the disease.
Cause of the Disease. — ^The disease is caused by a
minute bacterium that is able to grow and develop in
the body under favorable conditions. Two things are
necessary: the organisms, and a condition favorable
to their growth and development. In this respect it is
230 PERSONAL HYGIENE APPLIED
helpful to think of these essentials in the light of Osier's
famous analogy, and consider the nature of the seeds
(bacteria) and the soil (the human host).
The Seeds. — The bacteria are scattered widely among
human habitations. The two chief sources are: The ex-
pectoration of persons with advanced disease of the lungs,
and the milk of tuberculous cows.
There are other sources probably derived from the
former. Scores of experiments have demonstrated the
presence of bacilli in samples of dust from public
buildings, streets, railway coaches, traction cars, etc.
These bacilli are so ubiquitous that in cities, at least,
few individuals pass a week without coming in con-
tact with them and affording an opportunity for
their lodgment in the respiratory passages. From the
street the bacilli may be brought into the house on the
shoes, the skirts of women, the hair of cats and dogs,
and in the dust of the air. The tubercle bacilli of the
bovine type are usually distributed by the milk of tuber-
culous cows. Park has shown that from 6 to 10 per cent,
of the deaths in children with tuberculosis was of the
bovine type, thus indicating the supreme importance of
using for dairy pm-poses only those cows that are tuberculin
tested and shown to be free from tuberculosis.
The Soil. — It is a very interesting and highly instruc-
tive fact that approximately 90 per cent, of all people
are at some time infected with the tubercle bacillus.
This is instructive especially because a very much smaller
percentage die of the disease. The health of the body,
i. e., resistance to disease, is a prominent factor in the
case. Osier's' famous analogy of the Parable of the
Sower is interesting:
"Some seeds fell by the wayside and the fowls of the
air came and devoured them up." These are the tubercle
bacilli scattered widely over the human environment,
the majority of which die. "Some fell upon stony places."
•Osier, W.: The Principles and Practice of Medicine, D. Apple-
ton & Co., New York, 1912, p. 157.
HYGIENE OF THE BESPIBATOBY SYSTEM 231
These are the ones that find lodgment in many persons,
but they do not develop because "they have no root."
"Some fell among thorns and the thorns sprang up and
choked them." This represents the bacilli that find
suitable body soil for growth, but the thorns, representing
the protecting forces of the body, get the better of the
struggle.
"But others fell on good ground and sprang up and
bore fruit an hundred fold." This is the group that
produces one-ninth of all deaths in the United States,
and that costs about $200,000,000 annually; that brings
sorrow and suffering to thousands and ruins the plans
and purposes of many lives. To know what makes
the soil favorable for the development of the seeds is
very important.
Predisposing Factors. — 1. Environment. — It is true
that one can acquire a predisposition to the disease.
Dwellers in the cities in dark alleys and tenement houses,
workers in cellars and iU-ventilated rooms, and persons
addicted to drink are very prone to the disease. Dr.
Trudeau demonstrated the effect of environment when
he showed that rabbits, inoculated with tubercle bacilli,
if confined in a dark, damp place, without sunhght and
fresh air, rapidly succiunbed, while others inoculated
in the same way, but allowed to run wild, recovered or
showed very slight lesions. In this connection it is in-
structive to note that occupants of prisons, asylums,
and poor-houses, and large unsanitary factories respond
like Trudeau's rabbits in the cellar. Environment is a
factor of first-rate importance, and the social and economic
conditions creating unfavorable environment are at the
crux of the problem. The kind of people most Hkely
to get tuberculosis are those whose environment is favor-
able for the bacillus.
An important factor in environment is occupation.
The work one does is restricted to place and surround-
ings. Hence the death-rate from tuberculosis, classed
by occupation, is significant of the influence in the en-
232
PERSONAL HYGIENE APPLIED
vironment of the work done and conditions of labor.
Table VII, giving deaths from tuberculosis per 1000
deaths from all causes, prepared by Oldright and pre-
sented by Terman,^ is instructive:
TABLE VII
Deaths phom Ttibebculosis by Occupation and Place
m
n
Printers and pressmen
Female teachers in schools ....
Stonecutters
Dressmakers and seamstresses.
Saloon keepers and bartenders
Policemen, watchmen, detectives
Farmers, planters, overseers. .
Lawyers
Physicians and surgeons
Clergymen
429
452
432
396
213
183
141
119
204
138
342
395
333
386
305
187
176
125
103
120
437
272
398
385
296
190
207
102
120
153
370
336
423
350
295
169
128
236
113
91
377
441
261
405
223
161
103
139
135
140
430
477
496
388
276
113
83
96
90
83
398
396
391
385
268
167
139
130
128
121
The influence of occupation on the development of
tuberculosis is indicated in two statistical charts (Figs.
21, 22) presented by the Prudential Life Insurance
Company of America.
2. Heredity. — It was very common some years ago to
hear of the importance of heredity in the acquirement
of tuberculosis. Today there is no general acceptance
at all that tuberculosis is inherited biologically; the
term "tendency" is used to indicate that children of
tuberculous parents are more likely to acquire the disease,
because there is an inherited weakness or susceptibility.
There is considerable reason for believing the "tendency"
theory. It is true that children of tuberculous parents
are often weak and malnourished, but the important
thing to remember is that these children inherit tuber-
' Tennan, L. M. : The Teacher's Health, Houghton Mifflin Co.,
Boston, 1913, pp. 24, 25.
HYGIENE OF THE EBSPIBATOEY SYSTEM
233
culous parents, that they come into a home where tuber-
culosis is active. In short, heredity in this disease is of
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very little importance; enviroimient, on the contrary,
is exceedingly significant.
3. Race. — That individuals may inherit a weakness
to the disease is well illustrated by the fact of racial
234
PERSONAL HYGIENE APPLIED
susceptibility. Negroes are very prone to the disease
(Fig. 23), and the American Indian since his civilization
has succumbed in large numbers. The Irish are very
susceptible; the Jews very resistant.^
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4. Sex. — ^Women have a lower mortaUty than men (Fig.
23). The cause is not known.
» Dublin, L. I. : Scientific Monthly, January, 1922, pp. 94-104,
HYGIENE OF THE BBSPIHATORT SYSTEM
235
5. Habits of Life. — ^Aside from environmental factors,
such as light, air. and general surroundings, there are
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personal factors that tend to make the soil favorable
for the development of tuberculosis. These may be
briefly summarized under several headings:
236 PERSONAL HYGIENE APPLIED
(a) Overwork. — Fatigue of the body resulting from too long hours
of labor or lack of sufficient rest, reduces bodily resistance
and favors the development of tuberculosis.
(6) Improper Food. — Malnutrition with the resulting devitaliza-
tion of the body presents an unusual danger in this con-
nection. This is especially true for children who eat in-
sufficient eggs, milk, green vegetables, and meat.
(c) Lack of Outdoor Air and Exercise. — It has often been shown
that outdoor air and exercise have direct effect upon the
Eroduction of hemoglobin and increase of leukocytes in the
lood. The general wholesome effect upon all the functions
of the body is well known; the lack of these factors leaves
the body weak and ineffectual and offers a ready soil for
tuberculosis.
Prevention. — The problem of prevention is twofold-
personal and social. It relates, on the one hand, to ade-
quate care of the personal health, and on the other to
intelUgent social effort to provide sanitary conditions
for others. This disease in relation to health illustrates
in a striking way that hygiene can never be an academic
or cultural subject. It is only of significance and meaning
as it is lived. It illustrates also that as regards attitudes,
the one fostering a sense of social responsibility is of the
first and foremost importance even for those who are
selfish, primitive, and instinctive.
1. Personal Prevention. — The problem here is keeping
one's health at the highest possible level. For one with
the tendency or exposed directly to the disease, this is
of paramount importance. This means prevention of
fatigue, eating proper food, securing adequate hours
and conditions of sleep, and avoidance of insanitary-
conditions of work in factory or home.
2. Social Prevention. — Clearly this measure is the
more important, and if achieved with reasonable success
it will accomplish for all what a personal program could
not hope to secure alone. There must be at least six
parts to this program:
1. Education of the pubUe, and especially the tuberculous, in the
nature, course, prevention, and treatment of the disease.
2. Legislation that places tuberculosis on the list of reportable
diseases.
HYGIENE OF THE RESPIRATORY SYSTEM 237
3. Improvement of the housing conditions of the poor and of the
working conditions ia all industries not satisfactory.
4. State or municipal legislation and control relating to the milk
supply, food supply; cleanliness of streets, sleeping cars, and
public places; enforcement of the ordinances against spitting.
5. Adequate hospital and sanatorium facilities to care for those who
have the disease.
6. Prevention of other diseases especially predisposing, such as,
in children:
(o) Measles, which is frequently followed by pulmonary
tuberculosis, and
(6) Whooping-cough, which predisposes to tuberculosis.
Treatment. — It is very instructive in connection with
this disease that nature provides a cure frequently, if
the individual will early return to the course that nature
asks of aU who wish to live well. The treatment is not
by medicines, but by
1. Outdoor air and sunshine, and
2. Nourishing food.
The importance of early recognition is very great. It
can be said with considerable assurance that early cases
will recover (Fig. 24) if given the above treatment.
Late cases are often hopeless. There should be keen
appreciation of the value of medical examination of
school children, workmen, and college students every-
where.
The question of treatment cannot be dismissed with-
out vigorous warning against the unscientific cults, the
blatant charlatans who scream their cures, and the
futility of Christian Science, chiropractic, osteopathy,
and spiritualism in this disease.
Vaccines^ are used at times in the treatment of the
disease. They are likely to be of greatest value when
used by a specialist experienced in the use of tuberculin.
The von Pirquet test is a diagnostic test of value in
children under four years of age, and of relatively less
value with increasing age. The Cahnette test for the
diagnosis of tuberculosis is not to be used; and it would
> Vaccine therapy is not used so frequently today because of the
liabiUty to anaphylaxis (developed sensitivity to foreign proteins).
238
PERSONAL HYGIENE APPLIED
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be strange to find a modern physieian using it as a diag-
nostic test.
CHAPTER IX
HYGIENE OF THE CIRCDLATORY SYSTEM
I. The Importance of the CibcuIjATion:
1. The Increase in Circulatory Disease.
2. Plan of the Circulation.
II. The Blood:
1. Red Blood-cells.
2. White Blood-cells.
3. Plasma:
(o) Water.
(b) Gases.
(c) Food-stuffs — carbohydrates — ^fat — protein.
(d) Salts of the blood:
1. Special considerations.
2. Use of mineral waters.
(e) Protective substances.
(f) Hormones.
ig) Waste substances.
III. The Vessels:
1. The Arteries.
2. The Veins.
3. Varicose Veins.
rV. The Heart:
1. Injury to the Valves.
2. Injury to the Muscles.
V. The Convalescent Heart.
VI. The Influence of Poisons Upon the Heart.
VII. The iNPLtTENCE OF Tobacco:
1. A Need for Aceitfacy.
2. General Effects of Tobacco.
3. The Effects of Tobacco Upon Youth.
4. Tobacco and the Sexes.
The Importance of the Circulation. — The circulation
of the blood through the body is important because
the blood serves to carry to the tissues of the body oxygen
from the lungs and food-stuffs from the digestive tract';
' Burton-Opitz has shown that an amount of blood equal to the
entire amount in the body of a dog traverses the liver every three
minutes, Quarterly Journal of Experimental Physiology, 1912,
p. 189.
240 PEHSONAL HYGIENE APPLIED
it carries waste and excess water to the organs of elimina-
tion; it assists in the regulation of temperature; and,
finally, it is the medium for the transmission of the internal
secretions from the ductless glands.
From this statement it follows that the keeping of a
good circulation is a most important affair for every one.
This is not generally recognized. The deaths from
heart disease are apparently on the increase. At the
present time the number of deaths from heart disease
exceeds the deaths from tuberculosis. The Census
Bureau reports for 1920 in the registration area the
following: Organic heart disease, 124,143; tuberculosis
(all forms), 99,916. The Association for the Prevention
and Relief of Heart Disease reports the following facts:
"There are now not less than 20,000 children in the
pubUc schools of New York City already handicapped
by permanently damaged hearts. At BeUevue Hospital
alone last year there were treated 1413 patients from the
advanced stages of heart disease.
"10,682 deaths in New York City in 1916 were attributed
directly to organic diseases of the heart, a number greater
than either tuberculosis or cancer.
"Deaths caused by organic heart disease 10,682
Deaths caused by tuberculosis (all forms) 9,622
Deaths caused by cancer 4,702"
The economic loss due to impaired circulation is
very great. In addition, children with a handicap of
heart disease present a serious problem for parents, the
school, and society in general. To prevent heart disease
and to maintain a high level of circulatory efficiency
are important goals.
The Increase in Circulatory Disease. — ^We have become
accustomed to think of the seriousness of tuberculosis
and cancer; the preceding figures make heart disease
appear truly significant. These figures are part of a
general fact borne out by statistics, namely, that in the
United States there has been since 1890 a steady in-
HYGIENE OP THE CIBCUIiATOKY SYSTEM 241
crease in mortality from diseases of the heart, blood-
vessels, and kidneys. These three are so often found
associated that clinicians use the term "cardiovascular-
renal disease." By better child care, by improved sani-
tation, and other pubhc health measures the mortality
from the communicable diseases, especially in youth,
has been decreased, but the number of persons dying
in early adult hfe is increasing. This increase in deaths
due to circvilatory or kidney disease suggests serious
questions concerning the vitality of the people and
their habits of living.
Now while the mortality from this cause is increasing
in the United States, the expectation of hfe in the same
adult periods is more favorable in England, Wales,
Prussia, Sweden, and other European countries. The
meaning and significance of this increase in the chronic
degenerative diseases has been brought out by the Life
Extension Institute, Inc., and the cause for this increase
expressed by Fisher and Fisk.^
The chief factors in causing chronic diseases are the
following:
CAtrsES OF Chronic Disease, Premature Breakdown, and Pre-
mature Death
Heredity. Mental inactivity.
Infections. Physical inactivity.
Poisons. Too much food.
Mental strain. Too little food.
Physical strain. Badly balanced diet.
Accidents, injury.
A knowledge of these causes plainly points the way
to their control.
Plan of the Circulation. — To watch the circulating
blood in the web of a frog's foot, to see the contracting
heart of a man in a fluoroscopic picture, to watch the
clotting of blood and the separation of the plasma are
wonderful glimpses of Nature's marvelous provision
' Fisher, I., and Fisk, E. L.: How to Live, Funk & Wagnalls Co.,
New York., 1921, p. 393.
16
242 PERSONAL HYGIENE APPLIED
for life processes. The study of the circulation in a book
is a prosaic affair compared to the ebb and flow of its
tide in the human body.
A rather helpful analogy may be drawn between the
circulation of the blood and the water-supply system
of a large city. A water system is made up of powerful
pumps, water mains, and the water. The body circula-
tion is composed of a powerful pump, the heart; mains
that are adjustable in size, the blood-vessels'; and a liquid,
the blood. For purposes of discussion the system will
be presented under three headings — ^the blood, the vessels,
and the pump.
The Blood. — One-twentieth of the weight of the body
is blood. If an individual weighs 140 pounds, 7 of the
140 are blood. One may lose one-fourth of the blood
and Uve, but the loss of one-third is usually fatal, unless
immediate transfusion is performed.
The discussion of this chapter will follow the outhne of
the composition of the blood as given in Table VIII, and
will conclude with the heart and vessels.
Red Blood-cells. — The red cells (red corpuscles) of the
blood are small, circular, disk-shaped bodies. The
diameter of one is 7.7 micra (1 micron = 0.001 mm.);
it would take about 25,000 micra to make 1 inch. There
are 5,000,000 red cells in every cubic centimeter of blood
for man, and 4,500,000 for woman. These cells are
important because of a very vital function they perform
in carrying oxygen to the tissues from the lungs. They
are able to do this by virtue of having in their cell bodies
a substance, hemoglobin, which has the property of com-
bining chemically with the oxygen as it passes through
the lungs, thus forming oxyhemoglobin. In this form
all the oxygen, except a small amount in solution in the
' Only the smaller arteries are adjustable. The veins and large
arteries do not change their lumen, neither do the lymph-vessels.
The inclusion of the lymph circulation in the circulation of the blood
is desirable for purposes of this discussion. It is not illogical to do
so, although the flow of lymph from the tissues to the heart is in
special lymph-vessels (lymphatics).
HYGIENE OF THE CIBCULATOBY SYSTEM
243
rCeUs
BLOOD
Plasma
TABLE VIII
Composition op the Blood
f Red Blood-cells / -r „„i,„„„i.„_
White Blood-cells ( 1^°^^^^,
[platelets I Lymphocytes
f Water
C Oxygen
Gases • Carbon dioxid
, Nitrogen
f Carbohydrates — Glucose
Food-stuffs Fat-Fatty acids , .
I I Serum albmmn
[ Protein i Serum globulin
[Fibrinogen
Chlorids " - — . ■
Carbonates
Sulphates
Phosphates
Sihcates
Salts
of
Calcium
Sodium
Magnesium
Potassium
Iron
Protective substances
Autacoids — ^Internal
glands.
I urea
xanthin
Opsomns
Agglutinins
Bacteriolysins
secretions from ductless
hypoxanthin
quannin
adenin
plasma, is carried to the tissues and is given up to the
cells of the body when needed. There is no mechanism
for storing the oxygen in the body, and as soon as the
oxygen leaves the red cell it is used in the oxidation
of some food element.
The hemoglobin of the red cell is extremely important.
If it is inadequate in amount in the body a condition
known as anemia develops. Anemia may result from a
decrease in the percentage of hemoglobin in each cell
or by a reduction in the total amount in the blood through
a diminution in the number of cells. In the one case
the cells are usual in number, but contain less than the
normal percentage of hemoglobin in each cell; in the
other the hemoglobin may be normal in amount in each
cell, but the number of cells is reduced, and hence the
244 PERSONAL HYGIENE APPLIED
total amount of hemoglobin in the blood is lessened.
Anemia is a very common condition, especially in young
and growing girls, and it is, therefore, important to
determine its causes and prevent its occurrence.
Dr. Cabot^ gives the causes of anemia as follows:
(a) Hemorrhage — gastric, hemorrhoidal, traumatic, puerperal.
(6) Malaria, more rarely sepsis or other infections.
(c) Malignant disease (cancer).
(d) Chronic suppurations (old sores with discharge).
(e) Chronic glomerulonephritis (Bright's disease).
(/) Cirrhosis of the liver (inflammation and destruction of normal
liver cells),
(o) Poisons, especially lead.
(A) Chronic dysentery,
(i) Intestinal parasites.
The explanations in parentheses are mine. — J. F. W.
Now the causes of anemia are well known. In any
effort to correct anemia and secure good blood the first
step must be to remove the cause of the disturbance.
This cannot be done by giving iron or a similar blood
"remedy" unless the source of the trouble is removed,
e. g., cancer, malaria, intestinal parasites, etc.
It is interesting that Dr. Cabot does not include the
cause that is so commonly thought of by the layman,
namely, lack of exercise, fresh air, and good food. In
speaking of this point Dr. Cabot says, "It is important
to remember that insufficient food or even starvation
does not produce anemia,^ and so far as we know no
form of bad hygiene has any notable effect upon the
blood. Persons may grow very pale under bad hygienic
conditions, but their blood is usually not affected un-
less one of the diseased conditions mentioned above is
present."
Bad hygiene in connection with diseased conditions
aids the development of anemia, and the need of favor-
' Cabot, R. C. : Physical Diagnosis, 5th edition, Wm. Wood &
Co., New York, 1912, p. 447.
" Selenksy, McCollum, and others have shown that food deficient
in certain substances has marked effects upon the condition of the
blood.
HYGIENE OF THE CIRCULATORY SYSTEM 245
able hygiene in overcoming the effect of anemia is well
known by many who work with the sick and diseased.
In this connection it is necessary to speak of medi-
cines in the cure of anemia. Hemoglobin contains iron,
and for this reason iron has been used for many years
in the treatment of anemia. It is most often prescribed
by physicians in a form known as Blaud's pills. These
consist of ferrous carbonate and must be prepared fresh.
Other methods of administering iron are employed, but
the most valuable way to get iron into the blood is through
the food eaten. It is a known fact that certain foods
are rich in iron, and the most effective way at times to
give iron to the body is by securing in the diet food-
stuffs that are rich in iron. (See Table V on page 175.)
In the individual weighing from 132 to 154 pounds
there are about 3 grams of iron. In numerous experi-
ments to determine the amount of iron needed to sus-
tain the equilibrium of the body Sherman^ reports that
"the requirement appears to have varied with individuals
and with the nature of the diet from 0.006 to 0.016 gram
(6-16 mg.) of iron per man per day." In estimating
the amount of food rich in iron required Sherman says,
"We might conclude from these results that a daily
allowance of 10 to 12 mg. of food should suffice for the
maintenance of iron equilibrium in an average man
under favorable conditions, but until the conditions
which determine a larger metaboUsm of iron are more
clearly defined it would seem desirable to set a higher
standard, perhaps 15 mg. of food iron per man per day."
Those who desire to enrich the blood with iron will
have more success by eating food^ rich in iron than by
taking iron internally. Taking iron into the stomach
' Sherman, H. C. : Chemistry of Food and Nutrition, The Mac-
millan Co., New York, 1920, p. 299.
' Care must be taken not to be misled by advertisements. Manu-
facturers and distributors frequently create or capitalize a popular
interest in health without assuming responsibility for results. Just
now "Have you had your iron, today?" is a famihar slogan. Figure
18 and Table V will indicate accessible sources of food iron.
246
PERSONAL HYGIENE APPLIED
and depending upon the processes of absorption and
assimilation to change this medicinal iron into blood
iron is a doubtful measure.
Appreciating the desire of people to have good blood,
imscrupulous manufacturers put on the market and
widely advertise preparations which are supposed to
have a peculiar power of conveying iron to the blood-
Physicians Explain Wliy Women Need More
iron ill tlieir Blood To-Day than 20 Year^ Ago
Sfty Ai»en^«~jUck of Iron It QrMt«st Cune to the Health, Strength> Vitality and Beauty
of the Modan Am«ican Woman.
DR. FERDCfAiJO TttHG. Sew \wk
nirslclan snd lir«dli!al anthor, aj\
pkyslelaus sbonid prescrlUe moTA
er^le troa — Knxated Iroit^to
'aopplr tbe Iron deflclencr- OpiD-
•Ions «t Dr. Schayler C. jMines,
Tlsttlnff Surscon, St. Ellialwth's
. HoiipltaI,?feivl['orkCltr;]lr. Jomeg
' JPnnda SultlTan. formcrlT Fby-
^tclan ol ScUeraft HAspltnl (Ont*
' -door Bcpt). Stvt Ynrif and tbe
IVcstebester County Hoapltnl, and
other phyfilclans who fare tbor-
onffkly tested tlie ralae of >'axated
Iron.
Any woman who tlrea eailly, li| nervona
BT ItrlMble, or loolti pale, hiRard..and
voro, Bhould at once qbvc bnr Dloott ex-
UDlaed for Iron iieiIcleDi:>''-a([iiilnl!itratloD
bt itmplo NuxBteil IronivllI oflen iDerfFiHo
Ue atrcngtU anil cDdurAuee «( wtali, ukt-
ona, i-nron'orii vomcn lu [rou icn to touc-
tcen ilfkja' tlmr.
_, _ York
phralclan and Medical Antbor. " I hnta.
■tcoDgly eupbaalKed tba fact tbit docton
'•bouin pceacrlbe inar« orirBDlc Icon — Snx-
•Md iron— for their iierrouR, run-donn,
wank, tiaKiriird-lMibInK women iMIIeutK.
rPaliar mcaua ftnairniia. Tba akin of nn
Aiuanile WDnan la ipHic, the flelii IJabby. <
iTba muKlda lack tone, th« bratu taaa, and
UBjnBii)*>f/ l^)*i Bna oft^D tbor. become :
Tie Chiles Apjieal—What Xs Your Aaswer'
"Kotber, why
don't yon taJteNVX-''
ATEDIBONandbe
strong Mdwell an'd hftTi^
Blcc,roay dieaks Instead
of being BO nervons and
Irritable aU tbe time and
loofcluff' so hugffard and
old— H'he doet'or m^^
gome to Snsle Smlth'a
mother and she was
worse oD than yon are
and now she looks years
youttxer and feels Just
fine.*
...Ton can ^^-^^^ teUthewomen
beanUfal healthy rosy-cheeked women fnll ot
Ule, Vim and VJtaUty— nhUe those who lack
Iron are often cross, nerroBs, Irritable, weak,
Urei^ eomplalnlngr creatures whom nobody
/wants to Iiavo around, ^
Fig. 25. — Nostrum manufacturers seek to obtain reliability and sanc-
tion for their nostrums by securing a physician's endorsement.
cells. As illustrative of this type of "patent medicine''
business the advertisement (Fig. 25), appearing in numer-
ous newspapers, is reproduced.
The advertisement in Fig. 26 has appeared also in
many newspapers.
Regarding Nuxated Iron, the Journal of the American
Medical Association^ makes the following remarks:
* Journal American Medical Association, October 21, 1916, p. 1244.
HYGIENE OF THE CIRCULATORY SYSTEM
247
"Nuxated Iron is put on the market by the Dae Health Laborar
tories of Detroit. On the trade package we read:
" 'FORMULA.— The valuable blood, nerve force, and
tissue properties of this preparation are aue to organic iron
in the form of ferrum peptonate in combination with nux
vomica, phosphoglycerate de chaux, and other valuable
ingredients.'
TUB H*TIOHAl SVHDAt UAeAtlMg
$50,000 Ty Cobb "Comes Back**
Nuxated Iron Makes Him
Wimier— Greatest Baseball
BattMT of all tinw Mjra Nuuted Iron filled him iHth renewed Itff after ho wm
weakened and all run down. Suppllee that "itay there" iitrenrtb and vtm that
makes men of mark and women w power
wiuir m Uua coQBlfT aad Eatopt, «■■
pUfau whj Ukbic hon caabkd T> CtXk
to "C^me bkck** w qniddr end ilKiw suck
Um*Mou» rtfcnith mai MJeriice. Saye
qrdliiMir BUXMted ir^ will aftcB iaereaia
IkeibwncUi and
. Ktw VortE, y V — Vlus iDlnrifwcJ b
la tputmrat al Rmton UaX Tf OiUb
Mid "Hiudndi of puph «TiM to DC I*
JnnrbgH 1 Inia jnd^ntut I dalokwpiv
Itaat [ora and nidiiy vIikIi bhMm ■■ Is
pbj pnetictUj rmy diy nl
Tlltf iraadA' *h)> I cu pby i
MM em* Mil ihu cbcti
"m Hcm !• ktepiag up ib»
from FARirwniii, pippc, mBiunplJoo.
Mn hw and hart umibk, VIC Jtm
■nd tnifl nuM, irUcb flarle) Iholf jimnn
«il nMhinf Tnon not lea than a weakanni
toDdrlion brauoii db hj tirt bI ina s» Iht
blottd, ImnbalBohuelr ncesBarirlatnabk
youiUood 10 ehiRii lood inio hrini iiBua
Wilb«util,iM nalltr ho* mwt c« irbil
iraa «aL your rood intn\j paii tbnw^
, , j«nk,nk
and ticUt looUu, luK likt a jJant
U}1bi u crow £ ■ aoil dtndn'
. IT fou an 04 atreoii
H Iha WfloaiOE o( ^ pmot
<■ bmlbTa^ but aoeo tna papata fa^H (■
Mala Tj Cobb Km 'nnirMk' He b
MtlMa up tba old auidi " Tlw hmm ~ ~
iras-fNualtd Ino eOed i
■Ubaatballlcani.ytliiitlioulplutjpofli^
lo tnir blood I vouIdBt b* wirlh too aaalk
Hnniad Iran aupvlM thai *Wqr OmT
•trcBith lod yim llat
toakti mea of oark a^
•oaaa of powtr. I bcGnv
•nfjnine «vuU b« bclM
«tt. onlfM Ihc]) Inn aomr
meHam Mvnk IrouUt, lo
K'l dDcUftaji and tako
latad ' — '- "■
■RlkKiibauibaaoBuntiiiad Km
Uk«l*ol>T« niio UbhtaoToMi-
narr Buiaud irea Ihm timo nt
daji aftar modi (or tsa «««ta.
T6*n 1*1 yoltiMnnph apio and
, ••• roi younBUOoiTDnA jirtlitn
IHW* t han «aaa .xkvnt rf Mnnua
fua-don paoplt wtm.wtit ailud all Ihf
«AA^doub)« rti(valra%lhand tndtrann
•nd OBlindjr irt nd at aD aymplotw of
tljifilM; bvtf and ' othtr ireublta M
taw In to loortan dan lun* dknp^ fai
UkiDC mm w Iht noon Ivm. AndUifa
oTtor Ihin bd In aoM cw« bvo doctorinf
iDroaoUt wJibBul oWaiBnit oai bcnafll.
Bui doB'l Uko tho old tnitm J foducnl
ina, koa otouio a( Inclui* ol fren rimslv
''••'■ ■PwyaB**' dft poo aof fad. othoBkl H mi* fmi ■
tw feme i»4er «ontitMuarifs - "
•luMi tritm I wae ^Mupa.a(UMtarpru(H|MBrhai
1 III II MM *?* ^f ■nw']' ttaoiaa ha knoa Ib^M —
•"'"'"* •( p«t alftwili and tndiMii* and Alkd
^^ ;_V** P^ #gB M drfaol ao^dy (at ifct fctta
~ Hiiyi'gBo '
<n«,M tod iMlMiMmM^MaMfcm^mdrB— —
I and boiIp ig *j*i iMMiB. » .p*n^-w*i ^
btuoiai ahb Iba buaraMy -of B^aSyST.S aKfT toSZKZi ,
ta I haio aold a hundnJ luaa —gfcM fc * ■»¥ 'g'iW'Jw Jfey iCCi '
I a (h. VMM of aU tW«t>ilh Effi'irV™!tSjfcSiti?v2S3
■ bt rPtn. No* al M a nliwla of
■oM eonpfecatao tnrocuc aoaiUDM." tia fiM '
Hollpiuti«BkB>M<>maUiOTato*«d imk
■Mil* half o BaMsnoldaBd Hkad no M mw im. . _ _ _. . _ _ .__■■■,_--
riio Um a HdBdMnr cnmbaliiia te Eta bulMm. tl wpb aould anlp thn» oaip lanf Mt unpia M ^ _h . .m. K
bnMBM. T aoi aKMriibed lo^ fad bno paMot aoJuhiaa and a«»Ma eeaoaabMa r-¥. "^ jryj*?; ^ST; ,-, '*7'-'?W!
wllfc tfoHmilwiMiiia III II Imi ilTl 1 na sod lota Aapio wualad tnm,\ am *» miiMiMaitfj^riMrStt^r f^ ■■
Mjrti£r^!oag.^ioBgM» TOW jto^a** >>■""■ c'fcii"'^ es?wisi*iSscsjrgasi^aBg
■Greatly reduced plioto^raphic reprodudtioii of a typical "Nuxaicd
Iron" newspaper iadvertiseineiit. ■
Fig. 26. — Before Mr. Willard lost to Mr. Dempsey the former was
advertised in a manner similar to the above.
"Packages of the nostrum purchased on the open market were
subjected to analysis both in the Chemical Laboratory of the
American Medical Association and elsewhere. Qualitative tests
indicated the presence of iron, calcium, magnesium carbonate.
248 PERSONAL HYGIENE APPLIED
glycerophosphate, and small amounts of potassium and chlorid, and
the presence of cascara. Quantitative examinations were made, and
so far as the essential ingredients — nux vomica and iron — of the
nostrum are concerned, gave the following results:
Total nux vomica alkaloids per tablet zhs grain.
Iron (Fe) per tablet ^ grain.
"According to these analyses, there is only one-twenty-fifth of a
grain of iron in each 'Nuxated Iron' tablet, while the amount of nux
vomica, expressed in terms of its potent alkaloids, is practically
negligible. If a person wants to take iron on his own responsibility
— and this cannot be recommended — ^it is possible to get this drug
in a staple form in the well known Blaud's Pills. In a dollar bottle
of 'Nuxated Iron' the purchaser gets, according to our analysis, less
than 2i grains of iron; in 100 Blaud's Pills, which can be purchased
at any drug store for from 50 to 75 cents, there are 48 grains of iron.
The claim that 'Nuxated Iron' possesses great advantages over
other forms_of iron is the sheerest advertising buncombe."
One part of the patent medicine fake is to give the
preparation seeming reliability and character by using
the name of a physician in the advertising matter. The
Journal points out that the physician used to endorse
Nuxated Iron is without professional standing.
This preparation has been dealt with at some length
because it represents a group of nostnmis that advertise
to procure health for the individual, and all their adver-
tising and medicine are directly subversive of health.
The individual who seeks to hve a complete and effective
life will leave out of account all such commercialized
products. Health comes from living in the right way
and cannot be secured by taking patent medicine. If
one is sick, then health can be obtained only by an
accurate diagnosis of the malady and by appropriate
treatment to overcome the disease. Moreover, the
chances of success in diagnosis and treatment are better
with a regular physician in charge of the case.
As regards the use of iron preparations in the treat-
ment of anemia, there is accumulating evidence that the
giving of iron is tmscientific. The theory of Bunge,'
1 Hatcher, R. A., and Wilbert, M. J. : Pharmacology of Useful
Drugs, American Medical Association, Chicago, 1915, p. 362,
HYGIENE OF THE CIHCXJLATORY SYSTEM 249
that organic iron was more serviceable in anemia, is no
longer held by pharmacologists, although urged valiantly
by interested manufacturers of organic iron preparations.
Recent experimental work at the George Williams Hooper
Foundation for Medical Research by Whipple and Rob-
scheit' shows that the usual iron preparations prescribed
are inert so far as the effect on anemia was concerned,
and that dietary treatment was at once helpful and
constant in its effects.
We are coming back in this instance as in so many
other cases to look to suitable food, proper care of the
body, and correct habits as more useful than drugs in
rebuilding devitalized bodies. Potent drugs will always
be invaluable help to the physician in the care of sick
persons, but hygienic living is the foundation of all sane
procedures for both weU and sick.
White Blood-cells. — ^The leukocytes of the blood are
concerned primarily in defending the body against a
sudden attack of bacteria. They represent the Light
Horse Cavalry of the blood, and when infection occurs
they respond by a great increase in numbers, and an
immediate mobilization at the site of the infection.
The lymphocytes are concerned in protecting the body
in the more chronic diseases, and their number is in-
creased usually in the course of such diseases.
The white cells are strengthened and made better
soldiers for the protection of the body by means that
increase the general health of the body. There is an
increase in leukocytes in the blood after vigorous mus-
cular exertion, cold baths, and massage. These measures
tend in proper conditions to increase the general health
and by increasing the number of leukocji;es they increase
the resistance to disease. In disease the coimt of these
cells has important meaning. Experience shows that
the higher the percentage of leukocytes, the severer the
^ Whipple, G. H., and Robscheit, F. S.: Iron and Arsenic as In-
fluencing Blood Regeneration Following Simple Anemia, Archives
Internal Medicine, May, 1921,
250 PERSONAL HYGIENE APPLIED
infection, "while the body's resistance is mirrored in the
height of the total leukocyte count." Measures for
increasing the number of leukocytes and maintaining a
high count are valuable in the maintenance of health.
The measures concerned with improving the general
health are the rules of hygienic living.
Metchnikoff has pointed out the way in which the
leukocytes destroy bacteria by eating them. He called
this process "phagocytosis," and gave the name phago-
cytes ("eating cells") to the leukocji;es. In discussing
the substances in the plasma the assistance rendered
these cells by the opsonins will be described.
It is not known just what part the platelets play in
the blood (they are involved in coagulation), and hence
no information can be given with reference to them.
Plasma. — The fluid part of the blood is the plasma.
It is a straw-colored liquid.
(a) PFafer.— Ninety per cent, of the plasma is water.
It serves to carry in solution the food-stufis, salts, and
waste substances. Its percentage in the blood remains
fairly constant. When water is taken into the stomach
it is absorbed either partly there or after it has passed
into the intestines and colon. Whenever the percentage
of water in the blood rises above a certain point it is
eliminated from the blood by the kidneys. It may be
retained in the tissues in large amounts in certain diseases
when the kidneys and heart are affected, or when the
tissues are loaded with salt due to the diminished power
of excretion.
Most people in health drink too little water rather
than too much. In addition to the water taken in food,
it is desirable to drink four glasses. This should be dis-
tributed between meals and on rising in the morning
and on retiring at night. The question of hot water and
drinking at meal times was discussed in Chapter VII.
(6) Gases. — The presence of nitrogen in the plasma is
of no importance. It is inert and plays no part in the
function of the circulation,
HYGIENE OP THE CIBCULATORY SYSTEM 251
The carbon dioxid is a waste product of oxidation.
It results from the combustion of food materials. The
plasma carries it in solution and it is also found chemically
combined with the alkali of the blood in the form' of a
bicarbonate. The fact that carbon dioxid, an acid,
combines with an alkali is significant in that it indicates
the way the body acts to keep the blood from developing
acidity. Acidity of the blood develops in physical over-
work, in certain kidney conditions in which the acid
of the blood is not removed by the impaired kidney,
and in heart and lung deficiencies in which the excess
carbon dioxid is not removed rapidly enough.
A competent heart and blood-vessels are most important
in maintaining the proper condition of the blood, and an
efficient respiratory system is necessary to remove the
excess carbon dioxid as fast as it is produced. It is the
height of folly to take measures to change the character
of the blood when the diflficulty lies in the condition
of the digestive, circulatory, or respiratory apparatus.
The oxygen is carried in the blood both in the plasma
and in chemical combination with hemoglobin in the red
blood-cells. ' As stated above, an adequate supply of
hemoglobin is essential in transporting oxygen to the
cells. There are a certain number of people who are
living constantly below the level of their best, because
they are unable to carry to their tissues the proper amount
of oxygen needed. A series of examinations made on
school teachers gives the following figures on morbidity
as presented by Terman.' It should be noted that cir-
culatory conditions are prominent in the types of illness
presented, and although more prominent for women
than men, are factors of importance distinctly related
to the other diseases in the table shown on page 252.
> Terman, L. M.: The Teacher's Health, Houghton Mifflin Com-
pany, Boston, 1913, p. 16.
252 PERSONAL HYGIENE APPLIED
The Distribution op Illness Causing Absence
Nervous troubles
Pulmonary tuberculosis
Other respiratory troubles . . . .
Anemia and general debility . .
Gastric and intestinal troubles
All other illnesses
Male elemen-
tary teachers,
per cent.
32.3
7.9
17.9
5.5
8.9
27.5
Female ele-
mentary
teachers,
per cent.
36.0
6.0
16.8
12.0
7.6
21.6
Female infant
school
teachers,
per cent.
31.2
9.3
13.7
12.7
8.8
24.3
These figures for teachers are given because they
represent the blood and health disturbances in an occupa-
tion that is indoors and distinctly sedentary.
The improvement in hemoglobin content following
an outdoor life in a girls' camp where good food, adequate
rest and sleep, and outdoor air and exercises were pro-
vided is shown by the following figures:
Group of Forty Girls. Ages Twelve to Eighteen Years
Average gain^ in hemoglobin in nine weeks = 7 points.
Greatest gain in hemoglobin in nine weeks = 20 points.
(c) Food^stuffs. — Other important constituents of the
plasma of the blood are the three groups of food-stuffs: car-
bohydrate, fat, and protein. The blood and lymph streams
are the only channels by which the food from the digestive
tract can be transported to the outlying cells of the body.
The character of the blood and its rapidity of movement
are vital hnks in the whole matter of feeding the body.
Its nourishing power is dependent upon the carbo-
hydrates, fat, protein, and other substances present.
1. Carbohydrates. — Sugar is constantly in the blood
in a proportion of 0.1 to 0.15 per cent. This amount
is provided by the glycogen supply of the liver, and when
during activity the muscles use up the sugar of the blood,
I Normal hemoglobin content of the blood is 100 per cent.
HYGIENE OF THE CIRCULATORY SYSTEM 253
the liver at once supplies an amount suflScient to keep
up the margin. The supply of glycogen under normal
conditions is maintained chiefly by the carbohydrate food.
If excessive amounts of sugar are eaten so that the liver
cannot effectively store the amount ingested, the over-
supply in the blood will be eliminated by the kidneys.
There should be a balance between the supply of energy
foods and the expenditure of energy. Practically, this
means that if one eats large amoimts of energy foods,
one should engage vigorously in muscular work. Con-
versely, if one Works hard at physical labor, there is
required sufficient energy foods to supply that expended.
Any other arrangement wiU result either in loss of weight
or increase of weight due to the oxidation of the cells
of the body, on the one hand, or the storage of the surplus
in the body cells on the other.
2. Fat. — Fat is digested in the intestine and broken
up into fatty acid and glycerin. These two substances
are absorbed, and after passing through the epithehum
of the intestinal wall they are synthetized into fat of the
form characteristic of the particular animal. It is found
in the blood, therefore, as fat, and as such it is trans-
ported to the cells. As absorbed it may serve different
purposes.
1. It may be at once oxidized and provide energy in the form of
heat.
2. It may be stored in the body cells as fat.
3. It may be combined with other substances to form some com-
plex constituent of the body, such as lecithin.
4. It may be changed into sugar and serve the body in that way.
The fat of the body as stated by HoweU^ "originates
partly from the fat of the food, particularly in carnivora,
and partly from the carbohydrate of the food, especially
in herbivora, in whose diet this food-stuff forms such a
large part."
There is a good deal of interest in the question of why
• Howell, W. H.: Text-book of Physiology, W. B. Saunders Co.,
Philadelphia, 1910, p. 877.
254 PERSONAL HYGIENE APPLIED
some people become fat and others on similar diets fail
to take on weight. Voit has stated that this difference
is due to the varying capacity of individuals to destroy
food materials in the body. When food is eaten, digested,
and absorbed in excess of the energy requirements of
the body, the excess is stored partly as glycogen in the
liver, but chiefly as fat. Some people who eat a great
deal of food are unable to completely digest or absorb
sufficient amount to acquire an excess. Moreover, as
Howell' states, "A diet which wiU give such an excess
to one individual, may in the body of another of the
same weight be all consumed." Differences of this
kind are frequently inherited. Individuals who have
little tendency to lay up a store of fat may be made
to do so by increasing the amount of fat and carbohydrate
in the food and by changing the mode of life. Individuals
who worry, who expend large amounts of energy in fret-
ting and aimless movements do not store fat easily.
Unless the thinness of the individual is marked, there
should be no desire to lay up a store of fat. It is so much
extra weight to carry and is valuable only as an indication
that nutritional processes are active and pronounced.
Fat on the body is hke money in the bank without interest.
It pays no dividends and should not be sought for its
own sake. The hygiene of living that makes possible
the deposition of fat may be very desirable, but fat
itself is of no particular^ import except for those under-
weight. The role of fat in such cases seems to be that
of a reserve food supply.
3. Protein. — The protein of the blood exists in three
forms — serum albumin, serum globulin, and fibrinogen.
The history of protein in the body is uncertain and
not as yet clear. Whether or not in the process of diges-
tion the complex protein molecule is split into its final
divisions, the amino-acids, and then built up from these
units into more coinplex body proteins, has been a source
of some discussion and much investigation. We are
1 Howell, W. H.: Loc. cit., p. 879.
HT6IENE! OF THE CIRCULATORY SYSTEM 255
not at all certain just what goes on. It has been shown
in numerous experiments that proteins have a specific
"dynamic action" in the body in that they facilitate the
building-up processes of the body to a greater extent
than do fats or carbohydrates.* For the growing child
proteins are more essential than for the adult. The
tendency of the day is for people of adult years to eat
less meat and obtain the protein necessary from vegetables.
(d) Salts of the Blood. — In addition to the water, gases,
and food-stuffs, the plasma of the blood contains im-
portant salts. They serve a variety of functions. The
inorganic salts of the blood are valuable in maintaining
normal osmotic pressure in the tissues of the body and
in some way are combined in the chemical composition
of the cells, and are necessary to normal action by the
cells. The salts of calcium are important in the coagula-
tion of the blood and the curdling of milk, and the sodium,
calcixun, and magnesiiun play a useful part in the con-
traction of the heart and the irritabiUty of muscular and
nervous tissue. The part played by the iron salts in the
production of hemoglobin has been described.
1. Special Considerations. — It is estimated that the
average man takes with his food from 10 to 20 grams'*
of salt in the form of sodium chlorid a day. This is in
excess of the needs of the body because one may keep
in good health with only 1 to 2 grams in the diet. Bunge
has shown that men and animals hving on a pure meat
diet evince no desire for salt in addition to that in the
food, but on a vegetable diet there is an intense craving
for salt. This is due to the fact that vegetables are rich
in potassium salts which combine with the available
sodium chlorid, giving potassium chlorid and sodium
sulphate. One may eat too much salt in the food; there
is no danger in eating too little, if the proper selection
of foods is made.
» Burge, W. E. : Reason for Specific Dynamic Action of Protein,
American Journal of Physiology, March 1, 1919.
' Ten to 20 grams = J to f ounce.
256 PERSONAL HYGIENE APPLIED
There is reason to believe that the abnormal enlarge-
ment of the thyroid gland may be due to the absence
or presence of certain salts in the diet, because of the
geographic distribution of many cases.^ Goiter may
show at puberty, but it usually is temporary. The thyroid
also may enlarge at the menstrual period. The pubertal
and adolescent enlargements of the thyroid are usually
without significance.
The importance of habitat in connection with the
development of goiter is given by Osler^ as follows:
"Goiter, on the whole, is rare in the United States; it is perhaps
most common in the region of the Great Lakes. In an investigation
in Michigan Dock found a large number of cases, and the disease is
not very uncommon in lower Canada. In England it is common in
certain regions: the Thames valley, the Dales, Derbyshire, Sussex,
and Hampshire. It is very prevalent about Oxford and the upper
Thames valley. In Switzerland, in the mountains of Germany and
Austria, the mountainous districts of France, and in the Pyrenees
the disease is very prevalent. In the regions of Central Asia, in the
Abyssinian Mountains, and in the Himalayas there are many foci
of the disease."
The cause of the disease is not clearly known, but
there is considerable evidence to indicate that the char-
acter of the water drunk may have something to do
with its occurrence. On this point Osier' says:
"The water in goitrous districts is hard, rich inlime and magnesia,
poor in iodin, and (so Redin affirms of the Swiss waters) with a
high degree of radio-activity. Others speak of a 'miasma' of the
sou that gets into the drinking-water. McCarrison in Kashmir
found that the specific agent could be killed by boiling the water and
that it did not pass a Berkefeld filter. He produced goiter in himself
and others by the daily consumption of the residue of the filter,
but the residue when boiled was harmless. The disease was trans-
mitted to goats who drank water contaminated by goiter patients.
There are 'goiter springs' and 'goiter wells.' "
' Love, A. G., and Davenport, C. B. : Defects Found in Drafted
Men, War Department, 1920, Washington, D. C. Hayhurst, E. R. :
The Present-day Sources of Common Salt in Relation to Health,
Journal American Medical Association, January, 7 1922, p. 18.
' Osier, Wm. : The Principles and Practice of Medicine, D. Apple-
ton & Co., New York, 1912, p. 82.
abid.
HYGIENE OP THE CIBCULATOBY SYSTEM 257
Irritation of the gland by clothing has been given
as a cause.
Whether the salts found in certain waters cause this
disease, or whether the cause is bacterial or parasitic,
or whether pressure is a causative factor, is open to
question — the exact cause is unknown. With the avail-
able evidence, it is clear that the prevention of goiter
lies in elimination of the factors under suspicion. Per-
sons in predisposed famihes should leave goiter districts
and live in healthy localities. The drinking-water in
suspected areas should be boiled, for experimental evi-
dence indicates that the "cause" may be destroyed by
boiling. Tight collars should be avoided, especially
by those suffering any thyroid enlargement.
2. Use of Mineral Waters. — Mineral waters are con-
sidered valuable in the treatment of certain diseases,
but much of their supposed value lies in the comfort-
able surroundings, the outdoor activities, the exercise,
the baths — all are important factors. Consequently,
the use of mineral water away from the health resort
is frequently disappointing. Persons in good health
do not require special waters; persons with disease should
consult a physician.
The use of spring water in cities is not demanded on
health grounds unless the city water-supply is contami-
nated.
The commercial exploitation of mineral waters has
led to many fantastic health claims. The following
account of Buffalo Lithia Water is illustrative of many
"waters" that are supposed to have mysterious or un-
usual virtues in curing disease. The expos6 given here
appeared in the Journal of the American Medical Associa-
tion and has been reprinted in a pamphlet, "Mineral
Waters,"' describing a large number of fraudulently
advertised waters:
1 Journal American Medical Association, Chicago, June 13, 1914.
Published by the Propaganda Department of the Association, 635
N. Dearborn Street, Chicago.
17
258 PERSONAL HYGIENE APPLIED
Buffalo Lithia Water. — Some years ago Alexander Haig evolved
the theory that most diseases are due to uric acid. The data on
which he founded his theory were not corroborated by scientific
men, and investigation showed that his methods were unreliable.
In spite of the fact that Haig's theories are utterly discredited, and
have been for years, the uric acid fallacy stUl persists, although it is
now largely confined to the public. Shrewd business men, especially
those who are more intent on making money than they are concerned
with the manner in which that money is made, owe much to Haig's
theory. As a business proposition, uric acid has been one of the
best-paying fallacies on the market—and possibly still is.
MEDICAL OPINIONS OF
KiEDICALOPINlONS OF
BUFFALO
LmnA WntR
now AND THEN
Fig. 27. — Showing how "Buffalo Lithia Water" in the course of
time became "Buffalo Lithia Springs Water." The government has
shown that, to obtain a therapeutic dose of lithium from Buffalo
Lithia Springs Water, it would be necessary to drink 200,000 gaUons
of the water. The government also declared that Potomac River
water contained five times as much lithium as does Buffalo Lithia
Springs Water.
Contemporary with, and to a certain extent a corollary ofj the
uric acid fallacy was another, viz., that lithium would elimmate
uric acid. This at once gave a good working principle for the pro-
prietary men. Uric acid, we were told, causes disease; lithium, we
were also told, would eliminate uric acid; therefore, Uthium is the
new elixir of life! Could anything be simpler?
Accepting this theory, it was inevitable that mineral waters con-
taining lithium salts should become highly popular. Many ex-
E loiters of mineral waters began to place most emphasis on the
thium salts in their waters even in those cases in which lithium was
present in such infinitesimal amounts as to render its detection im-
possible by any but spectroscopic methods.
One of the best known, because most widely advertised, of the
so-called hthia waters is Buffalo Lithia Water — or what used to be
called Buffalo Lithia Water. After the Federal Food and Drugs
Act came into effect, by which falsification on the label was pen-
alized, the name of Buffalo Lithia Water was changed to Buffalo
Lithia Springs Water. When Buffalo Lithia Water was subjected
to examination by the government chemists it was found to contain
so little lithium that the amount present was unweighable — ^it could
be demonstrated only by the spectroscope. It was evidently,
therefore, not a lithia water in that it did not contain— at least m
quantities that could be consumed — an amount of lithium that would
HYGIENE OP THE CIRCULATORY SYSTEM 259
give the therapeutic effects of lithium. Possibly the coropany im-
agined that by changing the name from "Buffalo Lithia Water" to
"Buffalo Lithia Springs Water" it had cleverly evaded the federal
law. Their argument, apparently, was to this effect: The springs
from which this water is taken are known as Buffalo Lithia Springs;
therefore, it is not a misstatement of facts to caU this Buffalo Lithia
Springs Water.
WHAT IS A LITHIA WATER?
The Supreme Court of the District of Columbia, holding a district
court, has recently given an opinion on the Buffalo Lithia Springs
Water case. The findings of the court are refreshingly simple, and
characterized by that broad common-sense view that is becoming in-
creasingly more common among modern jurists. Read Judge Gould's
opinion as to what constitutes a lithia water:
"Speaking generally, and as an individual of average intelligence
and information, it would seem that if one were offered a water
which the vendor told him was a 'lithia' water, one would have the
right to expect enough lithium in the water to justify its charac-
terization as such, thus differentiating it from ordinary potable
water; and this amount would reasonably be expected to have some
effect on the consumer of the water by reason of the presence of the
lithium."
Certainly a reasonable attitude, and one which the man in the
street not only can understand but will agree with. Then came the
question as to the actual lithium content of Buffalo Lithia Springs
Water, and the court said:
"For a person to obtain a therapeutic dose of lithium by drinking
Buffalo Lithia Water he would have to drink from 150,000 to 225,000
gallons of water per day. It was further testified, without con-
tradiction, that Potomac River water contains five times as much
lithium per gallon as the water in controversy."
(e) Protective Substances. — In addition to the water,
gases, food-stuffs, and salts, there are protective sub-
stances in the blood, serving to save the body from the
ravages of disease. This fact has been known for some
time. About forty years ago Traube showed that if a
small quantity of putrefying material was added to
fresh blood, the blood possessed the power of retaining
its normal condition, and this experiment raised the
question whether the protective power of the blood
resided in the plasma or in the blood-cells. Buchner
named the germicidal constituents of the plasma "alexins"
(defenders).
Metchnikoff was the first to emphasize the importance
of the blood-cells, and he showed how the white cells
260 PERSONAL HYGIENE APPLIED
of the blood swallowed and destroyed the bacteria.
The phagocyte is not always able to win the fight with
the bacteria, and if weakened by unhygienic living or
disease, or attacked by bacteria either more powerful
or more numerous than usual, the phagocji^s them-
selves may be overcome in the contest.
It is also known that there are in the plasma certain
substances that make it possible for the phagocytes to
more readily attack bacteria. These substances are
called "opsonins," meaning "to buy victuals." It is
not known just how they are formed nor what increases
their quantity, but it is known that when these sub-
stances are abundant, the phagocytes are able to devour
large quantities of bacteria; that when these substances
are deficient the phagocytes feed less readily upon the
bacteria.
There are other protective substances in the blood,
probably in the plasma. The story of the scientific
experiments that have been laboriously performed to
determine these secrets of the blood is too long to be
told here. It is a story of great adventure and great
achievement.
It is a well-known fact that persons are protected
from recurring attacks of a disease once experienced.
Most of the communicable diseases, scarlet fever, measles,
diphtheria, typhoid, are, as a rule, capable of infecting
the same individual only once.
The protection afforded to the individual by an attack
of a disease is called "immunity" and is due in part
to certain substances developed in the blood in the
course of the disease and called by the name "anti-
bodies." By this is meant that these substances have
the power of exerting adverse ("anti" — against) action
against the invading bacteria. A description of these
antibodies and the general character of them is so well
given by Evans' that he is quoted in detail on this point:
'Evans, W.: Medical Science of Today, Seeley, Service & Co.,
London, 1912, pp. 89, 90.
HYGIENE OF THE ClRCtTLATOEY SYSTEM 261
"Many animals secrete poisonous substances which they can, at
will, inject into their enemies, and these poisons are called "venoms."
Poisonous snakes, scorpions, some spiders, toads, and salamanders
may be mentioned as examples. In the venoms formed by these
animals there are no germs, but they contain chemical substances,
most of which are of extreme virulence. Some snake venoms are
so potent that it has been calculated that a quarter of a drop is
sufficient to prove fatal to a man within a short time. We may
compare such a venom to the toxine produced by bacteria and it
will be instructive to consider how an antidote to snake venom can
be obtained. It does not appear that the animals that habitually
attack snakes, such as the mongoose and the secretary-bird, possess
any natural antibodies so that they might be bitten with impunity,
for they seem to depend for their safety on their agility. If a series
of very small quantity of snake venom (very, very much less than
would prove fatal) be injected at intervals into an animal, such as a
horse, it will be found after a time, that when a poisonous dose is
subsequently administered, the animal does not die, and in fact
seems none the worse for the dose that would have killed it, if it
had not been protected. This immimity is found to be due to certain
substances, 'antibodies' as we may term them, in the blood of the
animal, and if some of the animal's blood be obtained and the liquid
part, or 'serum,' separated from the corpuscles and the clot, 'anti-
venom' serum, as it is called, is obtained. "The action of the antivenom
on the venom appears to be purely chemical, the two neutralizing
each other, as do an acid and an aUiiali in a test-tube. If a suitable
quantity of antivenom be mixed with a poisonous dose of snake
venom and the mixture be injected into an unprotected animal, no
harmfxil result follows. Again, if a suitable amount of antivenom
serum be injected into an animal and then later a poisonous dose of
venom be injected, no symptoms are caused, for the antivenom
already in the body of the animal has neutralized the venom sub-
sequently injected. Nay, more, if a poisonous dose of venom be in-
jected into an animal, and then soon after the correct amount of
antivenom be injected — in this case also the animal survives un-
harmed. But it is absolutely essential that the interval between the
injection of the poison and its antidote should not be too long. If
the dose of poison is such that would naturally kill the animal in
three houis,_ the antidote must be given not later than one hour
after the poison."
This explanation of the nature of antibodies may be
added to from a description by Vaughan,i who says:
"Immunity due to bactericidal constituents of the bloody whether
it be natural or acquired, is always relative. Even the unmimity
secured by one attack of the disease may be overcome, in most in-
stances at least, by the administration of an overwhelming dose of
'Vaughan, V. C: Infection and Immunity, Commemoration
Volume, American Medical Association, Chicago, 1915, pp. 152, 153.
262 PERSONAL Hygiene applied
the virus in virulent form. ... A highly germicidal blood is of
great value in preventing infection, because the first few organisms
that find their way into the body are promptly killed before they
can mvdtiply and while the amount of poison set free is too small to
produce any marked effect."
In another place he says:
"Normal blood and the serum obtained from it contain non-
specific, bactericidal ferments or enzymes. In normal blood these
enzymes are not specific and they display marked, distinctive action
on certain bacteria, and are wholly without effect with others."
There is, then, normal serum containing general pro-
tective agents, and immune serum containing specific
defenders against specific diseases. This Vaughan makes
clear when he says: "The essential difference between
the germicidal constituent of normal sermn and that of
immune serum is that the latter is specific, while the
former is not." Normal serum may be made immune
by inoculation or vaccination for certain diseases, e. g.,
smallpox, typhoid.
The process of preparing an antisubstance for cer-
tain diseases has developed rapidly in recent years.
The different senmis used so effectively in the treat-
ment of certain diseases are founded upon this knowl-
edge of the protective nature of normal serum and inamune
serum. The aim of medical science in the use of immune
serums of other animals for treatment of disease in man
is to assist the blood by injecting into it antibodies that
have been formed usually in the body of another animal.
It is to be remembered that the blood normally con-
tains substances that have the definite power of destroy-
ing the poisons of certain bacteria. It would be valu-
able to know just how far hygienic living serves to in-
crease the formation and powers of these antibodies.
The exact significance of this is not known, but it has
been abundantly demonstrated that there is a very close
relation between vigorous health and resistance to in-
fection and disease, and this increased power of resistance
probably develops through an increase in strength in
HYGIENE OF THE CIRCtlLATORY SYSTEM 263
the protective substances of the plasma. The drunkard,
the chronically fatigued, the soft hver, and the high
feeder — ^these are types that show a weakened resistance
to infection.' The vigorous outdoor type of man and
woman, active in exercise, healthy in habits, and exact
in body care, promises more in high resistance to infec-
tion than the indoor sedentary type of unhygienic habits
and unwholesome attitudes for living.
(/) Autacoids. — The water, gases, food-stuffs, salts, and
protective substances make the plasma appear exceed-
ingly complex. There are still other important con-
stituents, namely, the secretions of certain glands giving
their products directly into the blood-stream. It is
generally well known that a gland is a group of cells
that produce and pour out a secretion upon some sur-
face of the body. The sweat glands, the salivary, the
gastric glands are familiar examples. These secretions
are carried from the gland by a duct or canal-like passage.
There are other glands that have no ducts and are, there-
fore, called ductless glands. Glands with this structure
are the thyroid in the neck, the thymus which lies above
the heart and disappears during puberty, the supra-
renals above the kidneys, the pituitary gland at the
base of the brain, certain parts of the ovaries, and the
testicles. It has been ascertained that these glands
true to their structure provide a secretion, but instead
' It is not always true that the strong and vigorous endure disease
better than the weak. In some diseases the strong man apparently
succumbs most readily, due to the fact that his metabolic activity
is more rapid and the poison set free by bacteria in the body is broken
up to exert its influence more effectively on the strong than on one
whose metabolism was slower and less thorough. To support the
view that the strong at times more readily succumb to infections
than the weak, Vaughan quotes Boghursts' account of the plague in
London in 1665:
"Of all the common hackney prostitutes of Luteners-lane, dog-
yard, cross-lane, Baldwins-gardens, Hatton-gardens, and other
places, the common criers of oranges, oysters, fruits, etc., all the im-
pudent drunken, drubbing bayles and fellows and many others of
the rouge route, there is but few missing — ^verifying the testimony of
Diemerbroech that the plague left the rotten bodies and took the
sound,"
264 PERSONAL HYGIENE APPLIED
of this being given to the body in the usual way, it is
poured directly into the blood. It is further known
that some of these glands are more active under emotional
excitement. " The active principles of this secretion have
been called autacaids, meaning self-remedy. Autacoids
that stimulate are called hormones, those that inhibit,
chahnes."
From the earliest times there has been a practice to
assign certain virtues to certain organs of the body and
especially in the treatment of disease of the same organs.
Thus it is that the works of Celsus and Dioscorides
advocate the giving of organs from animals for the treat-
ment of disease of the same organs in man. Savage
man in the belief that bravery was a matter of the heart
cultivated the custom of eating the hearts of his enemies
which he had slain in order to increase his own courage.
Throughout the eighteenth century "the lung of the fox
was advised for shortness of breath, for the fox is able to
run long distances at a high speed; the brain of the hare
for tremors, and rennet for disordesr of the stomach."
Very Uttle has ever been determined' concerning the
ways in which man can utilize the internal secretions
so as to enable him to Uve more effectively, but there
are a few indications that emphasize the avoidance of
certain acts in order to preserve his health with reference
to the way in which these glands operate.
The thyroid in the neck usually enlarges during puberty,
but this seems to be physiologic, and with proper living
no untoward results occur. Lack of development of
the thyroid in children may be compensated very largely
by internal administration of thyroid extract, a prepara-
tion made usually from the gland of a sheep.
The secretions of the pituitary gland, the thymus,
and the suprarenals are very important especially in mat-
' The use of animal extracts of the glands of internal secretions has
grown rapidly of late. Endocrinology has not progressed far enough
for the impartial observer to advise with any assurance concerning
general matters or general principles.
HYGIENE OF THE CIBCULATOBT SYSTEM 265
ters of growth and development, but we have no definite
knowledge of the way in which care and attention of the
body may influence the glands in a direct way.
The secretions from the ovaries and testicles are so
important that they make the characters that mark
the female, on the one hand, and the male on the other;
they are essential to the development of the most vigorous
type of manhood and womanhood. It is most important
for women to avoid gonorrhea because this disease fre-
quently invades the ovaries, requiring removal of the
diseased organs. Serious disturbance of health often
follows the artificial menopause produced.
(g) Waste Substances in Plasma. — Even as in a fire in
the furnace there are ashes of the combustion, so in the
body there are substances left by the process of chemical
reaction. These waste materials are called end-products,
waste substances, or fatigue products. The waste from
fats and carbohydrates is chiefly in the form of carbon
dioxid and water; that from protein is more complex
and consists chiefly of the following: urea, uric acid,
and creatin.
The waste as it is formed in the cells of the body is
gradually extruded into the lymph spaces of the tissues,
and thence finds its way into the circulating blood. The
rapidity with which this waste is removed is a good
index of the efficiency of the circulation, and a rapid
removal is essential for the best and most vigorous
health.
There is definite knowledge available regarding the
things that tend to increase the amount of waste, and
that help in the removal of the excess. It is very im-
portant to keep the body as free as possible from sub-
stances that are in their very nature poisonous.
Use of food in greater amoimts than is required by the
body probably results in the same type of reaction in
the body as occurs in the furnace when too much fuel
is thrown upon the fire. The combustion in each case
is partial and incomplete. Any imdue amount of waste
266 PEKSONAL HYGIENE APPLIED
must be removed in order to secure any really effective
combustion at all. Now the waste from fat and sugar
is simple and resembles the smoke of a fire; it is readily
removed. The waste from protein is complex and re-
sembles the clinkers of the furnace in its more complex
character and especially in its difficulty of removal.
So that, to reduce unnecessary waste and to secure most
complete combustion one will not overeat, and especially
one will not eat many nucleoproteins, because they
give rise to the purin bases.
To secure efficiency in the handling of food in the
body, the processes of digestion, absorption, and assimila-
tion should go on in an orderly, economical, and rapid
manner; such action is impeded by overeating and
especially the overeating of meat.
It is important to so live that imnecessary waste is
not produced; that the elimination of waste from the
cells and tissues wiU at all times be facihtated and not
retarded. Exercise, especially of the out-of-door variety,
is absolutely essential in this respect. The contractions
of the muscles aid the removal of waste from the tissue
spaces, move the lymph along to the heart, and stimulate
the complete combustion of food materials.
One so often hears persons speak of the blood as being
"bad," and especially in the spring of the year are some
inclined to think of the blood as being in a "bad condi-
tion." Only recently a student of medicine came to my
office to consult me regarding a pronounced case of acne
(pimples) occurring chiefly on the back and shoulders.
He thought his blood was "bad" and his general feeling
of unfitness he attributed to the same cause.
A simple word picture of this youth and his mode of
hving tells the story. He was accustomed to bathe once
a week or in a fortnight, and the condition of his skin,
as shown both by the sense of sight and the sense of
smell, confirmed his history. His teeth were dirty, and
he said that he "brushed them once in a while." He
took no exercise at all aside from that involved in walking
HYGIENE OF THE ClRCtJLATORY SYSTEM 267
a half mile to school and home again at night. He was
studying disease for the purpose of curing other people,
and yet his whole body was a fit subject for clinical study
in how not to care for the body. It was perfectly clear
that the "badness" in his blood arose from his bad habits
of eating, his lack of exercise, and his total lack of the
most simple and elemental care of the body. All the
pills and medicines in the world, baskets of sulphur
burned in his room or in his body, would not bring "good-
ness" to his blood. The waste products of his body,
the clinkers of the furnace, must first be removed before
any improvement in his skin could be noted.
The reason why persons so often speak of "bad blood'
as accompanying the opening of spring is because one
so often sees people who have lived the most unhygienic
lives during the winter— cooping themselves up in a
hot and ill-ventilated house, overeating, and generally
abstaining from bathing because of the inclemency of
the weather. When people learn to eat moderately, to
exercise regularly in the open whenever possible, to live
in well-ventilated rooms, and to keep the body in all
parts scrupulously clean, then, and then only, will the
question of "bad" blood be removed. Pimples, blotches,
cold sores, eczema,' and many skin disturbances are
often expressions of bad living. God in his wisdom was
not visiting our student with punishments, as was once
believed; he was merely paying the price of living poorly
and at a low level.
The "patent medicine" interests would have people
believe that "good" blood depends upon medicine. Tak-
ing sarsaparilla in the spring will not "purify" the blood.
The only reliable procedure for purifying the blood is
by removing the waste. This may be done by exercising,
especially in the open air, and by lightening the diet.
' Eczema in infants and childi'en may be a phenomenon of pro-
tein sensitization. See The Value of Cutaneous Sensitization Tests
Employed in Eczema and Papular Urticaria of Childhood, Sidlick,
D. M., and'Knowles, F. C, American Journal Diseases of Children,
April, 1922, p. 316.
268 PERSONAL HYGIENE APPLIED
In the diet one should avoid especially pastries, sweets,
greasy foods, all alcohol, and much meat, and should
partake of fresh fruits, green vegetables, coarse whole
cereals, pure milk, eggs, and a httle meat.
The Vessels. — The vessels of the circulation have
been compared to the water mains of a city, but the
Ukeness is in form only. In structure they are very
unUke. The arteries are elastic vessels, the veins are
collapsible tubes with valves.
The elasticity of the arteries permits them to stretch
and respond to the changing demands of pressure in the
circulation. This quality provides a very adjustable
mechanism especially useful during increased physical
activity.
The Arteries. — Loss of elasticity in the arteries results
in a condition known as arteriosclerosis. This may
develop in early adult life or come only in old age. The
cause or causes are not known. Age alone carmot be
regarded as a cause because of the possible factors extend-
ing over many years. Moreover, the condition has been
found in children.
MacCollum* gives an excellent summary of the knowl-
edge of this condition and notes six main points around
which fall the experimental and clinical evidence:
1. Hereditary tendencies have been emphasized by
numerous workers. Osler^ has called attention
to the fact that one may inherit elastic tissue of
poor quality in precisely the same way that one
may inherit defective nervous tissue.
2. Hard muscular work has been cited often as a factor.
As a condition it is always complicated by the
varying standards of personal hygiene. Syphilis
and other infections, abuse of alcohol and tobacco,
toxins, and metallic poisons in certain trades
expose the worker to possible causes.
' MacCollum, W. G. ; Physiological Reviews, January, 1922, pp.
70-91.
' Osier, W.: Modern Medicine, 1915, p. 453.
HYGIENE OF THE CIRCULATORY SYSTEM 269
3. High blood-pressure as a cause plays a contradictory
r61e. Numerous authors cite "mental activity
or overactivity, mental diseases, and various
nervous disturbances" as possible factors in
arteriosclerosis. Others mention diabetes, chronic
nephritis, and obesity as causes.
4. Infections, intoxications, and unbalanced diets are
probably the most important causative factors.
Ophlils shows in an excellent review that arterio^
sclerosis is related definitely to infections, especially
the chronic infections of the rheumatic type.
5. Intoxications of alcohol, tobacco, lead, and intestinal
poisons (constipation) have been popularly as-
signed as causes. The general statements have
not been substantiated by workers in this field.
6. Unbalanced diet s.eems to be a factor, at least in the
experiments with lower animals. Experiments
with rabbits seem to show that animal food in
the diet of the vegetarian rabbit does cause
modification in the arterial wall. The relation
of this to man, however, is not so clear.
These various causes may be regrouped imder two
headings: poisons and overwork. The former would
include the infections and the intoxications; the latter
would include physical, mental, and gastric overwork.
Extreme physical labor, prolonged for years, continuous
overwork in mental tasks, overwork of the gastro-intestinal
tract, with or without proper diet, suggest that an im-
portant phase of the problem is social adjustment.
One needs to get a true perspective to evade the dangers
of modern life. To live the temperate life — ^temperate
in all things, in work, in play, in mental endeavor, in
eating and in drinking — ^is to see straight and keep values
clear. Osier advises to "shun Bacchus and Venus,"
and the disasters that come from sharing company with
those imposters may be avoided.
The Veins. — The arteries are more easily injured, and
yet the veins suffer change that interferes with the activity
270 PERSONAL HYGIENE APPLIED
of the individual at times. The veins are concerned
with carrjdng blood from the tissues back to the heart,
and, therefore, should not be obstructed in any way in
the performance of that work. Valves in the course
of the veins prevent the backward flow that would other-
wise result in a system imder such low pressure and
in part working against gravity. Muscular activity
is very important in assisting the onward flow of blood
in the veins.
One needs to be guided by two principles in preserving
the normal condition of the veins — exercise that will
give assistance to the return of blood to the heart, and
freedom of the venous return flow by not wearing tight
bands, tight garters, tight collars, or tight corsets. The
body should be as unhampered by clothing as it can be.
Varicose Veins. — Varicose veins are broken-down ves-
sels in which the valves and walls have given away
resulting in slowing of the circulation in the part in-
volved. Varicosities result from a variety of causes.'
Prominent in their production is obstruction at some
point between the varicosity and the heart. This may
be due to a thrombosis (inflammation of the wall of the
vein with clot formation), pressure on the vein from
without, as in tumor growth or pregnancy, or to struc-
tural change in the liver preventing an imimpeded return
of blood to the heart. Aside from obstruction it is known
that occupation influences the condition. Prolonged
standing with its accompanying congestion in the legs
accounts for certain cases. It is commonly known that
motormen suffer from varicose veins, while postmen
are peculiarly free from the condition. Athletes engaging
in pole vaulting and high jumping at times develop
varicosities, due apparently to the effect of landing on
the feet violently. The influence of obstructing bands,
' The significance of gravity is shown in the greater frequency of
varicose veins among tall persons. See Statistics, vol. xv, Part I,
Avjay Anthropology, The Medical Department of the United States
Army in the World War, Washington, D. C, 1921, pp. 345, 346.
HYGIENE OF THE CIRCULATORY SYSTEM 271
such as garters, corsets, and belts, is probably also im-
portant in many cases.
Mild cases of varicose veins require no special treat-
ment. Surgery is often reqtiired when supportive treat-
ment by elastic stockings is not effective.
The Heart. — The blood, vessels, and pump were noted
as the chief elements in the circulation. The constituents
of the blood may be normal, the vessels elastic and effi-
cient, and yet, if the pump is unable effectively to dp the
work of pushing the blood to the tissues and forcing back
the venous blood, the efficiency of the scheme is gone.
The heart is made up of muscle and divided into four
chambers that are connected with each other through
valves and vessels. Now, as a pump, it is dependent
upon two factors: the valves must fit tightly and work
properly, and the muscle of the heart wall must be strong
and controlled enough to produce a vigorous heart im-
pulse. Injury to the valves of the heart or to the heart
muscle itself not infrequently occurs. The valves are
dehcate little leaves that are easily injured by certain
forces; the heart muscle is supphed with blood exactly
as are the other muscles of the body and has endurance
or lacks it precisely as other muscles do. It is just as
dependent upon good food as the other parts of the
body, and its importance is fundamental because of the
dependency of other organs upon the circulation. Alcohol,
tobacco, or poisons from disease in the body may ruin
a heart just as bad oil will ruin an engine. In many
ways it is helpful to think of the heart as a httle motor
piimping about 10 tons of blood a day — a tidy job for a
10-ounce motor.
Injury to the Valves. — The valves are most frequently
injured by infectious disease. The bacteria that may
gain access to the blood at the time scar and destroy
the shape of the valves, and prevent them from effectively
controihng the blood in the proper chambers of the heart.
The following communicable diseases are most important
in this respect and, therefore, should be avoided as far
272
PEBSONAL HYGIENE APPLIED
as possible: acute rheiunatic fever (rheumatism), scarlet
fever, tonsillitis, syphilis, and pneumonia. Infected
teeth are also important as a cause of injury to the heart
because they serve frequently as the gateway through
which the organism that causes rheumatism enters the
body.
Table IX, presented by Halsey* from a study of New
York school children, shows the prevalence of certain
diseases in cardiac cases as compared with non-cardiacs:
TABLE IX
Comparison of History op Occurrence op Inpectioits Disease
OP Cardiacs and Non-cardiacs
Cardiacs.
Non-cardiacs.
Number.
Per cent.
Number.
Per cent.
TonsiUitis
82
67
45
23
21
18
17
16
2
8
2
2
1
1
64
45
36
18
17
14
13
12
56
16
176
14
27
1
100
14
17
12
4
18
Rheumatism
Measles
5
68
Pneumonia
Diphtheria
5
9
Chorea
Pertussis
33
Scarlet fever
Influenza
6
5
Bronchitis
Typhoid
Nephritis
Jaundice
Otitis media
Chickenpox
Polyomyelitis
4
1
Total
125
297
It is with regret that one finds parents so often with-
out appreciation of the danger to the child of having the
so-called "children's diseases." It should be emphatically
stated that these diseases do not belong to children at
all and should never be contracted imless absolutely
> Halsey, R. H. : Heart Disease in Children of School Age, Journal
American Medical Association, August 27, 1921, p. 672.
HYGIENE OP THE CIRCULATORY SYSTEM 273
unavoidable. A child of eight years recently seen in the
hospital gave a history of having had scarlet fever,
pneumonia, neuritis, measles, whooping-cough, chicken-
pox, mumps, tonsilhtis. Her heart was badly damaged.
This was to be expected as a result of the infections she
had experienced.
Injury to the Muscles. — ^For years many have felt that
athletics injure the heart because of the intense strain
on the circulation in athletic contests. Opinions are
rapidly changing in this respect today, and most workers
in this field are saying that the heart is not injured in
the performances of athletic events unless there exists
at the time of the participation an infection. Mackenzie,
of England, than whom there is no greater authority
on the heart, takes this position. If the tonsils or teeth
are infected, or if a focus of infection is present anywhere
in the body, vigorous exercise is not desirable. One
who has a normal heart may engage freely in exercise
if the body is free from infection.
The influence of pre-existing disease, metallic poisons,
and emotional excitement are mentioned by Phipps* as
important for those engaged in physical occupations.
Emotional excitement will not injure the muscle, but the
first two will. Phipps says: "Trauma and muscular
strain damage the tonicity or contractility, or produce
an acute dilatation, when there is pre-existing disease;
metallic or bacterial poisons may cause or aggravate
lesions of the muscle, valves, or innervation; emotional
stress may upset the normal rhythm."
The Convalescent Heart.--After a prolonged sickness
or an operation the heart is weakened because of two
factors: the poisons from the disease and the inactivity
of the body. During and following an attack of rheu-
matism or tonsillitis the heart is very hable to injury.
Complete rest in bed during the disease and very gradual
activity afterward are important. No one can afford
'Phipps, C: Heart Disease in Industry, Journal American
MedicEU Association, February 25, 1922, p. 562.
18
274 PERSONAL HYGIENE APPLIED
needlessly to endanger the heart; it is too vital an organ.
Remembering that the heart is a muscle, it will be easy
to comprehend how inactivity weakens the heart by
comparing the effects of non-use of the skeletal muscles.
Therefore, after a period of illness in bed, the individual
should begin, gradually, an active hfe. A sudden exer-
tion before the heart has been strengthened by exercise
may result disastrously.
The Influence of Poisons Upon the Heart. — The
practice by the laity of using certain drugs for colds
and headaches is distinctly dangerous because of the
injury to the heart. Most headache remedies depend
for their effectiveness upon acetaniUd. Acetanilid,
antipyrin, and phenacetin are drugs made from coal-
tar. They have a definite depressing effect upon the
heart muscle. They should not be used indiscriminately.
They are dangerous, and yet there are on the market
himdreds of so-called headache and cold cures, labeled
"absolutely safe," that depend for their effect on ace-
tanilid. Aspirin, widely advertised as a remedy for
colds, headaches, and pain in general, is not without
danger to the heart. Self-diagnosis and self-treatment
of disease are tmscientific and should not be undertaken
by one who aims to achieve for himself the best in the
way of living. Simple disorders requiring home remedies
and home care may, of course, be handled without medical
aid. Disorders, however, that require drugs should have
scientific and intelligent diagnosis and therapy. Only
a reputable physician can give this.
The Influence of Tobacco. — Tobacco presents to the
lay mind a moral question. It is usually discussed on
that basis by the opponents of its use. It is more rational
to discuss it as a health question. Its effect on health
and particularly its effect on the heart has been a matter
of fact for some time.
Investigations carried out on healthy men and on men
suffering from "soldier's heart" by Parkinson and Koefod'
> The Lancet, August 18, 1917, vol. cxciii, No. 4903, p. 232.
HYGIENE OF THE CIBCULATOBY SYSTEM 275
showed the following immediate effects of cigarette
smoking on such individuals:
"1. The inunediate effect of cigarette smoking upon the
circulatory system and upon the breathlessness
of exertion was observed in 30 smokers, of
whom 20 were men affected with "soldier's
heart" and 10 were healthy soldiers. Each
subject smoked either four or five cigarettes
during a period of forty minutes.
"2. A demonstrable effect was recorded in 17 of the
20 patients; the 3 imaffected were non-inhalers.
Nine of the 10 controls, all inhalers, were in-
fluenced in the same fashion, though not to the
same degree.
"3. The average pulse-rate among the patients during
smoking was nine beats higher than before smok-
ing; in the healthy controls it was six higher.
Initial slowing of the heart was never observed,
nor any irregularity referable to smoking.
"4. The rate of respiration in the patients was un-
affected; in the controls it was slightly reduced.
"5. The average systolic blood-pressure was raised
by 5 to 10 mm. Hg., and the diastolic by 5 mm.,
both in patients and controls.
"6. These effects appeared within five minutes; with
the first cigarette they almost reached the
maximimi, and this was maintained throughout
the smoking period.
"7. A simple exertion test was performed before smok-
ing and repeated on its cessation. In the
patients the pulse-rate maintained a higher
level throughout the test after smoking, and
half of them were more breathless both sub-
jectively and objectively. In 2 patients pre-
cordial pain was induced by smoking, apart
from exertion. But in the controls the pulse-
rate cxave during exertion was much the same
after smoking as before, and breathlessness was
induced in 2 only.
276 PEESONAL HYGIENE APPLIED
"8. These observations show that, in health, the
smoking of a single cigarette by an habitual
smoker usually raises the pulse-rate and blood-
pressure perceptibly; and these effects are a
little more pronounced in cases of "soldier's
heart." Moreover, the smoking of a few cigar-
ettes can render healthy men more breathless
on exertion, and manifestly does so in a large
proportion of these patients.
"9. Excessive cigarette smoking is not the essential
cause in most cases of "soldier's heart"; but,
in our opinion, it is an important contributory
factor in the breathlessness and precordial
pain of many of them."
While these circulatory changes can be demonstrated,
it is important to remember that they may not be as
serious in their effect as would seem to be imphed. Cer-
tainly smoking to excess is injurious to health. For
some, one cigar may be "excess"; for others the margin
is greater. For any person "four or five cigarettes during
a period of forty minutes" is marked excess.
A Need for Accuracy. — The leaf of the tobacco plant
is used for smoking and chewing, and in powdered form
as snuil. There are many reasons why tobacco should
not be used by man, and probably few reasons for its
use. With this viewpoint there are some people who
say that a person who uses tobacco is a fool, and that
he will go insane if he smokes cigarettes. Now such
a statement is at variance with the facts. In condemn-
ing or praising any method or practice care should be
exercised in forming a judgment and discretion used in
stating a behef . What does tobacco do to the cells of the
body?' How does it injure them? What may be the
loss in terms of efficiency? These are the questions that
we should be prepared to answer.
1 Webb, G. B.: The Effect of the Inhalation of Cigarette Smoke
on the Lungs, American Review of Tuberculosis, 1918, vol. ii, p. 25;
Krause, A. K. : Tobacco Smoke and Pulmonary Tuberculosis, Amer-
ican Review of Tuberculosis, 1918, vol. ii, p. 99.
HYGIENE OF THE CIRCULATORY SYSTEM 277
General Effects of Tobacco.^ — "In the first place we
know men who are strong physically, keen mentally,
and sound morally, who at times use tobacco. If they
use it moderately, they may reply to our question by
saying "smoking does not hurt me." By such a state-
ment one means that there is no perceptible harm. Some
experiments^ indicate that moderate and habitual use
of tobacco is not harmful to advlts and distinctly helpful
to certain ones.
"It is true that the use of tobacco forms a habit that
tends to increase the amount of tobacco used. This
is the special danger in cigarette smoking. It leads
frequenliy to the use of so many cigarettes that health
and strength are lost.
"That smoking causes undesirable effect upon the
body is shown in the custom of college athletes. Coaches
and trainers do not permit smoking by those who play
on the team, and all athletes who seek -to excel in sport
do not use tobacco.
"We know that smoking impairs one's physical effi-
ciency. A war correspondent, visiting the ItaUan trenches
in the Trentino during the recent war, writes as follows:
" 'As we pushed on, all our old sins of pipes and
cigarettes began to be expiated in our middle-aged hearts.
. . . So we struggled on, the easy perspiration bath-
ing our bodies. Hiatt was doing better than I, being
younger and less guilty of cigarettes. I could force
myself until I could go no further; would stop; would
droop over my alpenstock and pant like a netted
fish.'
"Men who smoke to excess find that they become
nervous, lose their appetite for wholesome food, and
show a distinct loss in efficiency." On the other hand,
many men who smoke moderately testify to the values
J Taken in part from Healthful Living, pp. 413-415, The Mac-
millan Co., New York, 1920.
^ Gies, W. J., and others: Effect of Tobacco on Man, New York
Medical Journal, June 1, 1921, p. 809.
278 PERSONAL HYGIENE APPLIED
they experience in satisfying a habit that for them has
no known deleterious effects.
The Effects of Tobacco Upon Youth.— "The youth
who looks forward to physical efficiency as well as men-
tal efficiency as impoiiant factors in doing a work and
achieving a place in the world, should leave tobacco alone.
The growing boy is injured by the use of tobacco. His
growth is interfered with, his heart is made irritable,
and his stomach disturbed. If the boy thinks he wants
to smoke, he should wait until he is twenty-five years
old; then with developed body and a wiser mind, if the
use of tobacco seems desirable, let him make the choice,
cognizant of its dangers and limitations. Thp youth
who looks forward to excellence in athletics, to achieve-
ment in business or the professions, to authority and
control in store and factory, will select his habits as care-
fully as his friends, his food as carefully as his facts,
and he will leave tobacco out of the things that are for
him."
Tobacco and the Sexes. — ^The increase in the use of
tobacco by women has caused great concern to many
people who are interested in racial health. The state-
ment has been made that smoking is more serious in its
effects on women because of their possessing a more
delicately adjusted nervous system. No proof of a scien-
tific kind has been presented to show this.
More significant in effect is the secret and hidden
character of the act, resulting in destructive tendencies
in personality, showing especially in loss of confidence,
lack of self-expression, and even fears. No woman or
man may with impunity carry on any secret practice
without distinct personal loss that is reflected in the
general health and well being of the body.
CHAPTER X
HYGIENE OF THE EXCRETORY SYSTEM
I. Plan op Discitssion.
II. Nature and Function of the Skin:
The Skin as an Index of Health.
III. Care of the Skin:
1. The Wann Bath.
2. The Hot Bath.
3. The Cold Bath.
4. Substitutes for the Cold Shower or Tub.
5. The Habit of Bathing.
6. Other Forms of Bathing:
Sea Bathing.
The Turkish Bath.
The Russian Bath.
The Sun Bath.
rV. The Complexion.
V. Care of the Hair. >—
VI. Care of the Nails, t-
VII. Care of the Hands. i>
VIII. Pointed Pai;agrafhs.
IX. The Clothing of the Body:
1. Seasonal Clothing.
2. Underclothing.
3. How to Wear Clothing.
X. Elimination of Body Waste By the Kidneys.
XL Keeping the Kidneys Efficient.
XII. Injury of the Kidneys By Disease.
XIII. Kidney Remedies.
XIV. Medical Examination.
XV. Intestines as Organs of Elimination.
XVI. Causes op Constipation.
Plan of Discussion. — The waste of the body is carried
off via the lungs, the skin (to a limited extent), the in-
testines, and the kidneys. We have discussed the part
of the lungs in the removal of carbon dioxid; in this
chapter the part played by the other organs in this system
and their proper care will be presented.
Nature and Function of the Skin. — The skin is a
flexible and elastic covering of the body that serves
879
280 PERSONAL HYGIENE APPLIED
largely for protection, but slightly as an organ of elimi-
nation. For this latter function it is dependent upon
innumerable sweat glands located in the skin that give
off in a day from 1 to 2 pints of Uquid. This excretion
when profuse is composed^ of small quantities of sodium
chlorid, sulphates, phosphates of the alkaUne salts, urea,
uric acid, creatinin, aromatic oxyacids, ethereal sulphates
of phenol and skatol, and at times albumin. The action
of these glands is increased during exercise, or by any
condition that brings more blood to the skin, as an in-
crease of temperature of the surrounding air either by
direct heat or by clothing that is a poor heat conductor.
The Skin as an Index of Health. — It is a fact that the
skin is an important index of health. This is so because
we see in an individual more of skin than of any other
tissue, and the skin responds to circulatidh, waste prod-
ucts, poisons, bacteria, very much as other parts of the
body do. If the skin is healthy in appearance it repre-
sents internal health, although it is not an infaUible
guide. The muscles of the face, especially, indicate
general muscular tone, and if the skin is sagging and
flabby there, it represents usually a weak muscular tone
all over the body.
Because the skin stands in the popular mind for bodily
health, and because most people have the laudable desire
to appear well and strong and vital, it is a practice with
certain individuals to decorate the skin of the face.
Some criticize this as a remnant of barbarism and cite
instances of savages who practice face painting, but it
is reasonable to suppose that in modern life it relates
to a desire to appear attractive, to seem healthy and
vigorous. It is important to emphasize in this connec-
tion that such health is only skin deep, that it fools no
one, and that the counterfeit is evidence of the absence of
the real thing. Furthermore, health comes from within
> Burton-Opitz, R. : Text-book of Physiology, W. B. Saunders
Co., Philadelphia, 1921, pp. 896, 897. Howell/ W. H.: Text-book
of Physiology, W, B. Saunders Co., Philadelphia, 1919, p. 830.
HYGIENE OF THE EXCEETOBY SYSTEM 281
and cannot be put on. It cannot be bought in a box.
The skin itself is kept healthy by proper functioning of
the body with regular removal of waste, by cleanliness,
by avoidance of certain poisons and foods, and of condi-
tions that disturb the internal secretions of the body.
This last point will be discussed in connection with the
hygiene of the reproductive system.
The skin serves as an index of health because we are
accustomed to judge health by "looks." It is true, of
course, that the outward appearance is suggestive of the
internal health. Persons are continually judging the
health status of other persons by the way they walk or
sit, by the appearance of the skin or facial expression.
How often one conveys impressions of poor physical
condition by the way one walks is not generally appre-
ciated. The posture oft proclaims the man, and it is
important to remember that good posture, clear skin,
and happy expression are real evidences of health.
It is imnecessary to rely upon general signs in deter-
mining health. The science of medicine has advanced
beyond the tongue and conjunctiva stage. The laboratory
sciences are used to determine the way the body is per-
forming its functions. The hst of examinations given on
pages 108, 109, indicates the available scientific procedures
that may be used to determine the cause of ill health.
Many of these procedures naturally relate to the elimina-
tive system because many of man's errors in hving show
so quickly in disturbed elimination. To care properly
for this system is a matter of importance.
Care of the Skin. — So far as organic health is con-
cerned, it is probably true that bathing is not essential
to health. There are numerous examples of people who
live long and are peculiarly free from disease without
bathing, except perhaps at very infrequent intervals.
But the modern conception of health always involves
something more than mere freedom from disease, and
in this matter as in others the significance of the indirect
and reflex influences of procedures upon mental attitude,
282 PERSONAL HYGIENE APPLIED
outlook, and sense of bodily well-being must not be
missed. One of the values often associated with exercise
is the shower that follows the activity. This is service-
able not alone because of the removal of dirt, but also
because of the reflex, stimulating effects upon the nervous
system.
The external layer of the skin is made up of many
scale-like cells packed very close together. These outer-
most cells are dead and are continually shed from the
surface of-rfche— body. Held together by the sebaceous
matter from the oil glands of the skin, they form with
the dirt that collects upon the body a pellicle that covers
the openings of the perspiratory glands. The oil glands
and perspiratory glands are continually pouring their
secretions upon the surface of the body. To remove
this waste accimaulation it is very desirable that bathing
be made a regular and frequent habit.
The Warm Bath.— The warm bath (from 90° to 98° F.)
is essentially a cleansing bath. The heat causes dilation
of the skin vessels with resulting redness of the skin
and increase in perspiration. The warm bath produces
relaxation of the muscles and is particularly beneficial
after fatiguing labor. It soothes the individual and is
conducive to sleep and rest. For some, however, the
warm bath is stimulating and should not be taken before
retiring. This effect of stimulation is liable to occur
if a hot bath is taken (over 98° F.).
The Hot Bath— The hot bath (over 98° F.) should be
taken only if prescribed by a physician.
The Cold Bath (under 65° F.).— Bathing in cold water
is becoming more and more popular, due largely to the
pronounced beneficial effects. It should be performed
in the morning on arising because of its stimulating
action. The cold water acting upon the nerve endings
in the skin arouses them to increased activity, causing
constriction of the vessels (to be followed subsequently
by dilatation) and a wholesome stimulation of the nerves.
The ide&l method of taking the cold bath is by means
HYGIBNE OF THE EXCBETOBY SYSTEM 283
of the shower; bombardment of the skin by the dashing
particles of water is markedly beneficial in addition to
the effect of the cold. Moreover, the shower is a much
more sanitary affair than the tub.
The tub, though, is available to more people than the
shower, and it may be used effectively to secure all that
is essential. The procedure for the cold tub should be
as follows: Fill the tub from 12 to 14 inches with water
as cold as can be borne. For men the tub may be filled
during the shaving process. Before entering the tub
wash the face and neck with cold water. If desired,
certain parts of the body may be cleansed with soap
and warm water. One is then ready to enter the cold
tub. It is important to proceed according to directions.
Step into the tub and sit down, allowing the water to
come over the legs and thighs. At once lie back so that
the water rolls over the chest and shoulders. Immedi-
ately get out of the tub and rub down with a coarse
towel.
The normal result of the cold bath is to drive the
blood from the skin vessels to the internal organs. On
emerging from the bath the vessels of the skin dilate,
the skin becomes flushed, and a pleasing sensation of
warmth follows. This is called the reaction. If reac-
tion does not occur, this is an indication that the bath
is not suited to the individual.
For those who can bathe in cold water there are dis-
tinct health benefits. Most people, except the aged,
can indulge in this form of bathing the year around if
the practice is started in the summer, and if a warm
bathroom is available. Some people say that they can-
not take a cold bath because of the shock to the nervous
system. On the contrary, it may be noted that the
majority of people with profit to health can and should
practice the cold bath daily. In addition to serving as
an effective protection against colds it remains a pro-
cedure with marked wholesome effects upon the general
health, promoting appetite, digestion of food, and im-
284
PERSONAL HYGIENE APPLIED
proved mental activity. The cold bath should be taken
before breakfast; the warm bath before retiring. A
complete body bath should never be talcen until at least
two hours after a meal, and preferably three. The best
time, of course, is before eating.
Lusk states, "Cool baths and winds increase the metabo-
lism which must be effected through the chemical regula-
tion." The effect of baths and douches lasting three
and a half to five minutes is given by Lusk,' who refers
to the work of Rubner. "When the water has a tempera-
ture of about 16° C. (about 61° F.) he (Rubner) finds that
the carbon dioxid elimination may be very largely in-
creased, especially in the case of the douche. The effect
of the douche was more marked if taken before breakfast
when the intestinal tract was free from food. The
results before breakfast were as follows" :
Infltjencb of Cold Baths on Metabolism in Man
Douche 16° C.
Increase, per cent.
Bath 16° C.
Increase, per cent.
Volume of respiration
Carbon dioxid excreted . .
Oxygen absorbed
54.5
149.5
110.1
22.9
64.8
46.8
This increased metaboUsm lasts about one and a half
hours. The cold bath, by diminishing body heat and
by increasing metabolic processes, is a desirable pro-
cedure for a person who is overweight.
Substitutes for the Cold Shower or Tub. — If the tub
or shower is not available, or if the physical condition
does not warrant the full bath, the cold sponge bath
should be employed. There are few persons in America
who cannot take advantage of this procedure. A sponge
as large as a quart can should be used. Saturate the
sponge with cold water and squeeze over the arms, chest,
' Lusk, G. : The Science of Nutrition, W. B. Saunders Co., Phila-
delphia, 1919, p. 144.
HYGIENE OF THE EXCRETORY SYSTEM 285
back, and legs. Follow with a vigorous rub of the entire
body with a coarse towel.
For those who have not the facihties for the above,
washing the face, neck, and chest with cold water will
be found very helpful in protecting the body against cold.
The Habit of Bathing. — ^The great thing in all educa-
tion for health is to estabUsh habits. Much of the routine
care of the body involves at first considerable effort
of wiU and careful planning of the day's program. The
chief point of importance in forming a habit, as James
has so well pointed out, is to permit no exception to occur.
This instruction is particularly important in cold bath-
ing. Permit no exception. Begin in the summertime;
day in and day out follow the program.^ In several
months the habit will be fairly started, and after a year's
experience the body will have become so accustomed
to the refreshing and stimulating reaction that the habit
could hardly be given up at all.
Other Forms of Bathing. — Sea bathing is held by many
to be especially beneficial to health. The virtue ascribed,
usually, is in the salt of the water. In this connection
it should be noted that salt is not absorbed through the
skin, and that if salt were the efficacious agent then
sea baths could be taken at home by purchasing sea
salt. Salt baths may be taken in this way, but the values
of transporting the ocean to the apartment are psy-
chologic, if any at aU.
The real values in sea bathing are to be assigned to
other factors. The outdoor air, the usual sunshine, the
happy companions, the play and sport on the beach —
these are the great tonics, the real cause for the exhilara-
tion and bodily well-being that come from a swim in
the ocean. A business firm specializing in sea salt would
try to convince otherwise; this is because they have
salt to sell and are not able to sell pleasurable recreation,
pure outdoor air, and sunshine.
• It will be necessary for women to interrupt this schedule during
the menstrual period.
286 PERSONAL HYGIENE APPLIED
It is important not to stay in the cold water of the
ocean too long. If the body feels chilly it is time to come
out and get a good rub down. Probably for most people
twenty minutes is the limit in time to be allowed. Cer-
tainly, blueness of the lips or finger-tips indicates that
the heart and lungs are meeting with difficulty the body
needs; the intelligent person wiU not disobey such signs.
The Turkish bath is a form of bathing available usually
in large cities only. The Romans in the later days of
the Empire engaged in many of the procedures used
in the modern Turkish bath. This form of bathing is
well borne by most people, and although to be classed
as a luxury and in no sense a real necessity for living
healthfully, it is valuable after severe physical exertion,
and for certain types of muscular and joint conditions
following rheumatism.
The Russian bath is similar to the Turkish, but differs
in providing hot vapor instead of hot air. This type of
bath is recommended often for certain dry forms of
bronchitis and chronic laryngitis.
The sun bath indicates, by its name, that the body may
be bathed without water. We may consider logically,
therefore, exposure of the body to the sun and air as in
effect a bath. For some years sunlight has been used,
especially in Switzerland, for the treatment of bone and
joint tuberculosis. The extension of physiotherapy,
especially since the World War, has emphasized anew
the value of the sun's rays in stimulating metabolic
processes, and particularly the formation of hemoglobin.
Thus, the sun bath is to be considered as a valuable
hygienic measure, improving nutrition and general
health. Exposure to the sun's rays should be, for brief
periods, very gradually extended. If the exposure is
overdone, sunstroke may occur. Not infrequently,
people on vacations suffer with headache and general
debility from too much exposure to the sun.
The Complexion. — The care of the skin of the face
presents to many persons serious problems. The com-
HY6IBNB OF THE EXCRETORY SYSTEM 287
plexion is important as a matter of justifiable personal
pride. Some of the fundamental facts in relation to the
complexion are given below:
1. The complexion is an indication of internal bodily
states. Pallor, flabbiness, blotches, pimples, dis-
colorations, enlarged blood-vessels, floridness are
signs of habits of living and of the general health.
2. These unfavorable and undesirable signs are to be
removed (when possible) by correcting the errors
in living, by removing the cause.
3. The quality of the skin in different individuals
varies so greatly that a preparation effective for
one person may be injurious to another. The
dry skin and the oily skin require care of a differ-
ent kind.
4. Local conditions may injure the skin of the face
and result in constant disturbance until the condi-
tions are removed.
Unless one works at a dirty or greasy occupation the
face should never be washed with hot water and soap.
For most persons, it may be said, that washing the face
three times daily in cold water is sufficient for cleansing
purposes. The cold water tones up the elastic tissue in
the skin, improves the circulation, and is a deterrent to
the appearance of wrinkles. With the exception noted
above soap should not be used. The hope that many
people have in medicated soap is directly proportional
to their belief in the mystical and the magical, and
to their reading of promising advertisements. No justi-
fication exists for any rehance on medicated soaps. As
a rule, their virtue lies chiefly in their odor or appearance.
One soap claims to be a health soap because of the presence
of carbolic acid; another seeks preference because it is
impregnated with the salve that is to be used with it;
all rest their case upon unwarranted and unscientific
claims.
The following advertisement of a "skin beautifier"
illustrates the tendency to be combated: ". . . makes
288
PEBSONAL HYGIENE APPLIED
the skin transparent. Blemishes of every kind disappear
as if by magic."
This "beautifier" on analysis gives: Zinc oxid, 7 per
cent.; bicarbonate of soda, 5 per cent.; glycerin, 10 per
cent., and water, 78 per cent. The ingredients cost about
Prescription Fakes
A "prescription fake" is a "patent medicine" adver-
tised as one of tlie ingredients of a prescription, tlie
other ingredients being official products.
QUmoiN
This lake "Health and Beauty" department is reaily
an advertisement. Each "answer" conteins a "jolcer"
in the form oT a "patent medicine."
Fig. 28. — ^Newspapers publishing such health columns should re-
ceive the condemnation of all advertisers of honest products. (By
courtesy of the American Medical Association.)
4 cents; the preparation sells for 50 cents. This profit
will buy seats at the "Follies" for the manufacturer;
the skin often remains unbeautiful.
People today too often desire magic in medicine. To
such superstitious minds the "medicine man" speaks
HYGIENE OF THE EXCRETORY SYSTEM 289
with more authority than the scientific physician. They
long for buncombe. This tendency is capitaUzed by the
patent medicine interests who for simple compounds
of soda and borax use elaborate, meaningless, but mys-
terious names.
Frequently cosmetics are advertised imder fake columns
(Fig. 28) in second rate newspapers, as "Answers to
Correspondents," "Health and Beauty Advice," or
"Health and Beauty Helps." In one such coliunn the
following appeared:
"Lucile. A good 'liquid powder' or face wash is made by dis-
solving 4 ounces of spurmax in i pint of hot water and adding 2
teaspoonfuls of glycerin. This home-made complexion beautifier
whitens the skin without the use of powder and is particularly
recommended for anyone who has a saUow, dark, or oily skin."
On careful chemical analysis, spurmax is foimd to consist of
Crystallized magnesium sulphate (Epsom salts) . 100 per cent.
Perfume trace.
Coloring-matter trace.
The retail price of spurmax is one-half dollar. The estimated
cost of the ingredients is less than one cent.
The necessity for all persons understanding the nature
of the skin, its needs and fimctions, stands out as an
imperative demand in these days of such blatant and
\mshamed lying in advertisements.
If a soap is used for cleansing the Jace, the only de-
sideratmn is that it be pure and non-irrita,ting. For
persons with an oily skin or persons living in cities where
the air is filled with soot, the daily use of soap may be
necessary; but pallor is to be corrected by improving
the quaUty of the blood, flabbiness of the skin by exercise
and cold baths, blotches and pimples by medical advice
and guidance when hygiene alone has not sufiiced.
If the skin is unusually dry, a little oil may be applied.
In liot weather a httle powder may be welcomed. Cer-
tainly, if used sparingly, there can be no harm; its use
is a matter of taste.
19
290 PERSONAL HYGIENE APPLIED
The use of hot water on the face and subsequent expo-
sure to cold air or wind usually results in chapping. In
"make-up" for dramatics it is important to apply a
plain cream to the face before the paints or charcoal
are used. This permits their easy removal and prevents
clogging of the pores with irritating substances.
Care of the Hair. — The hair grows from follicles in
the skin. At the follicle the hair cells are alive, the
growth occurs in the follicle, and the hair is pushed out.
The ends of the hair are dead and resemble the outer
layer of the skin in this respect. This physiolo^c fact
should be borne in mind when singeing is proposed as a
method "to prevent the hair from bleeding." The scalp
has numerous oil or sebaceous glands which pour out
their secretion near the roots of each hair follicle. This
secretion keeps the hair oily and prevents breaking.
Individuals vary in the amount of oil produced by the
scalp; some scalps are dry, others are very oily.
The hair should be cared for as a part of the general
plan to keep one's self clean, well-groomed, and in good
condition. The loss of hair or dirtiness of the scalp
may have nothing to do with digestion of food, but it is
to be noted that health is a complex matter associated
with indirect as well as direct factors. Reasonable care
and attention to the body results often in reflex mental
states of optimism and cheer, in wholesome ways of
looking at problems, in consciousness of power, that
are immensely valuable to society as well as to the in-
dividual. Shampooing the hair should be performed
whenever the hair and scalp are dirty. For some with
oily scalps this may mean once a week; for others with
dry scalps, two or three week intervals will be desirable.
For the shampoo, any good toilet soap may be used.
There is no special value in the advertised products.
A good shampoo hquid soap is the official linamentum
saponis mollis. This may be purchased at any drag
store. It contains 50 parts of soft soap, 2 parts of oil
of lavender, and 33 parts of alcohol.
HYGIENE OF THE EXCRETORY SYSTEM 291
After thoroughly washing the hair and vigorously
massaging the scalp with the finger-tips, the soap should
be entirely removed by frequent douching. In winter
one should always end with cold water. The hair should
then be thoroughly dried, and particular attention should
be paid to drying the hair at the back of the aeck and
aroimd the ears before going out-of-doors.
If the scalp is foimd to be particularly dry after sham-
pooing, it will be advisable to add a small amount of
oil or grease. For this purpose, pure liquid vaselin will
be found very good. Some advise olive oil. The addi-
tion of the oil prevents cracking and breaking of the
hair and scaUng of the outermost cells of the scalp.
Daily massage of the scalp will improve the circula-
tion and favor the growth and luster of the hair. The
procedure of the hostler in caring for his horse may be
an example applied here. The hair will be maintained
in good condition by keeping it clean and by frequent
brushing.
Care of the Nails. — ^The nails are similar to the hair
in that they are growths from the skin. A Chinese
custom, gradually disappearing, is stiU found, especially
among Chinese students, who wear the nails long and
pointed, indicating that they have no need to do physical
work. The condition of the nails is a sign of the care
given to the body by the individual American just as
truly as the long nail is a sign of the vocation of the
Chinese. Clean, weU-kept nails may be considered with
other items of personal hygiene as representative of
the interest of the individual in maintaining an optimum
physical state. That some persons give more attention
to the care of the nails than they do to the care of the
nervous system is merely a sign of the quality of the
latter and the mixing of values; it does not mean that
the nails should be neglected.
The cuticle surrounding the nail should be pressed
back once or twice a week with an orange stick. If
excessively dry, the cuticle may be softened by applying
292 PEESONAL HYGIENE APPLIED
pure liquid vaselin at night before retiring. Unless the
cuticle is cared for in this way "hang nails" are liable
to form and may give rise to serious infections. The
surface of the nail should never be scraped.
The nails of the fingers should be cut in a curve with
a pair of curved scissors. Filing of the cut surface to
give smoothness is desirable. The toe nails should be
cut straight across, to prevent ingrowing of the nails.
Care of the Hands. — The hands are always contami-
nated with bacteria. Numerous experiments have
shown that it is very difficult to sterilize the hands and
nails, even after scrubbing with soap, hot water, lime
and soda, and soaking in bichlorid. The fingers contain
in the folds of the cuticle and under the nails always
a varying amount of debris that is ' bacteriologic. A
typical sample shows various cocci, particularly strepto-
cocci and staphylococci, colon bacilli and spiriUae, yeast
cells and other fungi derived from the mouth, soil, food,
body surface, water, nose, eyes, sewage, dust, dirt, etc.
It would seem that these were significant facts if they
helped one to prevent infection by the hands. To pre-
vent such infection there are at least two important
notations:
1. Clean hands for all first-aid services. In bandaging
wounds, or attending to any injury of the skin,
first clean the hands as thoroughly as* possible
with soap and hot water.
2. Prevent auto-infections. Because of the varying
uses to which the hands are put, and the nature
and conditions of the objects handled, the hands
are always dirty, i. e., they harbor bacteria. So
long as the skin of the hands is not broken, these
bacteria cause no disturbance if they are not
transferred to the mouth, nose, or to an opening
in the skin of the body produced by scratches or
cuts in its epidermal covering. It is important,
therefore, to indicate the ways in which the hands
carry bacteria.
HYGIENE OF THE BXCBETOKY SYSTEM 293
(a) Scratching the body with the nails.
By scratching the body with the nails the skin
' may be broken and a direct infection result
from the infected naU. In this way lupus,
acne, boils, and carbuncles have been trans-
mitted. In this way also a disturbance in one
part of the body may be spread widely over
the body, e. g., poison ivy.
(b) Biting the nails.
Biting the nails is unhygienic because of the
effect on the nails, of the undesirable nervous
habit, and of transmission to the mouth of
bacteria from the fingers.
(c) Putting fingers in the mouth.
It has been stated by Chapin that if the sali-
vary glands secreted indigo, this world would
be a blue place indeed. His reference strikes
at a very common and reprehensible practice.
It is seen among persons who moisten their
fingers with saliva to turn the pages of book
or magazine. Conductors engage in this uni-
versal trade as they give out transfers. It
should be stated, therefore, that nothing should
be put into the mouth except clean food and
clean drink.
Some people develop phobias relating to this fact of
contamination of the hands. Such persons refuse to
handle money without gloves and build up a number of
similar prohibitions that are senseless and foolish.
Pointed Paragraphs. — The great variety of practice
in the hygiene ofythe skin, hair; and nails, and the many
questions asked by students suggest that pointed direc-
tions be given to set forth in concise fashion the best
judgments on many questions:
1, Hair tonics have no special value. Health of the
hair depends upon the general health and the
blood-supply in the scalp. It may be desirable to
have a special prescription. This should be given
by a physician and based upon the local condition.
294 PERSONAL HYGIENE APPLIED
2. Daily massage of the scalp and frequent shampooing
to keep the hair clean are the best tonics to be
appUed locally.
3. There is no danger from frequent shampooing of the
hair. The mechanical stimulation is very bene-
ficial. If excessively dry, a little oil may be added.
4. The cold bath in the winter may produce an itching
of the skin of the legs. This bath pruritus is seen
in persons with an excessively dry skin. The
condition may be controlled by oiling the parts
affected after the morning bath.
5. It is advisable for men to shave themselves. Trouble-
some and obstinate skin diseases are not infre-
quently contracted in public barber shops. The
damp towel, or shaving brush, is usually the
medium of infection.
6. Shaving of the head to promote growth of the hair
is a useless procedure.
7. Curling the hair on pins or papers is not injurious,
but procedures used to produce a "permanent
wave"^ make the hair unusually dry and brittle,
and destroy the "life" and luster of the hair.
8. Hair removers should be used only upon the advice
of a physician. One sure method of removing
superfluous hair is by electrolysis. This requires
a specialist skilled in the technic. Painful and
serious abscesses are caused at times by crude
methods of removing the hair from the armpit.
9. It has been said that the only sensible thing to do
for gray hair is to admire it. Some persons are
unable to face the problem as squarely as that.
If dyes are used, great care should be taken that
they do not contain lead, for serious results fre-
quently follow in the form of lead-poisoning. The
following item (Fig. 29) in the New York Tribune
' It is interesting to note that negroes use preparations to take
out the kink in the hair and the white race (women) employ nu-
merous measures to achieve a curl or wave.
HYGIENE OF THE EXCRETORY SYSTEM
295
of August 8, 1920, indicates the danger of such
treatment:
Singer Treated for Gray
Hair Sues far $25*000
Mrs. Gertrude Bianco antl Her
Husband Seek Damage from'
Specialist
Mrs. Gerti'nd«i Bianco, of 316 West
122d Street, a concert singer, alleging
that she was blind for several days,
the glands in her neck swollen and
lumps developed on her head, follow-
ing treatment to restore gray hair to
its natural shade, filed a suit for
?25,000 damages in the Supreme Court
yesterday against John Andre, of 57
West Thirty-ninth Street. Attilio
Bianco, husband of the plaintiff, also
filed a suit for $5,000 damages against
Andre for loss of his wife's services.
Mrs. Bianco says she called on Andre
On December 26 in company with a
friend who had recommended the de-
fendant as an expert in the treatment
of the hair. Andre, it is alleged, as-
sured Mrs. Bianco he could make her
gray looks black again, and in such a
manner that neither, salt Viator, steam
nor hair lotions would tarnish them.
The plaintiff submitted to the treat-
ment- In a few days, she claims, all
thef things happened to her of which
she complains, she was in great pain,
besides being incapacitated for some
time,. sXLd suffered financial loss.
- ■
Fig. 29. — ^The use of dye preparations for the hair is frequently-
dangerous.
10. Perspiration checks depend for their action upon
salicylic acid. The nostrum PERSPIRO is said
to be the prescription marketed by a patient
for whom it was prescribed. The well-known
Thiersche's powder is the foundation of most
perspiration remedies. It contains salicylic acid
1 gram and boric acid 10 grams.
296 PBESONAL HYGIENE APPLIED
11. Most deodorants depend upon aluminum for their
effect. Odor-o-no, Mum, and others widely ad-
vertised are very simple preparations, perfumed,
and given names that advertise easily.
12. There are numerous depilatories on the market.
Whether as Delatone, Delol, El Rado or Nodene,
they are dependent for their action upon barium,
calcium, or sodium sulphid. Analyses are given
in Nostrums and Quackery, Volume II.
13. If the hands are always washed carefully before
eating and if fingers are carefully kept out of the
mouth and nose, and if the body is not scratched
with the nails, the bacteria and other dirt that
accumulate on the hands may be considered as
harmless.
The Clothing of the Body. — The r61e of clothing in
modern civilization appears in an uncertain hght when
one observes furs in summer and the thinnest of silk
stockings in winter, or when the young child with bare
legs is exposed to the cold harsh winds of winter or early
spring. Are these feminine foibles of no moment? Is
clothing to be judged by style merely? Are wholesome-
ness and beauty forever at odds in human dress? There
lies in this very problem of clothing the real heart of the
problem of health. The hygienic knowledge is avail-
able, but it must compete against selfish and foolish
attitudes, unworthy life goals and guides. Here as else-
whore the problem of living finely and well consists in
the utilization of scientific fact, of demonstrated truth.
The willingness to sacrifice health for high heels, to waste
in crude and vulgar ways the affective values of life for
momentary popularity, to let the race take care of itself,
are attitudes that must give way before the dominant
sense of the social and moral responsibihty for hving at
one's best. , The hygiene of clothing also demands, there-
fore, at the very outset the application of scientific fact.
Seasonal Clothing. — Clothing should be used as a
protective covering for the body and should fulfil the
HYGIENE OF THE EXCRETOKT SYSTEM
297
demands of the body as regards heat conservation or
dissipation. For civilized man only about 20 per cent,
of his surface is normally exposed to the air. For pro-
tecting the body against cold, clothing that holds air
in its meshes is most satisfactory. Rubner has shown
how valuable fur is because of this quality. He cites
the fact ihat the hair of the black cat, black lamb,
rabbit, skunk, raccoon, mink, musk-deer, and sheep
weighs very httle itself, but the fur contains so much
air that it may be said to consist by weight of 97.3 to
98.8 per cent, of air, and only from 1.2 to 2.7 per cent,
of hair.
Hot weather clothing that will permit circulation of
air and yet that will absorb moisture is very important.
Garments that do not take up moisture but allow per-
spiration to collect on the surface of the body are highly
unsatisfactory, because in times of high temperature
evaporation is retarded, and hence cooling of the body
is interfered with; and at low temperatures a great
amount of heat is lost by conduction through the moisture,
and hence there is rapid chilling of the body.
Clothing has marked influence on metabolic changes
occurring in the body as given by Lusk,* who uses Rubner's
figures:
iNTLtTENCE OF ClOTHES ON METABOLISM IN MaN AT A
Temperatube op 11° TO 12° C. (About 52° to 53° F.)
Remarks.
Summer clothes
Summer clothes and
winter overcoat
Summer clothes and fur
coat
Cold, occasional
. shivering.
Chilly part of the
time.
Comfortably
warm.
' Lusk, G. : The Science of Nutrition, W. B. Saunders Co., Phila-
delphia, 1919, p. 149.
298 PERSONAL HTGIENE APPLIED
This is the sort of scientific evidence from which the
hygienist determines his rules. It will be observed that
the individual with "summer clothes" had to burn more
food material, as indicated by the greater CO2 output,
than the individual who wore "summer clothes and
winter overcoat" or the one dressed with "summer clothes
and fur coat." This means, of course, that children
and women, who are chiefly concerned in this matter,
are losing valuable body heat by lack of proper protec-
tion of the body. It thus becomes a matter of prime
importance in health that the body heat be conserved,
that the losses of heat be prevented. This is of particular
importance on cold, windy days because of the greater
loss at such times.
Men who spend the days indoors in heated apart-
ments and offices will find it convenient and practical
and healthful to use Ught-weight suits, and in cold weather
to secure the additional protection by a suitable over-
coat. Women are less easily provided for because of the
widely varying types and quality of clothing used. The
principle to be applied by each person, however, is that
of adequate protection from cold in winter and freedom
from moisture on the body in summer. City persons
living indoor lives will find it desirable to have for out-
of-door or sport wear durable clothing that will not
only be suitable for physical activity but also serve
adequately the temperature and climatic changes.
The farmer, the truckman, the outdoor worker gener-
ally will find it essential in cold weather to wear woolen
next to the skin. This is admirable for two reasons: it
is very absorbent, and hence it takes up the perspiration,
and it prevents rapid evaporation, and hence it is warm.
Old persons and children will find it very satisfactory
to use woolens in winter. For summer wear light cotton
fabrics are very satisfactory. Silk is usually expensive,
but is always soft and cool.
The color of clothing is of high importance. White
and all light colors absorb fewest of the heat rays and
HYGIENE OF THE EXCRETORY SYSTEM 299
thus are more suitable as colors for summer wear. White
is preferable to colors produced by cheap anilin dyes.
Such dyes at times cause marked irritation of the skin.
Underclothing. — ^Underclothing is essential to protect
the outer garments from the perspiration of the body,
and to provide a covering that may be readily washed,
kept clean, and changed to meet the temperature and
seasonal changes. Underclothing should be changed
frequently. This necessity varies with the amount
of perspiration of the individual. When taken off at
night the underclothing should be placed over a chair
in such fashion that it will be thoroughly aired.
Damp underclothing should be changed at once, and
especially if the day is windy or cold. Soiled underwear
favors the development of micro-organisms which produce
at times annoying skin diseases.
Fortunately, women of the present day need little
instruction in the matter of tight lacing of corsets. The
old days of the wasp waist are gone— let us hope— for-
ever. It is held by some that women would be healthier
if they did not wear corsets, but this is conditioned upon
other matters, such as support for clothing, proper exer-
cise involving the trunk muscles, and child bearing.
The more flexible corset or waist so popular today is
generally desirable.
How to Wear Clothing. — The average woman who will
wear dresses and undergarments supported from the
shoulders or hips, who will be physically active, and who
will allow at least two years to elapse between preg-
nancies, will be healthier and happier without a corset.
For those who wear skirts supported at the waist a
light corset will be found very helpful.
The hygienic principle to keep in mind in corseting
the tnmk relates to the height, rigidity, and fit of the
garment. The corset should be low and flexible. It
should fit snugly over the hip bones and give support
to the lower third of the abdominal wall, exerting a force
upward and backward. In no case should the corset
300 PERSONAL HYGIENE APPLIED
be permitted to compress the waist or lower chest. It
is important in, this connection to emphasize the value
to the wearer of the corset of standing away from the
corset and not permitting herself to hang on the corset
as a support.
Unfortunately, men of the present day are victims
of a custom in clothing that is injurious in a similar
way as is the corset for women. Discarding suspenders
for supporting the trousers, men today in large numbers
wear belts. Because the trousera are often cut high to
complete the dressing joint with the vest, the belt is
tightened around the waist. This causes an undesirable
constriction. It is important, therefore, if a belt is worn
to support the trousers that the bearing of the belt come
on the hip bones of the pelvis and not above. An observa-
tion of the position of the belt in laborers doing heavy
work, such as trenching, will indicate the superior value
of the low position.
All tight and constricting clothing should be excluded
if one seeks to secure maximum health and efficiency.
Garters worn around the legs wiU, if too tight or if worn
above the knee especially, constrict the blood-vessels
and impede the venous return. The growing practice
among women of having garters attached to the corset
or underclothing is admirable in this connection, but
it should be remembered that the point of attachment
should be at the side of the hips rather than in front.
The front pull exerts a traction upon the pelvis tending
to produce an increased limibar curve, or hollow back,
with all the attendant ills and discomforts. For men,
the usual garter to support the socks is not bad if not
worn too tight. The sense of freedom and exhilaration
that comes at times when, in sport or camp costume,
one omits the usual garter, is an indication of the value
that would come by the provision of a support for men's
socks that would be practical and yet not constricting.
Collars should never be worn tight enough to constrict
the surface blood-vessels of the neck. Headaches not
HYGIENE OP THE EXCBETOEY SYSTEM 301
infrequently result from tight collars. It is advisable
for men to wear a collar J inch larger than the size of the
shirt band.
Socks and stockings should be large enough to permit
free movement of the toes. It is important to change
them frequently, especially in simimer. When tired,
it is very helpful to change the shoes and stockings.
Bathing the feet after fatiguing work is very refreshing.
If there is excessive perspiration of the feet with an
offensive odor, it wiU be found helpful daily to bathe
the feet in cool water, dry, and dust on the feet a powder
of saUcyMc acid 1 part and starch 4 parts. One may
use to advantage a powder of equal parts of alum and
talc. This powder should be dusted also into the socks
or stockings, which should be put on fresh every day.
Elimination of Body Waste by the Kidneys. — The
kidneys are two glandular organs that remove from the
blood excess water and waste materials. About 3 to
4 pints of water are removed daily. The waste is in the
form of urea, uric acid, creatin, creatinin, phosphates
and sulphates of calcium, sodium and potassimn, to-
gether with other complex chemical compoimds. Efficient
action of the skin makes less strenuous the demands
upon the kidneys. The waste materials removed by the
kidneys are chiefly the end-products of protein metabo-
lism. Diets rich in protein increase the work that the
kidneys must do. Urea is increased with muscular
exercise; with a decrease in the normal action of the
kidneys, the urea in the sweat is increased.
Keeping the Kidneys Efficient. — There should be proper
care of all the following factors influencing the kidneys:
1. Rational diet: The body should not be overburdened
with protein, and particularly nucleoprotein food.
Inadequate combustion, with greater waste, re-
sults from overeating (especially of protein), just
as inadequate combustion with clinkers results
from putting too much fuel in the furnace. This
waste in the body must be removed by the kidneys.
302 PEBSONAL HYGIENE APPLIED
In addition, it is to be remembered that irritat-
ing foods and highly seasoned foods are undesir-
able.
The need for keeping the protein and particularly
the nucleoprotein content small has been men-
tioned. Meats should not be eaten more than once
a day. The difference chemically between the red
and white meats is in the greater amoimt of purin
bases yielded by the former; the important point,
however, is to keep the total protein intake below
100 grams daily.
2. Sufficient water must be drunk to keep the kidneys
flushed out, to dilute the waste, and to prevent
the irritation that results from the concentrated
urine. At least one glass between each meal,
one with each meal, one before retiring, and one
on rising in the morning, should be taken.
3. Free action of the skin: Exercise, prevention of
chilling the body in winter, and appropriate light
clothing in summer are important.
4. Exercise: The exercise should not be too severe.
It has been found that vigorous athletics produce
an albuminuria, but whether it is transient or
represents a permanent injury to the cells of the
kidneys is not known. It is important to observe
moderation in athletics.
Injury of the Kidneys by Disease. — ^Because the kid-
neys are eliminative organs it falls to them to act as
poison and toxin removers during disease. It is, there-
fore, a prudent act and often a vital matter to pro-
tect the kidneys dining disease, and more intelligently,
to prevent the disease, if possible, and to avoid the
risk of renal injury. The kidneys are liable especially
to injury in scarlet fever, typhoid fever, malaria, and
in all the infectious diseases. One imperative reason
for relying on medical skill at these times rather than
on the unscientific and banal pathies, is to forestall kidney
disturbance by accurate diagnosis and preventive treat-
HYGIENE OF THE EXCKETOBY SYSTEM
303
ment. Figure 30 shows Blight's disease a prominent
cause of death, more fatal than cancer.
Kidney Remedies. — "Kidney troubles" are frequently
treated by means of patent medicines. This happens
because of the prevailing ignorance regarding the physi-
ology of the renal system, and the lack of understanding
of the kind and nature of renal disturbances, combined
with the tendency to expect pills, decoctions, and mix-
tures to restore diseased tissues to normal condition.
In the first place it should be pointed out that kidney
disease does not, as a rule, cause a pain in the lower
back. Lumbar pain in women is more frequently due
Principo/ Causes of Death
//if/aeaza
'Percent
/6./\
Fig. 30. — ^Principal causes of death, adult male lives, 1917 to July
1, 1920. (By courtesy of The Prudential Insurance Company of
America.)
to displacements of the uterus or disturbance of the
tubes or ovaries; in both sexes pain in the lower back
is not infrequently due to weak or flat feet and to im-
proper shoes.
Again, it should be remembered that the bladder is
only a receptacle for the secretion of mine. Painful or
burning micturition does not represent kidney disturbance,
but usually represents an inflammation of the bladder
that may be due to infection or to irritating substances
eliminated by the kidneys.
An illustration of the fraud and quackery in patent
medicines of the kidney-cure type is exhibited in the
304
PERSONAL HYGIENE APPLIED
parallel (Fig. 31) of the advertising claims made by the
manufacturers of Swamp Root in England and in America.
The British labels are the same as those used in this
coimtry before the Federal Food and Drugs Act. This
change therefore does not represent any inherent honesty
in the manufacturing concern, for it is still falsifying on
the British labels.
SWAMP ROOT
Th* NilloMi Food and Drim Aot, whioh wont Into offoot In 1907. forcod the ollmhatlon of Iho srotur fnlM.
hoodi from llio Inbols ol Swunn Root whon told In this oounlry.
Tho Muno falMhood*. howovor, wore uwd on tho oroduot* Mid In Croat BritainI
lUiUieAN UHLt-ltll
Compare the
British
and
American
lalKis of
1912
Fig. 31. — In Britain Swamp Root is a cure, in America it is a
remedy. Lying on the trade package is permitted in Great Britain.
(By courtesy of the American Medical Association.)
The general value of testimonials used by the "patent
medicine" business is indicated in Fig. 32. Doan's
Kidney Pills are widely advertised, with similar endorse-
ments — i. e., those of persons dying of kidney disease.'
Treatment of kidney disease must be based upon
diagnosis of the condition present. When physicians
who have given years to the study of disease, who have
' See Nostrums and Quackery, vol.
Medical Association, Chicago, 1921.
ii, pp. 18&-191, American
HYGIENE OP THE EXCHETOBY SYSTEM
305
at their command the chemical laboratory, microscope,
and a;-ray, still find it exceedingly difficult at times to
determine the exact condition, how absurd it is for one
to make a self-diagnosis and to prescribe patent medi-
cines. The kidney may be affected with tuberculosis,
with tumor, with stone formation, with infection of
common pus organisms, with degenerative changes as in
Brights' disease, as well as other serious and subtle
DOANS KIDNEY PILLS
" Every Picture Tells a Story " Is the slogan In the Dean's KWney Pills
advertisements. Here Is a picture that tells a different story.
HERE-
rOR OOAH-t KID-
MV MX«. IT JtPPeUID
IN H» HOMC P*»Ka
NOTE THE DATESI
•< HERE
14 MM. BUreHCVa HATH
CKRTiriCATK SHOWINa
THAT WK Don or UMHrS
DISUUK (MBPHIIITII) o4
JUHg M. ml.
WHEN THIS TESTIMONIAL APPEARED ITS WRITER HAD
BEEN BEl^D NEARLY TWO MONTHSI
KIDNEY DISEASE IS DANGEROUS!
DONT TRIFLE WITH ITl
Fig. 32. — ^Testimonials as used by patent medicine manufacturers
are usually worthless — those from tne tomb particularly so. (By
courtesy of the American Medical Association.)
disturbances. Health of the kidneys is to be restored
only by intelligent care in medical examination, diagnosis,
and treatment, and not by resort to guess work, faith,
and mysterious drugs.
Medical Examination. — ^As stated before, intelligent
care of the human body would provide at regular intervals
examination of the body. This advocacy of periodic
medical examination is justified by the early detection
20
306 PERSONAL HYGIENE APPLIED
of kidney disturbance. Diseased kidneys may serve
for many years if proper measures are followed in diet,
exercise, and general living conditions. The great in-
crease in middle age of deaths from kidney disease repre-
sents in part the lack of personal hygiene among many
persons, but also the absence of any well-organized
periodic examination.
The sort of work being done by the Life Extension
Institute, Inc., typifies what is needed everywhere, and
the kind of service, expert and medical, of which persons
should avail themselves.
The periodic medical examination that leads to correc-
tion of errors in diet, exercise, hving and working condi-
tions, may prolong active and vigorous life much beyond
what we are accustomed to. Old age is a relative term.
Some persons die of old age diseases at forty years;
others live happily at sixty or seventy. Scientific medical
examinations at regular intervals are the beginnings of
intelhgent care of the body.
Intestines as Organs of Elimination. — In addition
to the waste eliminated by the skin and kidneys the
waste of undigested food is removed by the intestines.
In the former the waste comes largely from the action
of the body cells; in the latter it comes chiefly from food.
Food material passing through the alimentary tract
is digested, and the digested foods are absorbed into the
blood-stream. The undigested waste material left behind
passes along the intestinal tract to be removed from the
body at periodic intervals. The movement of the con-
tents of the tract is faciUtated by a rhythmic contrac-
tion of the muscular walls of the intestine. This is called
peristalsis. Peristalsis is favored by exercise and by the
presence of food in masses that stimulate the rhythmic
contractions. The importance of food not highly con-
centrated, but with some waste, such as found in green
vegetables, is to be recognized in this respect.
The lack of proper peristalsis and inadequate action
of the intestines produces a stagnation in the tract and
HYGIENE OP THE EXCBETOBY SYSTEM 307
a condition of infrequency or irregularity in bowel action,
called constipation. There are many different causes
of constipation, some congenital or anatomic, others
purely hygienic.
Causes of Constipation. — 1. Visceroptosis — a dropping
down of the viscera of the abdomen is due often to bad
posture. Frequently it is associated with general bodily
weakness resulting from prolonged or serious sickness,
but often it results from laziness and ladk of proper
exercise.
2. Lack of tone is found in children without enough
vigor to produce peristaltic movements; it is a char-
acteristic condition in nervous cases and neurasthenic
individuals. Constipation is constant among mental
patients in institutions.
3. Chronic appendicitis is associated with constipation.
4. Lack of exercise: Sluggishness of the circulation
and general nutritive processes, associated with physical
inactivity, are prominent as causes of constipation.
5. Improper diet: Man has an alimentary tract devel-
oped in relation to certain foods in the intestines. The
foods that have played a part in determining the nature
of the hmnan intestine have been coarse foods and,
therefore, a concentrated diet, refined and too easily
digested, is unsuited for its action. The day will not
soon come when man, for any appreciable length of time,
can live fuUy and completely on refined food, or powdered
food, or liquid food.
6. Pressure of unhygienic clothing as a cause, was for-
merly more important than it is today, but it should be
stated that constriction of the waist by the belt or corset
should not be tolerated.
7. Lack of sufficient water: Too httle drinking of
water is a frequent cause of constipation.
8. Lack of habit of emptying the bowel: The daily
habit of emptying the bowel at a regular time should
be developed and rigidly followed. This is very important
in the training of children. The most favorable time,
308 PBHSONAL HYGIENE APPLIED
both as regards the physiologic states of the bowel and
the organization of the day's program, is immediately
after breakfast. It should be mentioned in this con-
nection that a very common cause for unsatisfactory
results at this time is improper height of the toilet seat.
It is usually too high. An ideal seat would place the
body in the position naturally assumed by man in primi-
tive conditions. The seat should_be low enough to bring
the knees above the seat level. This may be accom-
phshed by placing the feet on a small box.
CHAPTER XI
THE HYGIENE OF THE NERVOUS SYSTEM
I. The Natubb op the Nervous System.
II. Factors op Importance in Maintaining the Health op
THE Nekvotts System:
1. Hannony of Action Between Cerebrospinal and Auto-
nomic Systems.
2. Relation of Training to the Health of the Nervous
System.
3. The Significance of Defective Inheritance in the Nervous
System.
III. The Normal Mental Life.
IV. Worry:
1. Worry Over What We Have Dbne.
2. Worry Over What We Are Going to Do.
3. Worry Over the Opinion of Others.
4. Worry Over Health.
V. Development op Wholesome Mental Habits:
1. Confidence.
2. Faith in the Goodness of Life.
3. Openmindedness.
4. Unselfishness.
VI. Insanity:
1. Types of Insanity.
2. Causes of Insanity:
(a) Ss^philis.
(M Alcohol and Other Poisons.
(c) Physical Diseases.
(d) Mental Habits.
VII. Alcohol and the Nervous System.
The Nature of the Nervous System. — The nervous
system is an organization of stimulus-receiving and
stimulus-sending elements. In simple one-celled organ-
isms a stimulus is carried to all parts of the cell without
the use of a special mechanism. In the himian body,
however, there is a highly developed system of conduct-
ing nerves and co-ordinating nerve centers. In fact,
there are two closely alhed systems, the cerebrospinal
309
310 PERSONAL HYGIENE APPLIED
and the autonomic,^ engaged in relating the individual
to his environment. The former is concerned with velun-
tary movements; the latter with the involuntary move-
ments and actions — ^types of activity associated with
the involimtary muscles and the secretory glands. There
is another interesting and important characteristic differ-
ence in the two systems: the cerebrospinal is concerned
with the receptive, cognitive, and will aspects of life,
phases represented by the large sense experiences that
occur, by the understanding and interpreting of stimuli,
and by the planning and purposing that precede the
ultimate desired goal of the volimtary act, always an
act of wiU; the autonomic, on the other hand, is concerned
almost entirely with controDing the processes that main-
tain automatically the hfe of the individual. Some of
these (autonomic) processes are protective, some deal
with the transformation of energy, others with certain
emptying mechanisms — all, however, are associated with
the action of involuntary muscle in blood-vessel, heart,
intestine, or other organ and with secretory ceUs.
The cerebrospinal nervous system may be said to
consist of brain, spinal cord, and nerves that lead to
and from both brain and cord. The nerves coming
to and from the brain are associated almost entirely with
functions located in the head, such as sight, hearing,
the use of the tongue, the sense of smell, and so forth,
and are called cranial nerves. The nerves coming to
and from the cord are associated with the skin and muscles
of the body, and are called spinal nerves. It is to be
noted that the phrase to and from is used. This use
relates to function and not to structure. Thus it is that
certain nerves carry incoming currents or stimuli and
are known as afferent nerves; others carry outgoing cur-
rents or stimuli and are known as efferent nerves.
The afferent nerves carry to the brain either directly
'Langley has suggested "autonomic" for the old term "sympa-
thetic," as applying to the part of the nervous system in control of
the involuntary muscles and secretory glands.
THE HYGIENE OF THE NERVOUS SYSTEM 311
or by way of the cord stimulations from the skin,
muscles, or other distal parts; the brain receives this
stimulation, reacts in accordance with its character,
and then sends out an impulse over the efferent nerves.
No act may be considered completed until the entire
circuit is made and the stimulus received has been
responded to.'
The stimulations or impulses that pass over the efferent
and afferent nerves travel over imits in the nerve struc-
ture that consist essentially of a cell body with a number
of branching processes. The message does not travel
over a route like a telephone message, but at a number
of places the route is broken and the message must
transfer from one unit of the system to another. At
many of these breaks in the course of afferent or efferent
mechanisms a choice of routes presents itself. Which
imit shall be chosen to carry the message? Now all
that we do in education or in training of self relates to the
selection of routes, to the formation of pathways in the
brain and cord. Many connections are made that are
not serviceable — ^they are discarded. The successful
ones persist and habit forms to bind finally in firm bonds
the individual, limiting and defining the range of activity
for all time. Habits may be changed when they are
"yotrng"; on the other hand, it is often impossible to
change habits that have been formed for years. There
are exceptions, though, and by the force of a great emo-
tion, or strong impelling ideals, the individual may
with constant care entirely change the extent and char-
acter of his habits.
The autonomic system is associated with the digestive,
nutritive, excretory, and secretory functions of the body.^
Structurally it consists of groups of nerve tissue bound
together into the chains that lie in front of the vertebral
column (Fig. 33). By means of nerve branches they con-
' The response may be inhibition of visible activity.
' Timme, W. : The Autonomic Reciprocal Activities of Brain and
Viscera, Journal American Medical AssociatioM, January 23, 1915,
312
PERSONAL HYGIENE APPLIED
nect with other masses of nerve tissue, plexuses situated
in the neighborhood of different organs.
These two systems, the cerebrospinal and autonomic,
are closely associated in activity. In fact, the health
of the individual is dependent upon the maintenance
of a proper balance of activity between the two and a
certain co-ordination and harmonious action.
THE HYGIENE OF THE NERVOUS SYSTEM 313
Factors of Importance in Maintaining the Health of
the Nervous System. — Some parts of the human body-
are older than others in the sense that they have under-
gone less modification in the process of evolution. Other
structures may be considered as quite new. Thus the
nervous system with its elaborate modification of the
brain of man represents comparatively a recent achieve-
ment in organic evolution. Nevertheless, the nervous
system embodies the whole story of human development,
and, because of this fact, it exhibits in many of its reac-
tions the primitive responses of the race.
The autonomic system is associated with the fimctions
concerned in the maintenance of life. It is also connected
with the whole emotional life. Cannon' has very clearly
written of this relation of the emotions and has stated
with scientific accvuracy the fortifying mechanisms that
are brought into play by the action of this system. Prob-
ably aU cerebrospinal activity involves some excitation
of the autonomic system. The two systems are so closely
related that for many purposes of psychology they are
considered as one. For interpretation of health values
it is important to indicate some of the essential factors
that are to be considered by those who are seeking to
live at the optimum point.
Harmony of Action Between Cerebrospinal and Auto-
nomic Systems. — The health of the nervous system and,
indeed, of the body as a whole, depends upon a nice
adjustment of the work to be done by the two systems.
Overuse of either one or improper use produces char-
acteristic results.
A marked tendency in organic evolution has been the
elaboration of the cerebral hemispheres. The effort
has been directed toward central development. The
necessities in education and in economic life have made
the cerebrospinal a superior instrument for securing
satisfactions in life. The autonomic nervous system,
'Cannon, W. B.: Bodily Changes in Pain, Hunger, Fear, and
Rage, D. Appleton & Co., New York, 1915.
314 PERSONAL HYGIENE APPLIED
of supreme importance to the Pleistocene man, is today
in a secondary position as regards social iises, needs,
and duties.
This tendency has led imquestionably to a glorification
of the cerebrospinal, so that in education, in business
generally, in industry there has been little appreciation
of the place and the importance of the autonomic nervous
system in the life of man. It has produced the scholar
who sneers at the physical basis of neural elaboration,
the monk who seeks to give spiritual guidance by living
a more or less ascetic Ufe; it has evolved the scholastic
system that omits from the educational curriculum the
play life of the child. Historically, this tendency has
given us, as Hetherington suggests, asceticism with its
degradation of the body, scholasticism with its contempt
of the physical, and Puritanism with its hatred and fear
of play, self-expression, and drama.
Fortunately for man there is a growing appreciation
of the importance of the autonomic system as a ground-
work and foundation for the cerebrospinal. The great
increase in nervous diseases, in nervous breakdowns
points the way to a new emphasis. The basis of life
must be made secure. The whole tendency of civihza-
tion, with the tremendous growth of industriahsm and
the factory system, with the exhaltation of "system"
and "efficiency" as guides in production, is to cut straight
across the essential biologic needs of man, the organism.
The neurasthenic, the "shell shocked," the nervous
woman, the irritable man are persons who have taken
on cerebrospinal activities beyond their capacity for
accomplishment.
They need relief from the demands of the environ-
ment. As Weir Mitchell taught, "They need rest."
Fundamentally, the cause of this maladjustment is
twofold. One factor is an inheritance of nerve tissue of
poor quahty. The fact that some individuals break,
others do not, is a famihar one. The other factor is the
philosophy of the century. To get ahead, to succeed, to
THE HYGIENE OF THE NERVOUS SYSTEM 315
become a captain of industry, to achieve the maximum
production of wealth — ^these guides lead to nervous
breakdowns and moral disasters.
The superiority of life on the cerebrospinal plane to
life on the autonomic level is imquestioned. We can
never justify a mode of living with health as the end of
life. To develop the cerebrospinal system to its maximum
point is the only acceptable ideal, but its foundation
must never be forgotten. Socrates or Newton, Glad-
stone or Roosevelt, the common man himself, garbed
though he be in his own heart as a modern Galahad in
search of the Grail, wiU always need a generous partici-
pation in play, recreation, and physical work sufficient
to keep the physical organism fit and ready to serve the
cerebrospinal system to its best development. One
who seeks to live most and to serve best wiU be guided
very largely by this balance of systems. The great
ideals of achievement and of service should rarely mean
slow suicide; he only is fit to serve who keeps himself
at his best.
Relation of Training to the Health of the Nervous System.
— It is recognized that one may inherit a defective nervous
system just as well as a defect of the skin, skeleton, or
musculatitte. Nature passes on to the offspring the kind
of characters the parents possess. This fact is immutable.
Unfortunately, recognition of it serves as an explanatory
excuse for much undesirable and unhealthful nervous
response that is due to improper training. Not infre-
quently bad disposition, moods, temper, or irritabihty
in the child are explained or excused, as the case may be,
by the presence of similar traits in the parent. This
explanation is based upon a belief in the hereditary
transmission of the characteristic concerned. It is
important, therefore, to evaluate the evidence in the
matter and to determine the significance of training in
the development of a harmonious well-balanced nervous
system.
Bergson states one view of the problem: "Each of us,
316 PEBSONAL HYGIENE APPLIED
glancing back over his history, will find that his child-
personahty, though indivisible, united in itself divers
persons which could remain blended just because they
were in their nascent state: this indecision, so charged
with promise, is one of the greatest charms of childhood.
But these interwoven personalities become incompatible
in course of growth, and, as each of us can hve but one
Ufe, a choice must perforce be made. We choose in
reality without ceasing; without ceasing, also, we abandon
many things. The route we pursue in time is strewn
with the remains of aU that we began to be, of all that
we might have been."
This states the problem as regards the nervous system
and such matters as "nervousness," "fears," "moods,"
attitudes, bad tempers, etc. The child who fears Ughtning
and thunder probably expresses this instinct of fear
because the parent was afraid also in the presence of
the child.i Intelligent response by the parent would in
many cases prevent an instinctive response by the child.
The bad disposition in the child means usually bad dis-
position in the home. That is, we are deaUng here with
the effects of training; we are not deaUng with biologic
characters that are immutable.
It should be remembered, also, that bodily states
often determine mental and emotional reactions. James
says, "Our moods and resolutions are more determined
by the condition of our circulation than by our logical
grounds." This has its bearing and should receive con-
sideration. It is quite in harmony with James' theory
of the emotions. But, indeed, the identity of bodily
states and emotions, both as responses to a situation,
renders another aspect important. Mental and emo-
tional states are so closely associated witli the physical
expression of them that even the posture has influence
on the way one thinks and how one feels. One with a
• There is not complete agreement on this point. See Thorndike,
E. L. : Educational Psychology, Vol. I, pp. 57-68, Teacher s Col-
lege, 1919.
THE HYGIENE OF THE NERVOUS SYSTEM 317
depressing mood may speak hopefully and act happy;
and presently the emotion of joy will come. Thus for
health and happiness it may be essential to cultivate
the power to replace moods, to rise above the depression
of the moment by act of will.
The health and happiness of the individual are inti-
mately bound up with the sort of habits and attitudes
he develops and holds. Education should give all an
equal opportunity to form proper habits and to develop
wholesome attitudes. This does not mean imiformity
in education, nor will it lead to a level of mediocrity.
There will always be the superior ones who achieve,
and inferior ones who accomphsh little. Both groups
may be healthy and happy if proper habits and attitudes
are developed. It is important not to feed boys and girls
mentally with such fallacies as "All men are created
equal." Such an attitude leads directly to social unrest,
social inefficiency, social unhappiness. One person is
not the equal of another by birth, nor can equality be
conferred. Each person is just as "good" as he makes
himself, limited, of course, by heredity and environment.
The business of government is to supply equahty of
opportunity for aU before the law, for service and for
education. The business of education, as Professor
Briggs suggests, is to train each individual to his maxi-
mum, to learn to do better the things he would prob-
ably do anyway.
This means definitely as regards one's nervous system
that one should not try to do work beyond his ability.
An individual with C grade inteUigence in a position
requiring B grade intelligence is a failure. Socially he is
inefficient; individually he is unhappy, and with reference
to his nervous system extremely unhealthy.
To gain wholesome attitudes concerning home rela-
tionships and worthy use of leisure, to hold vocation
and avocation in proper relationship, to develop desir-
able social and moral quahties, breadth of view, scientific
appreciations, are the foundations of health of the nervous
318 PERSONAL HYGIENE APPLIED
system. Skill, honesty, diligence, spirit of sportsman-
ship, courage, self-control, faithfulness, loyalty to high
ideals, interest in and love for play — ^these are the result
of training,' not of birth.
Within certain limits anyone may determine the kind
of nervous system he will have. He may control wony
by steadfastly refusing to worry over little things; he
may avoid fears by early abstinence from all indulgence
of fear; he may surmoimt an irascible temper, moody
disposition, or introspective manner by constantly seek-
ing early and at all times for controlled expression, cheer-
fulness in life, and the needs of others.
The Significance of Defective Inheritance in the Nervous
System. — The most favorable training will not compen-
sate for defects in nerve structure. Numerous examples
can be given by clinicians of types surviving the stress
and strain of life's problems in a favorable environment,
that break completely when subjected to unusual and
too severe demands. Many miscalled "shell shock"
cases of the World War testify to this fact. It must be
recognized that many expressions of bad temper and
bad disposition, as well as bad politics, bad economics,
and bad sociology are due to defective innervation that
cannot in the present organization of society be pre-
vented easily. Nimierous instances of this state of
affairs occurred during the preparedness campaign in
America before the war and continued even during its
progress.
Frequently the conscientious ' objector and pacifist
are individuals with defective nervous systems whose
position is one of personal apology for their own in-
adequacy. For some, pacifism was a philosophic doctrine
with rational background in their individual Uves before
the war. For many it served as an excuse for their own
inability to meet the demands of the social environment.
Usually the pacifist in war times is the most militant of
*See Atlantic Monthly, Jxily, 1921, an article by Theodore
Knappen on the Morain Park School, Dayton, Ohio.
THE HYGIENE OF THE NERVOUS SYSTEM 319
persons in peace, fighting lost causes, posing as a martyr,
intensely antisocial; even with members of his own
family his relations are often strained. According to
his own statements he is frequently misimderstood.
The pacifistic philosophy even when held by those of
sound nervous system is frequently so short sighted that
it cannot see the larger goals beyond the immediate,
insistent difiiculties that must be met. The attitude of
such people is similar to the one held by numerous per-
sons to whom the operating-room of a hospital is a place
of horrors where hideous things are done to hving bodies
with sharp knives. They even regard the surgeon as
a monster of callousness because he can do such work
without repulsion.
The normal mental attitude toward difficult affairs
of life sees through the dangers, the strains, and the
uncertainties to the distant goal, the desired end. Thus,
one would not view war nor operations as ends in them-
selves, but only imperfect means to other ends more
worth while than the conditions which provoke the
war or the operation. Until hmnanity has evolved among
men better procedures than those represented by the
gun and the knife, injustice, slavery, and cancer must
be met with the tools that are serviceable. The normal
life wiU be prepared to meet crises. When the crises
come, and the stresses and strains weigh heavily, then
habits of clear thought, attitudes of social responsibility,
of honesty in facing problems, and of meeting them
squarely, will be sane guides and coimsellors.
The Normal Mental Life. — ^The normal mental life
flows from states of satisfyingness. The healthy state
of mind is satisfaction with life. Mental activity that
is hurried, driven, anxious, or depressed, that is charged
with "long-range apprehensions," fears, worries, is dis-
tinctly injurious to health both of mmd and of body.
Now the healthful mental state can be developed
just as surely as big muscles can be. The process is
neither so simple nor so easy, but it is not too much
320 PERSONAL HYGIENE APPLIED
to say that most persons can so direct their thoughts
and so order their Uves as to attain, gradually, a higher
level of control than either their heredity or training
would have promised.
Mental training means a training in control, in removal
of unwholesome states, and in substitution constantly
of wholesome plans, purposes, and satisfying interests.
Worry. — The most common form of abnormal mental
functioning is called worry. It represents a situation
that has been created by civilization with its many "long-
range apprehensions," fears, and outcomes. It requires
the direct cultivation and development of a mental
quaUty that will offset, neutraUze, and render harmless
the tendency to worry. We cannot put man back to
the state of the lower animals where only immediate
danger provides a stimulus. The food-supply next month
is of no concern to a cow or a camel, it is to man; the
length of tail or glossiness of fur amounts to nothing at
all in the immediate jealousies and quarrels of the fox,
appearance does in man; the wildness in a yoimg colt does
not cause the sire or dam to lose sleep, it does in man.
With man, then, the elaboration of the cerebrospinal
nervous system has brought into the field of mental
activity fears and anxieties that cannot be met at once;
they have "long-range" quality.
Now to such situations there must be presented a
philosophy of Ufe, a point of view, a characteristic reac-
tion that will enable the individual to meet the problem,
whatever it may be.
It must be clear at the outset that a wholesome mental
attitude cannot suddenly be acquired. It can never
be a gift; it is always won. It comes by persistent and
conscientious effort to see straight, to keep the values
of life clear.
Worry may be better understood by analyzing it in
the common groups in which it most often occurs. They
are: what we have done, what we are going to do, what
people think of us, and our health, ment;3,l and physical.
THE HYGIENE OF THE NERVOUS SYSTEM 321
Worry Over What We Have Done. — Worry over some
work that was done badly or some act that should have
been omitted is a very common form of worry. It is
tied up with the third form of worry, the opinion of others,
because we see the social judgment upon the act or work
more than our own cognizance of its impropriety or
inferiority. Now one can lessen worry about what one
has done only by reflecting briefly, "What is done, is
done." The mistake should be a lesson and not a sub-
ject for regrets and recriminations. The experience
may be made a stepping-stone; worry over it makes it a
stumbhng-block.
The present and coming generations will have in-
creasing need of a philosophic faith that wiU lead from
mistakes and failures to calm, clear resolution rather
than to incoherent, aimless wanderings of the mind.
This generation shows its need for help along this line.
The faith of our fathers is not strong today. "The Ever-
lasting Arms" do not appear to be "underneath" bearing
up the sojourner in life's whirlpools or recesses. The
constant invention of new religions indicates the demand.
There is a tvirning to Christian Science, to the Higher
Thought, to New Thought, to Psychotherapeutics, to
Occultism, to Spiritualism — even to Epicureanism (let
us eat and drink, for tomorrow we shall die). These
may be effective for simple minds in need of formulae;
the intelligent soul will face the mistake, the act and its
consequences, and will say, "It's done, but because it's
ignoble or because it's muddled, or because it's unwhole-
some, it shall not be done again." No need for hocus
pocus here. Break your best china — ^then think of a
lovely rose? No! Such formulae are only for those
weak spirits who wovfld never be interested in achieving
intelligent control in life anyway.
The psychologist is helpful with this type of worry.
He tells us that the mind is so constituted that a morbid
memory cannot be driven out by repeating, "I will
forget it." One thougM can only be driven out by another.
21
322 PERSONAL HYGIENE APPLIED
The stream of consciousness is a stream and is always
flowing. Selection of a proper subject for mental exami-
nation or engaging in work of an interesting kind will
replace the undesirable worry with an acceptable ac-
tivity. This choice must be conscious, intelligent, and
directed.
This form of worry is seen in its simple manifestations
among those who get up to unlock the door to make sure
they locked it. Better is it for one to allow a burglar
to carry the entire house away than to subject one's
nervous system to such activity.
It is important to give thought to the morrow, but
one should practice doing carefully what one has to do
and then dismissing the matter from the mind. The
danger of losing mental health must be set over against
the cost of leaving the gas burning in the hall, or the
door unlocked, or the possible eiTors in the final examina-
tion.
Wmry Over What We Are Going to Do. — ^Worry about
a task that is to be done is destructive of the power
to do the task well. Here again substitution is important.
One should substitute work on the task for the useless
feai^— whether one has sufficient ability for the task or
not. To size up the work, to decide to do it, and then
to start is the beginning of successful accomplishment.
One should avoid spending too much time deciding
what to do. A proper amount of attention should be
given to consideration of the thing to be done, and then
— one should pounce upon it. A mistake may be made;
others make mistakes. Important questions have been
and probably often will be decided wrong.
The young person who worries about success prevents
himself from succeeding. The whirling, interesting
present' moment is the treasure to grasp. The yester-
day with its failures, the morrow with its unknown,
are to be passed by. Life is here and now. One who
exists now only to live at some future time misses the
great opportunity. The training one puts oneself through
THE HYGIENE OP THE NERVOUS SYSTEM 323
is life, not a preparation for life. This very moment
will never come again. Even now it is gone. The hand
that writesj the eye that sees this line cannot bring it
back. Here and now is life — fill it full of "work, of play,
of love, of worship."^ The summum bonum is Happi-
ness.^ Not the base kind that smacks of race tracks,
wine, music halls, and commercialized vice. But rather
the kind that Saleeby speaks of,^ "There is no htiman
end but happiness, high or low. Its one absolute negation
is neither poverty nor iU-health, nor material failure,
nor yet starvation — 'he that is of a merry heart hath a
continual feast.' The one absolute negation of happiness
is worry or discontent. A prosperous society consisting
of strenuous worried business men who have no time to
play with their children, or listen to great music, or
gaze upon the noble face of the sky, or commune with
the soul ... of which another poet, Wordsworth,
said that it was 'like a star that dwelt apart' — such a
society may be as efficient as a bee-hive, as large as
London and as wealthy, but it stultifies its own ends,
and would be better not at aU. 'Better a handful with
quietness than both the hands fuU with travail and
vexation of spirit.' " We might well say of happiness
as Emerson said of the beautiful, "Though we travel
the world over to find the beautiful, we must carry it
with us, or we find it not."
Worry over what we are to do may take various forms.
At times it will be directed at vocations; at other times
it is greatly exercised over the problem of marriage.
These are important problems. They are not to be
solved out of hand, nor do they admit of continual analysis.
1 Cabot, R. : What Men Live By, Houghton Mifflin Co., Boston,
1914.
" Henri Poincar6 starts one of his recent books with the remark
that the chief aim of man is to search for truth. Truth and happiness
are very much akin when truth in concrete forms is directed in the
service of man and happiness remains truthful, free from sham, and
the similitudes of mere smiles.
'Saleeby, C. W.: Worry, Frederick A. Stokes Co., New York,
1907, p. 22.
324 PERSONAL HYGIENE APPLIED
To find one's best work where the tasks will have meaning
and the compensations are paid in happiness and joy-
is not easy. But worry over the outcome of a vocation
prevents any careful study of the vocation, its special
requirements, its fields of opportunity and responsibility.
The choice of a fife mate causes less worry as a rule
than the choice of a vocation because the former is so
often an emotional act rather than an intellectual judg-
ment. The worry comes more often after the choice
has been made. More inteUigence and less emotion
before and less analysis and more love after marriage
would probably decrease if not entirely eliminate worry
in this field.
Worry Over the Opinions of Others. — ^A friend of mine
keeps on his desk a card index of data that he is con-
stantly using. Under the section C he has a card headed
"Criticisms." There he has written from time to time
criticisms of his work, his manner, his personaUty. Some
have been very helpful; others have been siUy — ^in his
judgment. The only intelligent response to others'
opinions is to be thankful for the criticism. If it is good,
use it; if it is silly, throw it into the waste basket.
The danger to mental health of being sensitive to
criticism cannot be overstated. Most persons do not
appreciate the mental damage that comes from nursing
a slight or mulling over in the mind a fancied wrong.
One should avoid moods and poutihgs as one would the
plague.
If someone has spoken unjustly, unfairly, one should
classify the criticism as foolish and the critic as unreason-
able and forget it. If the criticism is a just one, one
should swallow one's pride, bow the knee, and learn.
It is not a question of courage, it is a question of per-
spective. As Theodore Roosevelt' would say, "It is a
question of the major interest driving out the minor
interest."
' Robinson, C. R. : My Brother, Theodore Roosevelt, Chas.
Scribner's Sons, New York, 1921, p. 274.
THE HYGIENE OF THE NEEVOTTS SYSTEM 325
Women need to be particularly alive to this matter
of criticism. All sensitive natures must cultivate the
unheroic and commonplace. One cannot with any safety
indulge in the melancholy pleasure of playing the martyr.
I know a woman who always seeks out difficult and
burdensome tasks, so she can say afterward, "Oh, how
hard it was! No one knows how I have suffered." For
such there is no mental poise, no happiness at all until
the relation of self to the world has been adjusted.
Worry Over Health. — It is important to form the habit
of taking the health of mind and body for what it is
and making the best of it. True, if the condition can be
improved, the most careful and scientific care should
be used to restore it entirely. But useless fear and worry
not only prevent the development of the best health,
but, indeed, produce disturbances that are quite dis-
Whenever the activity of the cerebrospinal system
flows over into the realm of autonomic control a precious
balance and harmony are disturbed. The nutritive
processes of life are designed to go on without conscious
direction. The beating of the heart, breathing, digestion,
peristalsis, liver activity, excretion, and other functional
activities are controlled by the autonomic system and
spinal cord. The higher centers should at no time be
conscious of them or concerned about them. Saleeby*
says, "Those bodily processes and functions which are
under the control of the lower levels of the nervous system
are best performed when those lower levels are left un-
disturbed by orders from above. This is true not only
of such fimctions as sleep and digestion but also of other
functions which, at one time in the history of the individ-
ual, have required the most direct and painstaking efforts
of conscious attention."
Functional diseases of the nervous system are fre-
quently caused by worry. Both hysteria and neurasthenia
result from worry. The following question and answer
"•Saleeby, C. W.: Loc. cit., p. 33.
326 PERSONAL HYGIENE APPLIED
from Dr. Evans' column in the Chicago Tribune^ illus-
trate a case of neurasthenia and suggests in the last
sentence of the reply the reason for the development of
Christian Science and other rehgious cults.
MENTAL HELP IS NEEDED
Hopeless writes: I have doctored ever since I was five years old.
At that time I had typhoid fever and pneumonia. It left me with
nervous trouble and which I have tried hard to overcome. I cannot
go any place because I get nervous. It seems to work on the stomach.
There is a beating and I always feel as if I have to vomit. Do you
think exercise wiU help, such as swimming and tennis?
EEPLY
Taking medicine will do you no good. You are a neurasthenic
and you suffer from anxieties and fears. You can be cured, but it
will take time. It is a matter of mental and social training. If you
get in the line of such training and have the patience and persever-
ance to stick, you can win. There are bushels of religions, philos-
ophies, cults, and such suited to just your kind of people.
The emotional person will often require a symbol,
creed, or formula by which to guide life; the person with
matured intelligence, with rational guides, will not
require any hocus pocus, but will, by vohtional power,
force himself to think properly, to control emotions,
and to banish fears. The neurotic person who is unable
to or does not desire to heal himself should in every
instance engage the services of a scientific physician who
commands the respect of the patient by the power of his
personality.^ Psychologists recognize this power and
call it suggestion. The skilful physician uses suggestion
in functional disturbances. Such a procedure for the
neurotic will secure the service that a magic cult would
give and, in addition, it would provide that medical
care which will be needed in the advent of a real organic
disease.
Worry over one's health leads inevitably to increased
1 Chicago Tribune, Aug. 23, 1921.
' It would appear that Dr. Evans could have served Hopeless
better if he had been in a position to recommend a physician.
THE HYGIENE OF THE NERVOUS SYSTEM 327
disturbance of body functions. Hysteria, neurasthenia,
hypochondria, with its many fears, are matters of gradual
growth. They are not suddenly developed out of hand.
One who allows oneself to worry about small matters,
who expects heart disease or deafness from every sore
throat, is laying a foundation in abnormal mental reac-
tions for unhappiness and ill health.
Development of Wholesome Mental Habits. — It is
quite possible for many persons to develop wholesome
mental responses and for many to achieve a higher type
of control than the usual and customary. The secret
lies in holding even, in unimportant situations, the un-
emotional, sane, intelligent attitude. Saleeby' says,
"It is pre-eminent necessity for the irradiation amongst
the people of that fine temper, half philosophic, half
religious, half intellectual, haK emotional, half rational
acceptance, haK faith — ^the faith of Socrates that to the
good man no evil thing can happen — ^the temper that
possessed the soul of Wordsworth, who, whilst others
were distressed, disheartened, at the betrayal of a patriot,
addressed him in these great words:
" 'There's not a breathing of the common wind
That will forget thee; thou hast great allies;
Thy friends are exultations, agonies,
And love, and man's unconquerable mind.' "
To train oneself in small things to meet the problems
of life is the beginning of that power which in the crises
of life will find the owner strong, able, and sufficient.
Such training should be begun in childhood.^ Situations
should be met by boys and girls without allowing them
to expect the rescuing hand.*
A list of wholesome mental traits important for health
will not satisfy everyone, perhaps, but the following
» Saleeby, G. W.: Loc. cit., p. 2.
^ Paton, S. : Human Behavior, Chas. Scribner's Sons, New York,
1921, pp. 394r^54.
' Wimams, J. F. : Values of Camping for Girls, Teacher s College
Record, January, 1920,
328 PERSONAL HYGIENE APPLIED
appear significant: confidence, faith in the goodness
of life, open-mindedness, and unselfishness.
Confidence. — Confidence in self, in one's power, in the
intrinsic value and worthwhileness of one's own per-
sonality is essential for the most abundant life. It was
the principle that Jesus taught in his insistence upon the
love of the Father for each person. This belief in one's
power and one's worth lies at the foundation of all
worthwhile work and accomplishment.
Experimentally, its value has been determined. Give
a subject a puzzle, and if he says, "I don't suppose I
can do it," he renders his mind less able to discover the
means for its solution. He may even insist that it can't
be done. If inadvertently he solves the puzzle, but hasn't
learned the process, he will attack it with more con-
fidence. The experience of success increases his con-
fidence.
This fact has significant meaning for education. It
suggests one reason for the large number of persons who
lack grit, courage, confidence. It corroborates the views
of Goddard' with respect to the necessity for vocational
training and adjustment.
The only way to develop confidence is to try honestly,
and to keep at it until the experience of success comes.
Reasonable intelligence would prevent selection of work
for which one was wholly unsuited, and from which no
success to mention could be expected.
Faith in the Goodness of Life. — Faith in the goodness
of life, here and now, will be based upon an understanding
of man's relation to man and to God. It will not con-
sider this world an evil from which an escape is Nirvana
to the soul. Rather it will hold the ptdsing moment
to be real life in which all that one most desires is en-
shrined. The devastating war, the serious disease, the
broken promise, the unrequited love, are but incidents
to the man with faith in the goodness of fife, whose
* Goddard, H. H. : Human Efficiency and Levels of Intelligence,
Princeton University Press, 1920.
THE HYGIENE OF THE NERVOUS SYSTEM 329
course is chartered . not by individual suffering, shame,
or joy, but by the progress of the race.
What happens to the individual is important, but
what happens to the race of man is supreme. Viewing
that, one should see with Tennyson —
"That nothing walks with aimless feet,
That not one life shall be destroyed
Or cast as rubbish to the void
TiU God hath made the pile complete."
and with Browning when he sings,
"God's in His Heaven,
All's right with the world."
The path to faith in the goodness of life lies among
the commonplace every-day affairs of work and play.
The exotic, the bizarre, sensational course must be
avoided. The simple life, as Pastor Wagner^ taught,
makes for such faith.
Faith in the goodness of life means optimism. It is
not the optimism of the Christian Scientist who says
that aU things are beautiful. Values need not be mixed
in that way. All things are not beautiful. Many things
are rotten, ugly, and totally to be condemned. Optimism
means joy in the wonderful things of hfe, of which there
are many.
Nothing is quite so destructive of real happiness and
health of mind as pessimism. Doubt, fear, and self-
consciousness are the plague-demons of joy. On the
contrary, play, laughter, lack of a duU seriousness are
the tonic needed by the jaded nerves of civilized man.
Those who can play (and play is a psychologic attitude)
live, they burn; others only smoulder.
Bangs' poem of a happy child strikes the note for this
faith that is the testimony of poets and the scientific
record of physicians:
1 Wagner, Charles: The Simple Life, McClure, Phillips & Co.,
New York, 1902.
330 PEBSONAL HYGIENE APPLIED
"I do not sorrow when there's snow
Or rain, or fog, or sleet,
There are more toys at home, you know.
Than out there on the street.
"So whether we have bright sunshine.
Or clouds all through the day,
I never sorrow or repine.
But play, and play, and play."
OperMnindedness. — Open-mindedness and breadth of
view make for sanity. The restricted vision, the institu-
tionalized mind, continually clashes with the growing
liberalism in the world. It will increasingly clash be-
cause asceticism, scholasticism, and Puritanism are
meeting everywhere the opposition of minds freed from
the traditional. To keep an open mind means to be willing
to accept any new proposal, however at variance with
estabhshed belief or custom, whenever the new presents
facts to sustain its contention. The open mind will
see the facts, will not close itself off from the facts. It
prevents thereby the rigidity of mind so allied to the
fixed idea of the insane. Open-mindedness means plas-
ticity of mind, ability to see new relationships, to feel
new meanings, to find new values. It makes for variety,
interest, and health.
Unselfishness. — Finally, unselfishness as an attitude
is to be cultivated because of its wholesome effect on
health. It may be warranted on moral and social grounds,
but aside from these justifications it lies at the very root of
satisfactions in fife. Mental growth and mental health
feed on satisfying situations. The permanent satisfactions
in modern society come from unselfish service to the
world. In a primitive society the original instincts for
selfish ends would be more satisfying, but today the
selfish person erects a splendid isolation aroimd himself,
that leaves him, because of the very gregariousness of
man, an unhappy, disgruntled, and unwholesome soul.
There seem to be at the very foundation of all whole-
some mental life — confidence and belief in self, faith in
the goodness of the world, open-mindedness and breadth
THE HYGIENE OP THE NERVOUS SYSTEM 331
of view, and unselfishness. To others may appear other
values. It is for all to choose. What roads we travel
matters very little. That we arrive at our desired goal
and that the goal shall be worth while — ^this is the test.
Insanity. — Insanity is a mental disease with such
departures of mental functioning from the normal that
the whole personality of the individual is changed. This
change is usually gradual. Commonly it is looked upon
as sudden, peculiar, and mysterious. Quite the contrary
is the case. It is the logical result of changes occurring
in the brain, its causes are, in the main, well known, and
it comes as a gradual deterioration. Many of the insane
in hospitals today might have retained their mental
health if they had known the necessary facts and had
acted in accordance with them.
In insanity there are two elements involved — the
predisposing and the exciting. "The predisposing are
the inherited and acquired abnormahties of the individual,
while the exciting are to be found in the storms and
stresses of life. Of these two the first must positively
be present, but not always being evident, it is often
overlooked, and it is the second or the exciting cause,
itself relatively unimportant, that is held in popular
beUef, generally alone responsible. Thus we hear of
persons 'going insane' from grief and from disappoint-
ment, from fear and from shock; but, while it is true
that without something of these the disease might never
have developed, it is equally true that none of them
alone can bring it on. Storm and stress factors enter
into the development of practically all mental disorders,
both mild and severe, but they are only factors, the
ultimate causes he deeper."^
Types of Insanity. — ^The types of insanity are fairly
well defined. De Fursac^ suggests a classification that
is used as a basis for the simplification given below:
> Pktt, C: The Psychology of Thought and Feeling, Dodd, Mead
& Co., New York, 1921, p. 233.
2 De Fursac, J. R. : Manual of Psychiatry, John Wiley & Sons,
New York, 1913.
332 PERSONAL HYGIENE APPLIED
1. Psychoses based upon defective nervous tissue, called morbid
predisposition or constitutional psychopathic condition. In
this group are paranoia, manic depressive insanity, obsessions,
sexual jjerversions, and mental instability. Mental hygiene
is most important in this group.
2. Psychoses based upon toxic or infectious processes. In the
former are alcohoUsm, morphinomania, and cocainomania,
and in the latter, infections such as typhoid, diphtheria,
hydrophobia, influenza, and tuberculosis. Personal hygiene
is very important in this group.
3. Psychoses based upon syphiUtic infection, as seen in general
paralysis (paresis) and locomotor ataxia. Personal and
social hygiene are important in this group.
4. Psychoses based upon auto-intoxication (KraepeUn's view), such
as dementia prsecox. This condition occurs usually before
the age of twenty-five and rarely after thirty. It follows a
poisoning of the body, at times after a severe infection, as
scarlet fever, or at other times a disorder of the sex glands
seems to be the factor, as indicated by its appearance at
puberty or in the female at the first childbirth. Meyer'
behoves that this type belongs more properly with the
constitutional psychopathic group (Group 1 above).
5. Psychoses of involution, such as affective melancholia and
senile dementia.
Causes of Insanity. — The causes^ of insanity are known
in the main. Omitting heredity, they may be considered
under four headings:
Syphilis. — Paresis, often called general paralysis, and
popularly known as "softening of the brain," accounts
for about 20 per cent, of the insane admitted to state
hospitals. Syphilis as a factor may be considered even
more important because of its relation to tabes dorsalis
and the mental deterioration that comes in the late
stages of this condition. Syphihs is a common infection;
insanity, a relatively rare condition. The disease may
be expended upon other organs than the brain, but when
it attacks the brain some form of mental disturbance
is bound to result.
In the main, syphilis is recognized as the cause of
paresis. The disease at this stage is incurable by any
' Meyer, A. : Fundamental Conceptions of Dementia Praecox,
British Medical Journal, September 29, 1906.
' Paton, S. : Human Behavior, Charles Scribner's Sons, New
York, 1921, p. 27.
THE HYGIENE OF THE NEBVOUS SYSTEM 333
means known to medical science. The brain tissue has
been, changed, and when once altered, it is thereafter
impossible to restore it to normal.
This causative factor causes serious destruction, to
other organs of the body, namely, the heart, liver, blood-
vessels, and bones. It presents a problem not only to
the individual but also to society that should challenge
the most inteUigent effort for diagnosis, isolation, and
treatment.^ Its frequent connection with immoral
living and its certain moral and social censure of the
infected individual are the factors that have prevented
a rational administration by boards of health. In the
light of aU the unhappiness, iU health, and early deaths
caused by the disease it is not too much to say that it
should be treated according to the estabhshed principles
of conmiunicable disease control.
A pamphlet prepared by the Committee on Mental
Hygiene of the State Charities Aid Association (N. Y.)
gives the following as additional causes of insanity.
This pamphlet is authoritative, having the endorsement
of leading psychiatrists and neurologists:
Alcohol and Other Poisons. — ^Another group of mental
diseases are due directly to the habitual use of alcohol.
Alcoholic insanity may be brought on by the regular
use of alcohol even in "moderate" quantities not pro-
ducing intoxication. The close relation between alcohol
and insanity has only recently been fuUy reahzed.
Statistics as to the number of cases in which alcohol
is the direct cause necessarily vary in different localities.
FuUy 30 per cent, of the men and 10 per cent, of the
women admitted to the State Hospitals are suffering
from conditions due directly or indirectly to alcohol.
So marked is the effect of alcohol upon the brain and
' Bigelow, N. A. : Sex Education, The Macmillan Co., New York,
1916. The Problem of Sex Education in Schools, United States
Pubhc Health Service, Washington, 1919. Social Hygiene Educar
tion, Bulletin No. 13, Teachers College, New York, 1921. The
United States Interdepartmental Social Hygiene Board Activities,
1919-1921, Reprint Annual Report, June 30, 1921, Washington.
334 PERSONAL HYGIENE APPLIED
the nerve tissue that it helps to bring about a number
of mental breakdowns in addition to the alcoholic in-
sanities. Alcohol is a poison. A long series of careful
tests' performed by eminent authorities showed that
even small quantities of alcohol may lower the mental
capacity, and that it takes much longer than is usually
supposed for this offect to wear off.
In this day of keen competition every man needs the
highest possible development of his mental capacities.
Not only is the highest mental development impossible
with the continued use of alcohol, but impairment of
the mental faculties is likely to follow.
Other poisons, such as opium, morphin, and cocain,
which, with alcohol, are the principal parts of many
patent remedies, often weaken the mental powers and
produce insanity.
Physical Diseases. — Some mental breakdowns may be
traced to the effects of other physical diseases. Typhoid
fever, influenza, diphtheria, and some other diseases
often so poison the system that for some time after the
disease itself has left, the regular functions of the body
are seriously interfered with. It is probable, also, that
the poisons so produced interfere with the nervous system.
Consequently, a mental breakdown is sometimes a
delayed result of such diseases. Among other physical
causes of insanity are tuberculosis and diseases of the
arteries, heart, and kidneys. Aside from the direct
physical effect of these diseases, they have a tendency to
disturb the mind by discouragement. A person suffering
from any such disease should have good nursing, skilled
medical treatment, pleasant surroundings, and freedom
from anxiety. Often these can be had only in a hospital.
Prejudice against hospital care is largely unjustified.
Overwork is often spoken of as a cause of insanity.
This is not correct.* Hard work alone rarely causes a
'Williams, J. F.: Healthful Living, The Macmillan Co., New
York, 1919, pp. 407-413.
^ Overwork associated with other conditions may result in an
exhaustion psychosis.
THE HYGIENE OF THE NBBVOUS SYSTEM 335
nervous breakdown. It only becomes a menace to health
when associated with worry and loss of sleep, or causes
mentioned under other headings.
The control of infectious diseases, protection of food
and water supplies, temperance, and healthful home and
factories, aU these help to prevent mental as well as
physical diseases.
Mental Habits. — Aside from physical causes there
are also mental causes. They are the most important
causes of some forms of insanity. The healthy state of
mind is one of satisfaction with life. This does not depend
so much upon ovu* surroundings, or how much money
we have, or how many troubles come to us, as upon
the way in which we train ourselves to deal with diffi-
culties and troubles. Anyone who departs too far from
this state of satisfaction must be regarded as tending
toward an unhealthy condition. Of course, not all
persons start with the same kind of mental makeup.
Some, owing to heredity, unusual experiences, or bad
training, have what is called a morbid disposition. But
disposition is not something fixed like the color of our
eyes. It must be looked upon as made up of many ten-
dencies which often can be changed or modified by
training and proper mental habits. Health is a duty
which the individual owes to himself and to others.
Mental health is as important as physical health. The
average person little realizes the danger of brooding
over sUghts, injiu-ies, disappointments, or misfortunes,
or of lack of frankness, or of an unnatural attitude toward
his fellowmen, shown by unusual sensitiveness or marked
suspicion. Yet aU these unwholesome and painful trains
of thought may, if persisted in and imreUeved by healthy
interests and activities, tend toward insanity. Whole-
some work relieved by periods of rest and simple pleasures,
and an interest in the affairs of others, are important
preventives of unwholesome ways of thinking.
Alcohol and the Nervous System. — The alcohol prob-
lem has not been settled by prohibition. It will be settled
336 PERSONAL HYGIENE APPLIED
only by education. The eighteenth amendment is the
quick way to remove the deterioration in human hfe;
it must be supplemented by the continued effort of
education.
Alcohol presents a social problem that cannot be
treated at this time. Evaluation of its relation to poverty,
immorality, crime, and general unhappiness is a matter
of social economy. What are the facts regarding the
effects of alcohol upon the health of the user?
The chief effects are seen in the nervous system. Diges-
tive tract and circulatory system show untoward changes
from alcohol, but the nervous system is mainly attacked.
Legraini made a careful study of the effects of alcohol
on the nervous system, and presented data that should
be considered carefully by the opponents of prohibition.
The external effects show in the irritability, the in-
creased susceptibility to disease, the lowered vitality.
The internal effects are more marked, and of most signifi-
cance are the experiments of Professor Stockard of the
Cornell University Medical School, which show the
influence of alcohol as a detrimental factor in inheritance.
Professor Stockard^ has proved that the germ cells
of males can be so injured by allowing the individual
to inhale the fumes of alcohol that they give rise to
defective offspring although mated with vigorous un-
treated females. In commenting on this work the
Journal of the American Medical Association^ said,
"The extension of these unique investigations, in which the
offspring from the treated animals which reach maturity are usually
nervous and sUghtly undersized, have further shown that the effect
of the injury of the germ cells is not only exhibited by the im-
mediate offspring of alcoholized animals, but is conveyed through
their descendants for at least three generations. There are many
instances of matings followed by negative results or early abortions,
' A monograph on Alcoholism and Heredity, published in the
Annates Medico-phychologiaues, December, 1921.
2 Stockard, C. R.: Archives of Internal Medicine, 1912, x, 369;
American NaturaUst, 1913, xivii; Proceedings of the Society of Ex-
perimental Biology and Medicine, 1914, xi, 136.
' Journal of American Medical Association, October 17, 1914.
THE HYGIENE OP THE NERVOUS SYSTEM 337
stillborn young, or defectives. An instructive illustration was
afforded in a case in which two of the four young were completely
eyeless, the eyeballs, optic nerves, and chiasma being absent. Such
defects result, according to Stockard, from the injury originally in-
flicted on the germ cells by the experimental treatment. Yet this
injury may have been received by early generations only. Thus
the parents of the anophthahnio guinea-pigs just mentioned were
untreated, their four grandparents were also untreated, but their
great-grandfathers were all alcoholized and the great-grandmothers
were all normal animals. The defective eyes of descendants are due
to impaired development, not to the direct action of alcohol. Plainly
the spermatozoon is actually weakened if not disabled by the
alcohol treatment and all individuals arising from combinations in-
volving such a germ cell are likely to be below normal. There is
food for reflection in these facts."
The scientific evidence is available. Alcohol is not a
food (it burns too fast for the human machine), it poisons
the highest centers, and sets free the lowest instincts
by removing the inhibitions and controls of the brain.
It is in the same position, so far as social approval may-
go, with the use of cocain, morphin, and other drugs.
The classical study of the effects of alcohol by Dodge
and Benedict' may serve as the scientific basis for the
determination of action by all rational minds.
The modern view of health that is sustained largely
by an ideal of social responsibihty rejects the fallacious
argument for personal liberty. Oh, Liberty, how many
crimes are committed in thy name! Liberty does not
mean the right to do as one pleases, but rather an oppor-
tunity to develop to the highest and secure the greatest
happiness in hfe so long as other members in society
are not injured. Ideas or odors cannot be deported,
but one can get rid of the source of the disturbance,
and then eradicate the effects. The most needed thing
today in connection with the alcohol problem is educa-
tion that will make the deportation effective and the
eradication complete.
* Dodge, R., and Benedict, F. G. : Psychological Effects of Al-
cohol, Carnegie Institute, Washington, D. C, 1915.
CHAPTER XII
HYGIENE OF THE SEXUAL ASPECTS OF LIFE
I. A DiPFicuLTT OP Terminology.
II. The Sex Instinct in Life.
III. New Interpretations op Sex.
rV. The Institution op Marriage.
V. Menstruation.
VI. Pregnancy.
VII. The Social or Venereal Diseases:
1. Gonorrhea.
2. Syphilis.
A Difficulty of Terminology. — The hygiene of the
reproductive system would be the logical term to use in
sequence to the previous chapters, but here, as elsewhere,
the logical does not always serve. The hygiene of the
reproductive system wovdd relate to the care of the
reproductive organs, to menstruation, to pregnancy
and labor, and to the prevention of disease. The sex
instincts, however, relate to the whole of life and touch
problems that reach into all aspects of Ufe. The hygiene
of the sexual aspects of life, known as social hygiene,
concerns itself not only with the hygiene of organs, but
indeed also with the institution of marriage, social cus-
toms, prostitution, perhaps even the Malthusian move-
ment. The finest forms of life can develop only where
work, play, friendship, love, and worship are continually
expressed in fine forms and under high standards.
A newer concept of social hygiene has come in recent
years in the social hygiene movement itself. In a report
on Social Hygiene Education" the following is found
under the heading "Fundamental Principles of Social
Hygiene Education":
'Teachers College Bulletin, Twelfth Series, No. 13, Teachers
CoUege, New York, 1920.
338
HYGIENE OP THE SEXUAL ASPECTS OF LIFE 339
"Meaning of social "hygiene: The American social
hygiene movement aims at the best possible develop-
ment of aU physical, psychical, and social aspects of life
as it is determined or influenced, directly or indirectly,
by the sexual instincts and related traditions.
"Sex hygiene education or sex-education in its largest
sense includes all scientific, social (including ethical),
and religious instruction and influence which directly
and indirectly may help young people prepare to meet
the problems of life that have their center in the sexual
instinct, and inevitably come into the life of every normal
human being."
The Sex Instinct in Life. — If the instincts of man be
studied, it wiU be found that they group themselves
into two categories — one looking toward preservation
of the individual, the other toward perpetuation of the
race. The first is personal, real, and conscious of its end;
the second is personal, real, but largely unconscious.
Freud claims that the sex instinct is the root of all
hfe, the energy for all activity, whether sexual, intellectual,
or physical. Many feel that he claims too great a hierarchy
for sex, but aU students of hfe also know that this instinct
is not a simple thing at all, but that it is, at least in its
expressions, bound up with most of the human problems
of the sexes.
The hfe impulse has worked itself out in a variety of
ways. In the vegetable world there are asexual and
sexual forms of reproduction providing for the perpetua-
tion of the species without the guidance of instinct or
intelhgence. In the animal kingdom the maintenance
of species has been entrusted to the sex instinct. With
the lower animals this instinct is marvelous in its skill
in acquiring just the proper conditions for effective action.
The beetle Sitaris is a wonderful illustration of the power
of this instinct to provide for hfe, to satisfy its essential
purpose.*
' Bergson, H.: Creative Evolution, Henry Holt & Co., New York,
1913, p. 146.
340 PERSONAL HYGIENE APPLIED
With man, however, nature departed from her scheme
of the animal world by bringing in intelligence. If in-
stinct had ruled in the primates such as man, there would
not, of course, be the civiUzed life of a modern man,
the social disharmonies, prostitution, and the whole
chain of social iUs that have arisen for modern man.
Instinct in man as the supreme force would have given
a life comparable to that of the lower animals. The
development of intelligence made possible the forms of
civilized life, the economic achievements of society, and
the moral and social advances of the race. The chasm
between instinct and intelligence as used in human life
accounts for most of the social disorders of the race.
Sex conduct if guided only by instinctive urge is on
the level of lower animal life; if directed by intelligence
and the forces of the affective life, it can be made to
contribute to life values in the same way that intelligence
has enriched life in other fields.
There are those who are willing to attribute to man
power for fine controls in aspects of life other than sex,
but who insist "we have always had these disharmonies
and always must have them." They frequently end by
saying, "Human nature is human nature." Such a
person is thinking on a level with the inhabitants of the
age described by Lecky in his History of European
Morals.
It is probably true that the whole of life, sex, emotions,
spirit, work, play, and love are best achieved and best
expressed when intelligence rules and guides and when
the purely instinctive elements are controlled. More-
over, evolution is continually developing such control.
Human conduct today is different from the human
conduct of two thousand years ago. The young person
interested in achieving the finest life must be guided
by the compelling dictates of intelligence and not by the
force of instinct in all manifestations of sex in life. Thi^
will mean, then, that intelligence is to control, to direct,
to approve, or disapprove of instinctive desire. This
HYGIENE OF THE SEXUAL ASPECTS OP LIFE 341
progress will come mainly through an enrichment of our
social inheritance.
New Interpretations of Sex. — The instinct of sex
denotes a great desire. Its free expression because of
social iUs produced has been subjected to almost uni-
versal disapproval. Its very reality has been viewed
with apprehension. The scholastic doctrine that we are
conceived in sin drew the lines that determined the
picture of all sex activity. Platt^ speaks of this peculiar
view in the following words:
"So far are the extremities of the sexual function
separated in man's mind that the first step, its inception,
has always been counted as more or less shameful, and
the last step, its culmination, has been esteemed as a
blessing. Gods and heroes have been gloriously born
into this world, but so firmly is the idea of an unworthy,
carnal lust attached to the beginning of the great miracle
of nature that theologians and peoples have always
felt it necessary to provide for them a supernatural or
immaculate conception."
Science recognizes no such interpretation of nature.
For the inteUigent no value is conserved by such dis-
torted view. Rather, must there come into our con-
sciousness an appreciation of the beautiful aspects of
sex. The sexual life in man must be concieved as a differ-
ent sort of thing entirely than that among the lower
animals. True, it issues in the production of new in-
dividuals, but just because man is man, a being of intelli-
gence, it differs in its "high spiritual meaning and pur-
pose."
It is just this thought that prompts the following
statement of fundamental principles in the Report on
Social Hygiene Education^:
"Human meanings of sex: It is only by frankly
1 Piatt, C: Psychology of Thought and Feeling," Dodd, Mead &
Co., New York 1921, p. 43.
2 Teacher s College Bulletin, Twelfth Series, No. 13, Teacher s
CoUege, New York, 1913.
342 PERSONAL HYGIENE APPLIED
recognizing and developing the psychical and social and
esthetic meanings of sex, that are distinctly human and
superadded to the merely propagative function of the
animal, that people can be led far away from the almost
universal secrecy, disrespect, vulgarity, and irreverence
concerning every aspect of sex in human life. Sex in-
stincts and processes are essentially pure and beautiful
phases of that wonderful something we call 'Life.'
Sex-education should aim to give this esthetic attitude
by presenting Ufe as fundamentally free from the deg-
radation arising from the common misuse and mis-
vmderstanding of the sexual nature."
The Institution of Marriage. — Marriage is a hvunan
institution serving in the establishment of . homes and
the rearing of children.' It has profound possibilities
for unhappiness and social distresses; it has sublime
possibilities for happiness and social progress. Prob-
ably its values far outweigh its failures; certainly society
would be less satisfying for all without marriage. In
the paragraphs that can be devoted to its discussion
in this book only a few outhnes can be traced; adequate
treatment would require a volume in itself. Yet in a
httle space some very important matters affecting health
and happiness can be set forth.
There is a need for a broad general understanding
of marriage by young men and women.^ What does it
mean? What does it give? What does it require? First
and foremost in any catechism of marriage would appear
the statement: Young people should value, in the opposite
sex, things other than the sexual merely. Sex attraction
is not enough to be satisfying for the whole of life. Winds
of feeling are not fair weather for the matrimonial venture.
They are too gusty. The human vessel needs the support
' Castle, W. E. : Genetics and Eugenics, Harvard University Press.
^ Addams, J. : A New Conscience and an Ancient Evil, The Mac-
millan Co., New York. Ulrich, M. S.: Mothers of America,
American Social Plygiene Association, Pubhcation No. 180, New
York. Bigelow, M. A.: Sex- Education, The Macmillan Co., New
York, 1916.
HYGIENE OF THE SEXUAL ASPECTS OF LIFE 343
of an auxiliary engine supplying appropriate power in
the form of interests and ideals.
Marked incompatibilities should be avoided: The
man interested in camping, out-of-doors, and the woman
not interested; the woman fine in her appreciations,
manner, and standards, and the man coarse; the woman
artistic, and the man crude; the man ambitious, produc-
tive, with a strong social sense, and the woman a creature
of decoration, only to be entertained. The power of the
sex appeal is often not great enough to hold together in
comradeship, happiness, and enduring love the man
and woman of no common general interests.
The young man and young woman should have enough
imagination to see that married life is not one continual
act of love making in the usual sense of that term. That
there should be expression of love cannot be denied,
but the broad general common interests of fife are the
channels through which love may be continually set
free and expressed, and true comradeship developed.
There are those who would have marriage to begin
and to end at will. At the other extreme are the ortho-
doxists who would make of it an indissoluble bond.
Perhaps somewhere between lies the golden mean in
which all the social and all the individual values will
be preserved. Certainly there wiU be less reason for
extreme positions if the male-made double standard of
morals can be abolished, and if the male-made institu-
tion of prostitution can be broken down. Marriage
can mean all that it ought to mean if one principle is
remembered: Everything exchanged between husband
and wife can only be the free gift of love, can never be
demanded as a right.' Love never demands. The
tenderness of love, the thoughtfulness of love, the sacrifice
of love are the portals to love itself.
When shall young people marry? Biologically they
are prepared to assume the reproductive fimctions in
' The thought is expressed by Ellen Key in her book, The Morality
of Women, Ralph Seymour Co., Chicago, 1921,
344 PERSONAL HYGIENE APPLIED
adolescence. But society with its economic demands,
its plans of education, its organization of trades, occupa-
tions, and professions has gradually prolonged the mar-
riageable age. The young man should never feel that
he has solved the control of the sex impulse by marriage;
he has as great or greater need for control after marriage.
This control is necessary during certain physiologic
periods and also during pregnancy.
Menstruation. — For the woman the menstrual period
involves certain marked physiologic changes. These
are more marked on the psychic side in the few days
before the period. During the period the woman should
Hve the usual life if possible, avoiding undue fatigue,
work, or strain. Vigorous running and jumping are
not to be advised, and yet moderate exercise is helpful.
It is entirely correct to bathe the body at this time
and to keep clean. This should be accomplished by a
sponge bath, avoiding the tub and shower. During this
period the feet should be kept dry, the body not exposed
to cold, and plenty of rest in sleep indulged at night.
Pregnancy. — During pregnancy exercise should be
continued daily and plenty of time spent out of doors
— at least a walk of two miles, and one hour in the open
air if possible. The diet should be supervised and the
condition of the patient carefully determined by the
physician in charge. After the birth of the child every
reasonable effort should be made to nurse the baby
because the child has more chances for Ufe and, more-
over, it is better for the mother.^
The Social or Venereal Diseases. — The social diseases,
gonorrhea and syphiUs, are, in the main, diseases con-
tracted in clandestine or organized prostitution. Some
cases are acquired asexually, but they are, in the main,
the vaginitis'' cases seen in institutions for girls, such
' West, M.: Care of Children Series, Nos. 1, 2, and 3, Cliildren's
Bureau, U. S. Department of Labor, Washingtonj D. C.
' There is some evidence that the asexual vaginitis cases are not
caused by the gonococcus. Relationship not definitely determined.
HYGIENE OF THE SEXUAL ASPECTS OF LIFE 345
as asylums or orphanages. Commercialized or clandestine
prostitution provide the chief infections.
The venereal diseases constitute one of the most serious
handicaps and hazards for any health plan that con-
fronts society today. The extent of these diseases can-
not accurately be stated. That it is very great is sug-
gested by the number of cases of gonorrhea ophthalmia
and syphihtic insane, by the sterility in men and women,
and by the abdominal operations on women occasioned
by gonorrhea. It has been estimated that a large pro-
portion of the operations on married women for abdominal
conditions are occasioned by gonorrhea transmitted
by the husband, supposedly cured of the disease. The
extent of the infection in the nation is not accurately
known, but the possible and frequent results of the in-
fection is a weU-known medical fact.
Gonorrhea. — This disease is caused by the gonococcus,
an organism that is grown with difficulty in artificial
media, that dies soon on exposure outside the body, but
that grows with rapidity on the mucous membrane
of the genito-urinary tract and on the mucous membrane
of the eyes.
Contrary to popular opinion, it is not an insignificant
disease. The initial symptoms may pass quickly, but
the complications are serious and almost always result.
In the male there may occur stricture of the urinary
passage, involvement of the prostate gland, and infection
of the sperm ducts leading from the testes, producing
steriUty at times. The disease may extend throughout
the body, involving the joints and producing an inflam-
mation that results frequently in stiffness and loss of
motor function. At times the heart itself is involved,
and less frequently other body structures.
The disease is exceedingly difficult to cure. Even
after all the symptoms have cleared up gonococci may
still remain in the prostatic glands; when discharged
later, they are able to produce the disease. A cure can
be prognosticated only after two tests have been made:
346 PERSONAL HYGIENE APPLIED
1. Massage of the prostate and examination of the secretion under
the microscope for ^onococci.
2. The complement-fixation test for gonorrhea.
In the female the compUcations may result more
disastrously. In addition to the local disturbance,
infection of the tubes and ovaries is almost certain to
occur. This results frequently in sterihty, and often
requires an abdominal operation for removal of the
diseased organ. Not infrequently the removal of both
ovaries is necessary, thus producing an artificial meno-
pause, and causing the woman continuous ill health
and nervous disturbances.
In the female treatment is very unsatisfactory. Some
gynecologists question if a complete cure is ever secured;
all recognize its extreme difficulty.
For any young person to look upon this disease as
insignificant, and to ignore the scientific evidence avail-
able is a sign of ignorance or stupidity, or both.
Syphilis. — This disease is caused by a spiral-shaped
organism, the Spirochceta pallida. It produces a disease
that may attack any part of the body structure. The
course of the disease is divided into three stages:
The first stage is marked by a characteristic sore or
lesion, usually on the genitals. The second stage pre-
sents a typical sore throat with characteristic patches,
an eruption on the skin, and at times such disturbance
of nutrition that the hair is lost in characteristic fashion.
The third stage sets in anywhere from two to twenty
years after the original infection with disturbances in
the bones, joints, liver, heart, blood-vessels, and nervous
system.
In addition to the serious effects upon the individual
himself the disease may be transmitted to offspring by
prenatal infection, so that the succeeding generation
may be syphilitic.
In both male and female the disease may be cured
in the early stage of the disease with thorough treatment
by a reputable physician, For syphilis of the nervoug
HYGIENE OF THE SEXUAL ASPECTS OF LIFE 347
system no satisfactory results have been secured in treat-
ment. Locomotor ataxia may be checked in its develop-
ment and a certain amount of muscular re-education
accomplished, but, in the main, the results must be con-
sidered as meager.
Again, as in gonorrhea, we have a disease that is cap-
able not only of destroying the health of the individual
but also, and quite as important, wrecking his life and
bringing strains and stresses upon family and friends
that are unfair and unwarranted.
There is a sort of justice to the dissolute when syphilis
produces an aneurysm of the blood-vessels or causes
his disablement or death by disease of the nervous system.
He pays the price with his hfe. But here, as in all diseases
contracted selfishly and without thought of and care
for others, it is most unfair to family and friends to be a
burden and care through the years of adult Ufe because
of selfish and uncontrolled desires in youth.'
Here, as elsewhere in life, the problem of living well is
the problem of seeing straight, of not getting values
mixed. The important matters in life relate not to
wealth or to social position, not to culture or to voca-
tion, but to the eternal truths of all time. To know the
truth, to know thyself in whom the truth really lies —
here is the ma^c wand for health and happiness.
' The following pamphlets published by the American Social
Hygiene Association may be secured from the New York office for
10 cents each: Sex in Life, No. 52; The Boy Problem, No. 284;
Health for Men, No. 283; Healthy, Happy Womanhood, No. 60;
Keeping Fit, No. 55; Sex-education in the Home, No. 61; Human
Welfare and the Monogamous Ideal; No. 314, Conquering an Old
Enemy, No. 250.
CHAPTER XIII
PREVENTION IN SPECIFIC DISEASES
I. The Emphasis of Hygiene.
II. The Universal Disthibtttion op Disease.
III. Types op Disease.
IV. Causes of Disease.
V. The Transmission of Disease.
VI. The Prevention of Disease:
1. General Means of Prevention.
2. Special Means of Prevention.
VII. Prevention op Communicable Disease.
VIII. Prevention op Nutritional Disease.
IX. Prevention op Acute Poisoning.
X. Prevention op Chronic Degenerative Disease.
XI. Prevention op Functional Nervous Disease.
XII. Prevention op the Local Infections.
XIII. Prevention op Cancer and Tumors.
XIV. What Are the Chances?
XV. Summary.
The Emphasis of Hygiene. — The time is past when
one thinks of disease as necessary. For many persons
it is a grim reality, a dread specter continually threatening
and at times grasping its victims. But the point of
view in this book maintains that much disease is un-
necessary, that its occurrence represents failure of some
person, or persons, to observe the laws of healthful living.
Consequently, the emphasis for living finely and well
is always to be placed upon the ways and means of attain-
ing and maintaining health.
The Universal Distribution of Disease. — ^The emphasis
on healthful processes should not shut us off from recog-
nition of the fact of disease and the means of its pre-
vention. Disease is a common phenomenon in all hfe.
It varies with races, geographic location, climate, and
mode of living. Complete eradication of disease, while
not theoretically impossible, is not probable in the near
348
PREVENTION IN SPECIFIC DISEASES 349
future. Men will need to accomplish great studies in
sanitation, in hygiene, and in improvement of racial
stocks through application of eugenic principles. At
present man is subject not only to a variety of diseases
that are present all the time with marked seasonal in-
creases in certain months, but is attacked at times with
epidemic diseases that cause great gaps in the population.
At times, assuming a world-wide character, a disease
may sweep in severe form over the entire habitable world,
as recently occurred in influenza. Such a manifestation
is called a pandemic.
The studies made by scientific medicine in combating
the prevalence and force of smallpox, bubonic plague,
typhoid, syphilis, cholera, yellow fever, and malaria
are tokens of promise that should hearten the race in
its struggle for existence.
Types of Disease. — Commonly, we think of the trans-
missible diseases when discussing the ills that affect
the human body, but such view is incomplete and un-
satisfactory. It is important to make clear the forms
of disturbance which may arise in the body. They may
be classified for our purposes into seven groups:
1. The communicable diseases.
2. The diseases of nutrition.
3. The acute poisons.
4. The chronic degenerative diseases.
5. The functional nervous diseases.
6. The local infections.
7. Cancer and tumors.
Causes of Disease. — The cause of disease has been a
momentous question from early times. Curious beliefs
have arisen out of the efforts of man to determine the
reason for loss of health. The early philosophers, the
medicine man of savage tribes, the modern types of the
unscientific and irrational give illustrations of super-
stition, occultism, and frank ignorance at work on the
problem. Whether it is "evil spirits" abiding in the
person, or "subluxated vertebrae" pressing on nerves,
350 PERSONAL HYGIENK APPLIED
or insufficient force of mind over matter, the cause
seems to persist until attacked in laboratory and hos-
pital with medical and surgical service.
The causes of disease are as follows:
1. Causes of communicdbh disease:
(a) Bacteria which act by producing virulent poisons (toxins)
destructive to the cells of the body.
(6) Other organisms which as parasites act by producing
poisons, by using up the blood of the host, and by ob-
struction of vital and important pathways and organs.
2. Causes of nutritional disease:
(o) Absence of essential food elements, salts, or other matter
from the diet.
(6) Presence or absence of important secretions from the
endocrine glands.
3. Causes of acute poisoning:
(a) Poisons developed in animal matter, such as milk, meat,
and fish.
(6) Poisons developed in improperly canned vegetables and
fruits,
(c) Poisons from certain metals, such as lead, mercury, and
phosphorus. These poisons come usually from certain
trades in which these metals are used.
4. Causes of chronic degenerative disease:
While heredity unquestionably plays an important part in
these disorders, it is also true that improper Uving is chiefly
the causative factor. Intemperate living as exemplified in
mental or physical strain, mental or physical inactivity, too
much or too little food or improper food. Certain cases are
undoubtedly due to long-continued infections or the action
of poisons over a period of years. Some cases seem to be
associated with injuries and physical strains.
5. Causes of functional disease:
There is included in this category those diseases of bodily
disturbance due to maladjustment of the individual to life
and represented by the improper functioning of the mind and
emotions. Not infrequently there is a sexual basis for these
disturbances; always there is a strong psychic force at work.
The increase in this type of disease is to be expected so long
as the standards of life remain what they are, and the social-
economic strains continue without relief of a more whole-
some and more scientific approach to the problems of human
life.
6. Causes of the local infections:
Included in this group are the pyogenic infections due to
entrance of streptococcus or staphylococcus into the body.*
• A local infection may become general, such as occurs in septice-
mia (blood-poisoning). Care for infections of this type is very im-
portant so that general involvement of the body may not occur.
PREVENTION IN SPECIFIC DISEASES 351
7. Cancer and tumors:
Included here are the various forms of carcinomata,
tumors, or other wild growths.
The Transmission of Disease. — ^Bacteria may be trans-
mitted directly from one person to another, as in tuber-
culosis, diphtheria, measles, whooping-cough, etc., or
by means of agents, such as drinking-water, milk, food,
soil, or objects, such as cups, handkerchiefs, toys, money,
books, clothing, etc.
Insects and vermin may carry the disease agent
either directly as a host or indirectly through infection
of food suppUes. Malaria is the classic example of direct
carrier, in which the mosquito acts as the host for the
malarial parasite that reaches the blood-stream of man
by means of the bite of the infected mosquito. Flies
are notorious agents for transmitting disease by con-
tamination of food. Rats are indirectly responsible
for bubonic plague by harboring the rat flea in which
occurs the complete cycle of the organism causing the
disease.
It is important to note, therefore, that disease-produc-
ing bacteria or parasites may be transmitted to man by
1. Direct contact of the sick with the well,
2. Infection of food and drink supplies,
3. Contamination of articles used, or by
4. Insects and vermin which harbor the germs of cer-
tain diseases.
The Prevention of Disease. — The question of living
finely, in the present state of society, frequently resolves
itself into combating the prevalent agencies of disease
transmission. Moreover, in addition, man must be awake
to the dangers from improper food combinations, the
hazards of acute poisoning, the menace of hereditary
taint, the perils of degenerative disease, the attacks of
pathogenic bacteria, and the deplorable functional dis-
turbances. To face squarely the problems involved
requires more courage than some can muster. These
blunder along through life, frequently escaping disaster
352 PERSONAL HYGIENE APPLIED
through chance. Others when confronted with the
facts develop an unwholesome fear and proceed at once
to a procedure in hygiene and sanitation that marks
them as "freaks" or neurotics, according to the motive
behind their program. Somewhere between these two
extremes hes that golden mean that calculates life's
hazards as the athlete measures the height of the obstacle
to be surmounted. It aU is part of the great game.
The fact that the normal habitat of tetanus is the intesti-
nal tract of herbivora/ and that, therefore, the bacillus
is found most frequently in stable yards, wiU not mean
that horses and barns wiU be shunned, nor that puncture
of the foot by a nail in a board in the barnyard wiU be
ignored. The rational hfe will recognize the facts of life
and life processes; the courageous life will meet and face
the facts. Prevention of disease will be considered by
those who live fully, as an important means for rendering
service. To avoid colds, to evade pneumonia, to escape
Brights' disease are pathways not to Nirvana, but to
that condition of physical superiority that is justified.
only by service and finds its fullest and best satisfaction
in worth-while work.
The prevention of disease resolves itself into what
might be called general and specific means.
General Means of Prevention. — Resistance: It is a
common observation that some persons when exposed
to disease contract and develop the infection, while
others do not. This freedom from disease by one exposed
to it illustrates what science understands by the term
"resistance." Resistance to disease may be racial, e. g.,
the Jew and tuberculosis, and at times it seems to be an
individual matter entirely. Resistance to disease in
general may be developed. Healthful conditions of the
body tissues and fluids renders the protective mechanism
of the body more effective in its safe-guarding activities.
' Park found tetanus bacilli in the excreta of about 15 per cent, of
horses and calves in the vicinity of New York City. They are
present in other herbivora to a less extent.
PREVENTION IN SPECIFIC DISEASES 353
Resistance is developed through proper habits of hving
and is a result of correct adjustments of the body to the
life of the environment.* Resistance and health are in
one sense synonymous. Both flow from hygienic living.
Resistance may not always protect from disease be-
cause at times an organism will be so virulent that the
protective forces of the body are broken through. It
represents, however, the first Une of defense in all war
on disease.
Disinfection,'' isolation, and quarantine: Disinfection
is an effort to destroy the attacking disease agent; iso-
lation and quarantine aim to confine and control the
patient while there is a possibihty of transmitting living
organisms.
Knowledge of the life history of various disease-produc-
ing organisms has made possible a more intelligent, and,
therefore, a more effective attack on the problems pre-
sented by communicable disease. Isolation and quaran-
tine have grown in importance; disinfection has, perhaps,
diminished.
Special Means of PrevenMon. — ^Artificial resistance:
That some persons possess a high degree of resistance
to disease is well known. This non-susceptibiiity has
been called immunity. It is also known that immunity
may be conferred artificially, and so there has developed,
markedly in recent years, definite procedure in serum
and vaccine prophylaxis to prevent disease by giving the
individual an artificial resistance or artificial immunity.
Notable achievements in this direction have been vacci-
' It is generally believed that fatigue lowers resistance to disease.
People speak of "catching cold" because "they got tired out."
There seems to be some evidence from experience for this general
belief. On the contrary, Oppenheimer and Spaeth found in experi-
menting with white rats that fatigue increases resistance to the
toxins of both tetanus and pneumococcus (Type I). While this work
(Oppenheimer, E. H., and Spaeth, R. A., American Journal of
Hygiene, January, 1922, p. 51) does not discredit entirely the
popular beUef, it suggests at least the necessity for more scientific
study of the factors influencing Hving, particularly human Uving.
' Rosenau, M. J. : Preventive Medicine and Hygiene, D. Appleton
& Co., New York, 1913, pp. 966-1034.
S3
354 PERSONAL HYGIENE APPLIED
nation for smallpox, inoculation for typhoid, and anti-
toxin and toxin-antitoxin^ for diphtheria.
Avoidance of the cause of disease : In the final analysis,
disease prevention rests largely upon the avoidance of
the causative agent of disease. It is, therefore, important
to describe the prophylaxis of the diseases of the six
groups named, with appropriate emphasis upon the more
significant examples.
Prevention of Communicable Disease^:
1. Tjrphoid fever.
(o) Cause of the Disease. — Typhoid baciUus. The bacillus is
spread chiefly in the water and milk supply. Contamina-
tion of wells, springs, and even municipal reservoirs by
sewage containing typhoid bacilli does occur. The milk
supply is infected by means of polluted water used in wash-
ing the utensils or by unclean hands of the milker. Butter,
ice, oysters, lettuce, and cabbage are known to have trans-
mitted the disease. Flies may carry the organism by feed-
ing on the excreta of typhoid patients and then contam-
inating exposed food by walking on it. Typhoid "carriers"
employed in the preparation or handling of food may
transmit the disease. Food, fingers, and flies represent an
alliterative triumvirate of immense importance in causa-
tion.
(b) Prevention.
1. Protection of individual and community water sup^ilies
by proper disposal of excreta, by appropriate
location of privies, and by protection of the water-
shed of reservoirs.
2. If gathered in an insanitary way pasteurization of all
milk used for drinking purposes and for making
of dairy products. Education and supervision of
dairy men and milk distributors in the proper way
of gathering and handling milk.
3. Careful washing in water of certain foods eaten raw.
4. Examination and supervision by health authorities
of typhoid "carriers."
5. Proper construction of privies so as to be fly-proof
and water-tight.
6. Adequate and sanitary care of the discharges and
clothing of tjT)hoid patient.
7. Vaccination with the typhoid vaccine.
• Toxin-antitoxin is given to individuals who are susceptible to
diphtheria, as shown by the Schick test.
^ Tuberculosis has been discussed in Chapter VIII, and the venereal
diseases in Chapter XII.
PBEVENTION IN SPECIFIC DISEASES 355
2. Typhus fever.
(o) Cause of the Disease. — ^An organism (as yet not com-
pletely identified) that is transmitted by the body louse.
The seriousness of this disease in central Europe during
the World War directed the attention of all persons to the
underlying insanitary conditions as important factors. Un-
cleanhness, lack of bathing facilities, overcrowding, inade-
quate food and clothing are conditions favoring the growth
of the body louse.
(6) Prevention.
1. Fumigation or disinfection of clothing, living and
sleeping quarters of those with the disease.
2. Fumigation and disinfection of all persons likely to
harbor the louse, such as soldiers and refugees.
3. Isolation and quarantine separately of all those
suffering from the disease and those suspected or
exposed to the disease.
3. Relapsing fever.
(o) Cause of the Disease. — SpiriUum obermeieri. This or-
ganism is transmitted by bedbugs, fleas, biting flies, and
lice.
(b) Prevention.
1. Cleanliness in the home. Destruction of the vermin
by means of thorough cleaning of all crevices in
woodwork and furniture with corrosive sublimate
or kerosene and fumigation with sulphur.
2. Isolation of the patient.
3. Disinfection of aU clothing worn by patient, also the
bed clothing.
4. Smallpox (variola).
(a) Cause of the disease is unknown. An organism has never
been isolated^ but the virus is supposed to be transmitted
by the secretions of the eye, nose, mouth, aijd skin.
(6) Prevention.
1. Vaccination is of first and major importance. The
value and importance of vaccination may be in-
dicated by the fact that systematic vaccination in
the six provinces near Mamla, P. I., of a population
of over a million, with a death-rate from small-
pox exceeding 6000, has resulted in no deaths from
smallpox in the vaccinated. Vaccination protects
and should be rigidly required of all persons. (See
Chapter V.)
2. Isolation of the patient.
3. Disinfection of the patient, room, and furniture after
the disease.
5. Chicken-pox (varicella).
(a) Cause of the disease is unknown. Chapini has shown that
the disease is transferred even when the patient is in a
cubicle. It is believed to be air-borne.
> Chapin, C. V.: Source and Modes of Infection, John Wiley &
Sons, New York, 1912, p. 270.
356 PERSONAL HYGIENE APPLIED
(6) Prevention.
The disease is readily transmissible. It can only be
prevented from spreading by strict isolation.
6. Scarlet fever.
(o) Cause of the disease is unknown. A streptococcus has
been foxmd in the blood of patients dying from the disease
and it is often found in the mouth, but it has not been
demonstrated' as the cause of the disease. The seasonal
prevalence is shown in Fig. 34.
(6) Prevention.
The disease is readily transmissible. It can only be
prevented from spreading by isolation. All dishes used by
patient shovild be sterilized; all waste matter and uneaten
food burned. Thorough cleaning of the room after use by
the patient to be done with hot water and soap and bi-
chlorid 1 : 2000. Room should be aired and sunned for
two weeks after termination of the case.
7. Measles (morbiUi).
(a) Cause of the disease is unknown. The mortality from
measles in Massachusetts is shown in Fig. 35.
(6) Prevention.
Isolation of the patient is alone effective. Disinfection
after the disease is over is useless. This view is held by
the majority of health oflBcers and epidemiologists. The
disease is transmitted by mild cases, carriers, early cases,
and convalescents. The same may be said for whooping-
cough, influenza, pneumonia, and cerebrospinal meningitis.
Chapin^ gives the evidence upon which these statements
are based.
8. Mumps (epidemic parotitis).
(a) Cause of the disease is unknown.
(6) Prevention.
Isolation of the patient is alone effective. See Measles.
9. Whoopirife-cough (pertussis).
(a) Cause of &e disease is the bacilliis of Bordet and Gengou.
The disease is more prevalent in the late spring. See Fig.
36.
(6) Prevention.
1. Vaccine treatment is effective in a large percentage of
the cases.
2. To prevent its spread, isolation is alone effective.
' The demonstration of the cause of disease, must meet rigid re-
quirements. The germ theory of disease as given by Koch provides
for:
1. The isolation and identification of a specific organism in the
tissues or fluids of the body affected.
2. The production of the same disease in another body by in-
jection of the organism secured from the first.
3. The recovery of the organism from the second body with its
isolation and identification with the organism as taken from
the first body.
2 Chapm, C. V.: Loo. oit., pp. 145, 146, 253, 278.
PBEVENTION IN SPECIFIC DISEASES
357
358
PEESONAL HYGIENE APPLIED
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10. Influenza.
(a) Cause of the Disease. — The influenza bacillus has been
given as the cause. The recent epidemic (1918) raised some
doubts. At the present time this question cannot be called
settled.
(6) Prevention.
1. Vaccine treatment has been helpful in some cases.
Not yet established as a sure method.
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public health oflBcers primarily. It spreads along
lines of communication. Doubtless many persons
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ing up the resistance and avoiding crowds. Contrary
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dence that whisky prevents the disease.
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(a) Cause of the disease is the Diplococcus intraceUidaris.
(6) Prevention.
The disease is spread by carriers. Disinfection is futile
to stop the spread of the disease. The patient should be
isolated.
12. Pneumonia.'
(o) Cause of the disease is the pneumococcus in Tjrpe I, II,
and III. Type IV is caused by a mixed strain in which are
streptococci and pneumococci.
(6) Prevention.
The pneumococcus is present in the mouths of from 40
to 50 per cent.^ of well persons. It has greater virulence in
the winter. Prevention of the disease relates to keeping
the mouth clean by brushing and cleaning of teeth and
tongue and by keeping objects and hands out of the mouth
and avoiding exposure to cold and wet. In particular
avoid chilling the body. An effective serum is available for
treatment of Type I pneumonia.
13. Diphtheria.
(o) Cause of the disease is the Klebs-Loffler bacillits. See
Fig. 37, and note the age susceptibility in diphtheria, the
pre-antitoxin and antitoxin periods, and the effect of early
administration of antitoxin.
(6) Prevention.
1. Isolation of patient and avoidance of contact with the
case.
2. Use of Schick test to determine susceptibility.
3. Giving of toxin-antitoxin to those susceptible to the
Schick test.
4. Giving of a prophylactic dose of antitoxin to those
exposed to the disease.
6. Be on guard against it, especially in the winter and
spring. See Fig. 38.
'Stimson, P. M.: Review of the Literature on Respiratory Dis-
eases from January, 1920 to June, 1921, American Journal of Dis-
eases of Children, March, April, 1922, pp. 261-282, 338-374.
2 Chapin, C. V.: Loc. cit., pp. 101, 102,
PREVENTION IN SPECIFIC DISEASES
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PKBVENTION IN SPECIFIC DISEASES 363
14. Rheumatic fever.
(a) Cause of the disease is unknown. Probably a streptococcus
is the factor. Whatever the organism is, "in four-fifths of
the cases of rheumatic fever tonsillitis precedes or accom-
panies the disease.''^
(b) Prevention (see Chapter XIV).
1. Removal of diseased tonsils and adenoids.
2. Proper treatment of abscess, decayed teeth, and in-
flamed gums.
3. Proper treatment of foci of infection in nose or
sinuses.
4. Avoidance of chilling the body.
15. Malaria.
(a) Cause of the disease is the Plasmodium malarioe.
(h) Prevention.
1. Destruction of the Anopheles mosquitoes by draining
their breeding places, and by destruction of larvse
by covering with oil swamps that cannot be drained.
The effect of adequate sanitary measures in the
Xa/e/)er/00,opO Sii}/>yoyee£
aSf-Jm f^yxsf eaasfnic//ooPer/eif /SOAZ^^^SS^^^S^
Fig. 39. — After adequate sanitary measures by General Gorgas in
1908 the disease was controlled. (By courtesy of The Prudential
Insurance Company of America.)
Canal Zone from 1908 to 1917 is indicated in Fig.
39. Figure 40 shows the geographic distribution of
the disease in the United States and the reduction in
malaria mortality in t3T)ical southern cities.
2. Prevention of entrance of the parasite into the
human body requires precaution against being
bitten by the Anopheles. Screening of living
quarters with a screen of 2.5 mm. mesh, and stay-
ing indoors after sunset.
3. In malarial districts, the use of prophylactic doses of
quinin has been helpful.
4. Prevention of infection of the mosquito requires pro-
tection of malarial patients from the Anopheles.
If the Anopheles bites a person sick with malaria
and sucks out blood containing the malarial parasite
the mosquito becomes infected. After an mterval
» Winslow, K.: The Prevention of Disease, W. B. Saunders Co.,
Philadelphia, 1916, p. 203.
364
PERSONAL HYGIENE APPLIED
the parasite completes a cycle of development in
its host. If the mosquito now bites a well person
it will produce the disease by conveying some of the
parasites through the salivay secretion in the
proboscis of the mosquito.
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PREVENTION IN SPECIFIC DISEASES 365
16. Anthrax.
(a) Cause of the disease is the Bacillus anthrads.
(6) Prevention.
The disease is transmitted through herbivora, especially
sheep and cows. The hides, wool, secretions, excretions,
and blood of infected animals may give the disease to man
through any abrasions of the exposed skin or by dust
carried to the limgs.i Veterinarians, grooms, shepherds,
drivers, butchers, and tanners are often exposed. They
must be careful not to scratch themselves when at work
with animals or their hides. .The disease has been trans-
mitted by shaving brush bristles, leather gloves, and other
* articles coming from animals. New shaving brushes
should be boiled in water for at least three hours before
using.*
Rosenau' says: "The prevention of anthrax is first and
foremost a problem iu animal husbandry which in this
country comes under the purview of the Bureau of Animal
Industry. Animals having anthrax should be killed and
aJl anthrax carcasses should be buried, incinerated, or
tanked in such a manner as to destroy the infection and
prevent its dissemination. This is one of the reasons for
international sanitary agreement, for the wool from
Prussia, the hair and mohair from Asiatic Turkey, the
horsehair from China, the bristles from Siberia, and the
hides from India may cany the anthrax spores from
these far-off lands and cause infection among our work-
men."
17. Hydrophobia (rabies).
(a) Cause of the disease in man is a virus conveyed in the bite
of some lower animal, usually the dog.
(b) Prevention.
1. The wound produced by [the bite of an animal
supposed to be rabid should be cauterized with
fuming nitric acid. This should be thoroughly
done.
2. If the dog dies of rabies, then the patient should have
the Pasteur prophylactic treatment.
3. Muzzling of all dogs if the disease appears in any
community.
18. Lockjaw (tetanus).
(a) Cause of the disease is the Tetamis haciUus.
1 Chapin^ C. V.: Loc. cit., p. 286.
* There is no way of sterilizing shaving brushes without injury
to the brush. If boiled for three hours many tjTies of brushes
would be severely damaged. In New York City shaving brushes
cannot be sold unless the bristles have been sterihzed before manu-
facture by heating in an autoclave at high temperature for three or
four hours.
' Rosenau, M. J. : Preventive Medicine and Hygiene, D. Appleton
& Co., New York, 1913, p. 943.
366 PEBSONAL HYGIENE APPLIED
(6) Prevention.
1. Thorough cleansing of all wounds.
2. If wound contains garden earth, street dirt, or manure
from herbivora the cleansing process should be
most complete, even to enlargement of the wound
to promote free bleeding. Wounds caused by blank
cartridges and fireworks are especially dangerous.
3. Use of tetanus antitoxin in suspected cases.
19. Trichiniasis (trichinosis).
(a) Cause of the disease is the Trichina spiralis.
(6) Prevention.
1. Careful inspection of pork by meat inspectors.,
2. Thorough cooking of all pork eaten. Uncooked pork
should never be eaten.
20. Hookworm disease (anchylostomiasis).
(o) Cause of the disease is the hookworm, one species of which
is zoologically known as the Anchylostoma duodenale; the
form seen more often in America is the Necator americanus.
(6) Prevention.
The disease is transmitted through soil polluted by human
excrement and the prevention aims directly therefore at:
1. Preventing human pollution of the soil, and
2. Medicinal treatment of cases to diminish the in-
fection.
Education in personal hygiene, habits of cleanliness, and
sanitary disposal of the body excretions will eliminate the
21. Intestinal tapeworms.
(a) Cause of the disease is any one of a number of cestodes.
The Taenia saginaia of beef, Tcenia solium of pork, Both-
riocephalus of fish may infect the body of man.
(6) Prevention.
1. Careful inspection by experts of meat at abattoirs.
2. Thorough cooking of all meat.
Prevention of Nutritional Disease :
1. Rickets.
(o) Cause of the Disease. — Not fully determined as yet. The
lack of calcium and phosphorous salts and vitamin A seem
to be important etiologic factors.
(6) Prevention.
The easiest prevention in the light of the unknown factors
is exposure to sunlight,' or the addition of cod-liver oil to
the diet. The oil used should be as pure a product as
possible.
2. Scurvy (scorbutus).
(a) Cause of the disease is the absence in the diet of vitamin C
in sufiicient quantities.
' Sunlight will cure the disease, as shown byHess and McCollum.
Hess, A. F. : Journal of Biological Chemistry, January, 1922, p. 77;
McCollum, E. v.: American Journal of Diseases of Children, Febru-
ary, 1922, p. 91,
PREVENTION IN SPECIFIC DISEASES 367
(b) Prevention.
Oranges, lemons, and canned tomato juice ^re efficient
antiscorbutics. Kaw fruits, vegetables, and salads will
supply sufficient vitamin C if used regularly throughout the
year.
3. Pellagra.
(a) Cause of the disease has not been definitely determined.
There is behoved to be a relation between the disease and a
vegetable diet (restricted in kind of vegetables and without
meat).
(6) Prevention.!
Prevention seems possible along dietary lines alone.
Addition of meat and variety in cereals and vegetables
prevents the disease.
4. Diabetes.
(a) Cause of the disease is not known. There is often an
hereditary predisposition. Associated in the production of
the disease at times are disturbances in the nervous system,
exophthalmic goiter, disease of the hver or pancreas.
(b) Prevention.
Individuals whose parents^ have had diabetes should be
exceedingly careful of exercise, diet, and general hygiene.
Diet is most important. Restriction in quantity of food
eaten and restriction especially of sugars are to be prac-
tised. A semi-annual medical examination would be
advisable.
5. Gout.
(o) Cause' of the disease is the accumulation in the body of
excess purin bases derived from the nucleoproteins of
food. See Chapter VII.
(6) Prevention.
1. Moderation in eating, avoidance of alcohol, tea,
coffee, and cocoa.
2. Elimination of meat and vegetables rich in nucleo-
proteins.
3. Outdoor exercise. Avoid sedentary life.
6. Goiter.
(a) Cause of the disease is not known. It has been attributed
to the mineral content of drinking-water, to infection of the
individual, to poor hygiene of life.
(6) Prevention.
Because the cause is so uncertain, the prevention cannot
be sure. Removal from goitrous districts or boihng all
drinking-water in goitrous areas would seem important.
'Goldberger and Wheeler: The Experimental Production of
Pellagra, Bulletin 120, Hygienic Laboratory, V. S. P. H. S., February,
1920. Wheeler, G. A.: Treatment and Prevention of Pellagra,
Journal American Medical Association, April 1, 1922, p. 955.
* This refers, of course, to real diabetes. Sugar in the urine does
not alwajrs mean diabetes.
> Predisposing factors are heredity, the male sex, and alcohol.
368 PERSONAL HYGIENE APPLIED
7. Cretinism and myxedema.
(a) Cause of the disease is the deficiency in thyroid secretion
in the chUd (cretinism) or in the adult (myxedema).
(b) Prevention.
The development of the disease with our present informa-
tion cannot be prevented. The giving of thyroid extract
in cretinism will stop the progress of the disease and re-
store the person practically to normal. The extract must
be given for Ufe.
8. Obesity.
(o) Cause of the Disease. — In susceptible persons, eating too
much food and lack of exercise. It is often hereditary.
(6) Prevention.
1. Exercise.
2. Reduction of fats and carbohydrates in the diet.
Prevention of Acute Poisoning. — ^A distinction is to
be made between food infections and food poisoning.
A food infection is due to the growth of micro-organisms.
Rosenau and Weiss' affirm that students of the subject
of food infections "now beheve that practically all in-
stances . . . are due to the bacillus of Gartner (B.
enteritidis), which is taken as a type of a group of closely
related organisms." Food infection is not common in
America. There have been in recent years numerous
cases of food poisoning. This disturbance is due to the
product of the growth of bacterial hfe. The organism
producing the toxin is the Bacillus botuUnus. It may
grow in meat, sausage, and vegetables. It has been
found in improperly canned vegetables. Recently sev-
eral deaths were caused by the eating of olives which
had not been prepared properly, so that botuhsm devel-
oped. An excellent extended discussion of food poison-
ing is given by Rosenau, Preventive Medicine and
Hygiene, pp. 538-570.
The acute poisons from meats or canned vegetables
are to be prevented by better inspection in food industries,
and by care in the selection and use of food products.
The poisons from lead and other metals can be avoided
by protection of the worker in certain trades by means of
masks and facial appliances, and by careful washing of
the hands, especially painters, before eating.
'Rosenau, M. J., and Weiss, P. D.: Food Infections, Journal of
American Medical Association, December 17, 1921, p. 1948.
PREVENTION IN SPECIFIC DISEASES 369
Prevention of Chronic Degenerative Disease. — Chronic
degenerative diseases are seen particularly in the heart,
blood-vessels, kidneys, and nervous system. They repre-
sent the deterioration in systems due to wear and tear,
growing more pronounced with age, and the unusual
degeneration due to poisons from unhygienic living, or
chronic poisoning from metals or chronic pus infections.
The prevention of such diseases lies in the observance
of the rules given in Chapters IX and X, and avoidance
of metaUic poisons.
Prevention of Functional Disease :
1. Neurasthenia.
(a) Cause of the disease is complex. Hereditary predisposition
plays an important part. Upon hereditary weakness the
stresses and strains of life at times bear too heavily. With
such overload the individual frequently develops bodily
complaints that have little or no organic basis.
The common active causes of breakdowns are mental and
physical overstrain, worry, sexual disorders, poisons, such
as morphin, tobacco, or alcohol, and the poisons from
typhoid, malaria, influenza, and syphilis.
(6) I>teveiition.
The prevention relates directly to the cause of the
disease. Cabot has many helpful suggestions in his book,
"What Men Live By." See also Baton's "Human Be-
havior."
2. Hysteria.
(a) Cause of the disease is complex. Heredity is a most im-
portant factor in its causation. Charcot held that every
case was based on bad heredity. Exciting causes are mental
or emotional shock, long-continued anxiety or care, worry,
and mental strain. In some cases sexual worries or dis-
turbances may induce the disease.
(6) Prevention.
On the basis of psychology prevention must be based on
educational lines.
1. Education must seek to inculcate habits of self-control.
2. Whims and desires are to be gratified only on a rational
basis of worth.
3. Sympathy must not be too lavish. Trifling hurts and
sorrows are not to be made the occasion for excessive
sympathy. The treatment of girl children must be
made similar to the treatment of boys in this re-
spect. Self-reliance and self-control are as im-
portant for girls as for boys.^
1 Williams, J. F. : Values of Camping for Girls, Teacher s College
Record, January, 1920.
2i
370 PERSONAL HYGIENE APPLIED
4. Out-of-door activities with development of interests in
sports, games, and friends must replace the day
dreaming and romantic, erotic coloring of the usual
social life of the girl at the beginning of adolescence.
5. The hereditary factor is a eugenic problem.
Prevention of the Local Infections:
(a) Cause of the infections are a number of disease-producing
organisms that enter through a break in the skin or mucous
membranes. (See Chapter XIV for focal infections.)
(b) Prevention.
Prevention resolves itself into three factors:
1. Keeping the general resistance as high as possible.
2. Avoiding skin and mucous membrane injuries.
3. Careful treatment of all wounds and injuries. (See
Chapter XIV for focal infections.)
Prevention of Cancer:
(a) Cause is unknown. The increase in cancer, the parts most
frequently attacked, and the age, sex, and race distribution
are given in Fig. 41.
(b) Prevention.
Although the definite cause is not known, certain con-
ditions are associated with cancer, and prevention has to do
directly with these.
1. The mouth and teeth should be kept in good condition.
Teeth with rough edges should have dental care.
2. Any local skin defect, such as ulcers, warts, moles, or
tumors, should be removed at once if they show any
irritation.
3. Any unusual lump appearing in the breast should be
examined by a physician.
4. Any lumps or swellings in the soft parts of the body
or pam or enlargement of bony parts should be.
carefully examined.
5. After the change of life the appearance of the menses
should be viewed with suspicion, and an early ex-
amination by a gynecologist should determine the
cause of the condition.
6. Indigestion persisting over long periods may be re-
garded as favorable for the development of cancer
of the stomach.
The preventive measures listed above relate to the
avoidance of irritation and the early detection of the
disease. Until the cause or causes are known prevention
will be unscientific and not particularly effective. Bulkleyi
'Bulkley, L. D.: Cancer a Mutiny of Body Cells, The Medical
Record, October 1, 1921; see also, Bulkley, L. D.: On the Responsi-
bility of the General Practitioner in Regard to Cancer, Medical
Record, March 12, 1921.
PREVENTION IN SPECIFIC DISEASES
371
believes that cancer is caused largely by improper diet,
and most vegetarians claim that it is caused by the eating
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sonal hygiene in general may be a cause. While recog-
372 PERSONAL HYGIENE APPLIED
nizing the need for open-mindedness upon this point, it
should be said that there is Uttle evidence to support the
dietary view.
The recent survey by Janowitz^ is commented on by
the Journal of the American Medical Association" as
follows: "In view of the reputed relation of cancer of
the stomach to the character of the diet, and especially
the vegetarian's behef that this disease is the result of
meat eating, it is interesting to report that a careful
study by Janowitz shows no evident alteration in either
the number or the location of cancers of the digestive
tract as observed in Berlin during the war,' when com-
pared with a similar group of population before the war."
What Are the Chances? — Disease results in recovery
or death. The recovery may leave the patient impaired
for months, for years, or during life. The course of disease
is fairly well known, and the following statement of
prognosis should be helpful in estimating the seriousness
of different diseases:
1. Diseases from which recovery is possible:
(a) Complete cure jiossiWe:
1. Mild intoxications, such as food poisoning.
2. Mild mechanical and chemical injury.
(b) Complete cure probable :
1. Chicken-pox (varicella).
2. Dengue.
3. German measles (rubella).
(c) Recovery probable, but dependent upon patient and treat-
ment:
1. Measles.
2. Erysipelas.
3. Mumps.
4. Early tuberculosis.
In this group a complication may be fatal.
(d) Recovery probable in the majority of cases :
1. Serious infections, such as pneumonia, give a guarded
prognosis.
2. Trichinosis, scarlet fever, typhoid, yellow fever.
• Janowitz, F. : Ueber das Verhalten der maligner Tumoren des
Verdauungstraktus Wahrend des Krieges, Zeitschrift fiir Krebs-
forsoh., 18, 34, 1921 (abstracted in the Journal of the American
Medical Association).
' Journal of the American Medical Association, December 24.
1921, p. 2064.
• During the war the diet in Germany was very largely a vegetarian
one.
PREVENTION IN SPECIFIC DISEASES 373
2. Diseases in which recovery from acute attack is probable, but some
chronic injury is likely to remain:
1. Endocarditis (heart disease).
2. Infantile paralysis (poliomyelitis).
3. Acute rheumatic fever.
4. Nephritis.
5. Arteriosclerosis.
Nephritis may not and arteriosclerosis does not show
an acute form. Injury to kidneys or arteries is usually
permanent.
3. Diseases in which recovery is rare:
1. Hydrophobia.
2. Tetanus.
3. Sepsis.
4. Anthrax.
The mortality in this group is over 80 per cent, imless
a special curative agent is used early. Hydrophobia and
tetanus will show a good prognosis under early Pasteur
treatment for the former and early antitetanus serum
for the latter.
4. Diseases in which recovery is not sure: •
1. Malaria.
2. Secondary syphihs.
3. Epidemic meningitis.
4. Diabetes.
5. Gout.
6. Chronic tuberculosis.
7. Tertiary syphilis.
5. Diseases from which complete recovery is impossible:
1. Purulent meningitis.
2. Acute leukemia.
3. Acute septic endocarditis (except the gonococcus
form).
Slowly fatal types are:
4. Chronic leukemia.
5. Addison's disease.
6. Carcinomata (cancer) of internal organs (some ex-
ceptions).
7. Leprosy.
8. Endocarditis (Streptoccocus viridans type).
6. Diseases in which afunctional cure may be secured by the surgeon:
1. Renal calculus (stone in the kidneys).
2. CholeUthiasis (gall-bladder disease).
3. Internal suppurations.
4.' Malignant growth that has an early diagnosis and
complete removal.
The outcome of any disease is dependent upon the
nature of the disease itself; upon such personal factors
as age, habits, sex, race, heredity, and resistance; upon
such environmental factors as economic strains, social
374 PERSONAL HYGIENE APPLIED
surroundings, and sanitary standards; and upon the
judgment and skill of physician and nurse.
Summary. — The causes of disease are bacterial, proto-
zoan, and at times metazoan. In addition, poisons from
food or drink, or imperfect metabohsm of food in the
body may produce disease. The maladjustments of the
individual to Ufe's problems may result in functional
disturbances and failure of endocrine organs to function
properly may bring on serious disorders.
The carriers of disease of the communicable kind are
either persons suffering in mild form from disease, such
as colds, measles, etc., or "carriers" in whom the organism
grows and develops without producing the symptoms
of the disease. The "carrier" is well recognized in typhoid
and diphtheria. In addition, objects may carry disease,
although they are held now to be less dangerous than
they were thought to be formerly. Nevertheless, in-
fectious material on objects may be transmitted to well
persons. Flies, rats, bedbugs, lice, fleas, cows, dogs,
cats, and other animals may carry certain infectious
agents to man. Typhoid, plague, typhus, tuberculosis,
diphtheria, and many other serious diseases may be
transmitted by means of insect or other animal carriers.
The defenses against germ disease are the forces of
resistance developed in the body naturally and the
artificial immunities which may be conferred by vaccina-
tion and serum treatment. In constant warfare against
many transmissible disease agents are sunlight and air.
Thus the environment offers forces of tremendous value
to man in combating disease. Organized society has
erected administrative defenses in the form of isolation
and quarantine which are indeed helpful.
To eliminate causes, to control "carriers," and to
build up defenses are the three legs of the tripod — Disease
Prevention. To do this, hygiene in all its aspects is
immensely valuable.
CHAPTER XIV
HYGIENE OF THE MOUTH, EYE, AND EAR
HYGIENE OF THE MOUTH, NOSE, AND SINUSES
WITH REFERENCE TO SEPTIC INFECTIONS
I. Septic Infections,
II. Portals of Entby.
III. Teeth:
The Cause of Dental Defects.
Teeth as Foci of Infection.
Pyorrhea Alveolaris.
How to Keep the Mouth and Teeth Clean.
IV. Tonsils as Foci of Infection.
V. The Nose and Sinuses as Foci of Infection.
VI. MoTTTH-W ASHES, SPEATS, AND GaBGLES.
HYGIENE OF THE EYE
I. The Eyes Need Care.
II. How TO Care for the Eyes.
III. The Cause op Eye Defects or Disturbance.
IV. The Use op Drops and Other Treatment.
V. Common Disorders op the Eye.
HYGIENE OF THE EAR
I. The Ear Needs Care.
II. How to Care for the Ear.
III. The Mastoid.
HYGIENE OF THE MOUTH, NOSE, AITO SINUSES
WITH REFERENCE TO SEPTIC INFECTIONS
Septic Infections. — The word "sepsis" means a general
disease produced by pus-producing bacteria. Specific
diseases such as typhoid and diphtheria are recognized
as infections, but they are not classed as septic infections
because the organisms are not pus producing. Typhoid
baciUi select, as a rule, the small intestine for their develop-
ment, and diphtheria bacilli choose usually the mucous
membrane of the nose, pharynx, or larynx,
375
376 PEBSONAL HYGIENE APPLIED
The organisms producing septic infections are of two
types: streptococci and staphylococci. At times the
pneumococcus is a factor and in certain tracts the colon
bacillus is responsible for the trouble. These organisms
may come from outside the body or they may come
from the host where they have dwelled for some time
without sign. The particular significance of this fact
has only in recent years been fully appreciated.
It has been observed that foci of infection in the body
may serve as sources from which organisms may be
spread to distant parts of the body. There is usually
a definite relation between the portal of entry and the
lesion or diseased process that develops. This relation-
ship is not established for all cases, but it is so definite
in many instances that foci are always under suspicion
when infection develops systemically in the body.
Portals of Entry. — The gates by which pus-producing
organisms enter the body are several. The skin affords
a large field. Boils and skin infections following cuts,
abrasions, or other injuries may develop into general
septic conditions. Certain disturbances in the gall-
bladder come from the extension of colon bacilli normally
present in the intestinal canal, and these organisms may
also invade the urinary tract, attacking the kidney,
ureters, and bladder. While these forms exist and cause
serious disturbance at times, the chief portal of entry
is in the head and face. Teeth, tonsils, nose, and sinuses
are common pathways for organisms. To understand
the liability of these structures as foci of infection and
the preventive measures to be appUed is very important.
They will be discussed in the order given above.
Teeth. — The temporary teeth of the child are lost
in the second dentition, and are replaced by a permanent
set. Belief that the temporary teeth are unimportant
is unfounded in fact.* Their care is significant for the
following reasons: Proper development and care of the
' Snyder, J. R. : The Temporary Teeth, Journal American Medical
Association, August 14, 1920, pp. 458-460.
HYGIENE OF THE MOUTH, EYE, AND EAB 377
temporary set' determine the shape and size of the upper
and lower jaw bones; they condition the maturing of
the permanent set, for if the temporary teeth are lost
too early, the permanent teeth do not have the proper
stimulus for growth; and finally, good oral hygiene is as
important for the health of the child as it is for the health
of the adult.
The importance of oral hygiene for children has been
demonstrated by Fones in Bridgeport, where a five-year
program of oral hygiene in the schools reduced the educa-
tional budget spent on re-education from 40 to 17 per cent.
The Cause of Dental Defects. — The quality of tooth
substance is determined in part before the child is bom.
The developing embryo must get the tooth-forming
salts from the blood of the mother. Frequently the
mother gives up needed and essential salts of her own
body to the developing child because of insufficient
content in her diet. It is extremely important, therefore,
^or the pregnant mother to select articles of diet from
food with a high calcium content (see page 174).
After birth the importance of dietary factors is not to
be forgotten. Too often oral hygiene is viewed too
narrowly as a tooth-brush affair merely. Dental deteriora-
tion is due to what is omitted from the diet rather than
to what the diet contains. Attributing to candy or soft
foods the cause of dental decay is not well supported.
For example, the Rhodesian skull' shows "unmistakable
evidence of dental caries, and even of abscesses at the
roots of the teeth."^ Dental decay is not a modem dis-
ease apparently, but one experienced by our earliest an-
cestors.' While the evidence is not complete, it would
appear that the tooth-brush, candy, and soft foods were
unknown to primitive man, but that deficient dietary
factors could play then the r61e that they are playing
so surely today. For other good reasons the tooth-
» Science, p. 129, February 3, 1922.
» Journal American Medical Association, p. 586, February 25, 1922.
s Ibid., p. 282, January 28, 1922.
378 PERSONAL HYGIENE APPLIED
brush should be used regularly and well, candy should
not be eaten between meals, and coarse food requiring
mastication should be selected. But reliance on such
procedures for development of good teeth is precarious.
Adequate diet is extremely important.*
Teeth as Foci of Infections. — There is abundant evidence
to show a causal relationship between infected teeth
and many varied forms of general bodily disturbance.
At times esrtreme claims are made and tooth extraction
is expected to accomphsh too much in health restoration.
Reaction against overzealousness on the part of the
inexperienced should not lose sight of the real facts.
Evidence by both foreign and home clinicians is avail-
able. Antonius and Czepa,^ following a systematic use of
the x-ray in Falta's service, found that 66 per cent, of
225 cases of various diseases had some infectious process
at the root of one or more teeth. Their observations
led them to affirm a causal relationship between focal
infections in the teeth and nephritis, chronic septic endo-
carditis, joint and muscular rheumatism, neuralgia, and
other disturbances.
The Life Extension Institute, Inc., reports that "in a
recent series of 200 x-rays at the head office of the Institute,
67.5 per cent, were found with infected roots or gums.
Among 200 individuals there were 205 foci of infection
found." Lambert' reports that in 1000 cases of rheu-
matism at BeUevue Hospital, 68 per cent, showed bad
teeth, and that since the establishment of the dental
clinic in Bellevue "the number of rheumatics has de-
creased enormously."
The story of dental infection is most interesting. At
times the relationship seems clear enough because of
iMcCoUum, E. V.: The Effect of Diet on Health, Journal of
National Dental Association, April, 1922.
' Antonius, E., and Czepa, A. : Wiener Archiv fiir innere Medizin,
Vienna, February 15, 1921, p. 293; (abstracted) Journal American
Medical Association.
'Lambert, A.: Journal American Medical Association, October
16, 1920, p. 1041.
HYGIEKE Ot THE MOtTTH, EYE, AND EAR 379
alveolar abscess, marked inflammation, and frank evi-
dence of decay. Quite often, however, the astounding
a;-ray shows the trouble to be in the root canal or at the
tip of the tooth in the jaw, while quite disturbing to
the layman is the fact that there may be no signs to the
owner that anything is wrong with the teeth. Such
cases are only revealed by the x-ray examination.
Because of experience, modern dentistry views with
suspicion crowns and bridge work, and especially if
these were mounted some years ago before the practice
of root canal fiUings. It is not an extreme position that
the dentist takes when he advises, after an a;-ray diag-
nosis, that expensive crowns be removed or even that
teeth be pulled for the purpose of eliminating sources of
infection.
Fortunately, there is developing rapidly among den-
tists a technic for filling root canals in instances when
the nerve has been killed. This technic involves use of
the x-ray to determine whether or not the filling has
reached the tip of the tooth. With extension of this
procedure among dentists, and with understanding by
laymen of its necessity, certain forms of general bodily
disturbance and ill health will be prevented.
Pyorrhea Alveolaris. — Pyorrhea alveolaris' is an infec-
tion of the giuns with characteristic changes in the bony
alveolar process that holds the tooth. It begins at the
gum margins and extends, causing marked inflammation.
A common picture in well-developed pyorrhea shows
the gums retracted so that the teeth appear abnormally
long; the giuns are red and bleed easily; and around
their margin a yellowish pus exudes. A disagreeable
taste in the mouth, foul breath, and disturbances of
digestion are common results. More serious are general
systemic infection of other parts due to invasion by pus
organisms of the lymph and blood-channels.
The cause of pyorrhea has been assigned to an animal
> Bass, C. C, and Johns, F. M. : Pyorrhea Dentalis and Alveolaris,
Journal American Medical Association, February 13, 1916.
380 PERSONAL HYGIENE APPLIED
parasite, the Endameba buccalis. The case is not clear
against this particular organism, but the preventive
and treatment methods are well known. A mouth-
wash of 2 drops of the fluidextract of ipecac to | glass
of water is helpful in the early stages. If the condition
is well developed thorough dental prophylaxis is impera-
tive.
How to Keep the Mouth and Teeth Clean. — There is
considerable conflicting testimony regarding the efficacy
of different methods of oral hygiene. Competent dentists
are in essential agreement with the following procedures:
1. Brush the teeth daily, preferably after each meal. Use a
rather stiff brush with uneven bristles and thoroughly
cleanse all surfaces of the teeth. A rotary, across, and up-
and-down motion are the proper movements to make. Never
neglect the night brushmg. This is the most important
■ single brushing.
2. One should have three tooth-brushes, to be used alternately,
This will give time for the bristles to thoroughly dry out.
3. Use a paste or powder that is not scratchy.
4. Food particles caught between teeth should be removed with
dental floss. Care should be taken not to injure the gums.
5. An alkaline mouth-wash is useful before retiring, although not
essential if the mouth is in good condition. Lime-water made
from coarse unslaked Mme may be used.
6. Cleansing of the tongue with a tooth-brush used only for this
purpose assists in the removal of decomposing material that
at times causes foulness of breath.
7. Examination of the teeth by a good dentist everjr six months,
preferablj^ every three months, is strongly advised. Atten-
tion to this matter will prevent many defects from occurring.
If evidence of dental defect develops, immediate attention
should be given to it.
Tonsils as Foci of Infections. — ^The tonsils are lymphatic
glands situated at the entrance to the throat, or pharynx.
They lie in pockets or depressions between two bands
of musculomembranous tissue called the pillars of the
fauces. They serve, like all lymphatic tissue in the body,
to protect against bacteria,' and because of their situation
they are liable to become infected.
• Davis, D. J. : The Tonsil in Relation to Infective Processes,
Journal American Medical Association, January 31, 1920, pp. 317-
320.
HYGIENE OF THE MOUTH, EYE, AND EAH
381
The evidence against the tonsils as foci of infection
is very strong. Heart disease, rheumatic fever, and
chorea have shown certain relationship. St. Lawrence'
reports a study of 94 cases, and shows the effect of re-
moval of the tonsils upon the recurrence of general
disease (Fig. 42). After tonsillectomy the occurrence
of rheumatic manifestations dropped from 85 per cent.
to slightly over 30 per cent. This careful work shows
that the tonsils are the most important single portal
of entry for rheumatic infections, and that their removal
greatly decreases the liabihty of recurrences.
Fig. 42. — ^Effect of tonsillectomy on the recurrence of rheumatic
manifestations: shaded area, number of cases before operation; soUd
area, number of cases after operation : figures above and below, num-
ber of cases. (By courtesy of Dr. William St. Lawrence.)
Belief that removal of the tonsils causes injury to the
voice, ears, or interference with the protective mechanism
of the body is not well founded. The voice is usually
improved after tonsillectomy, particularly if the tonsils
are large. Only the amateur in surgery would damage
the neighboring throat structures in the operation.
In the second week after the operation pain in the ears
' St. Lawrence, W. : Effect of Tonsillectomy Upon the Recurrence
of Acute Rheumatic Fever and Chorea, Journal American Medical
Associ?.tion, October 19, 1920, pp. 1035-1041.
382 PERSONAL HYGtENE APPLIED
may be quite marked, but this is temporary and of no
vital significance. The protection to the body is unim-
paired because the deeper lymphatic nodes take over the
work formerly performed by the tonsils. Their pro-
tected position in the deeper tissues prevents exposure
to the great number of bacteria constantly present in
the mouth.
Finally, it should be remembered .that removal of the
tonsils, especially in children and young adults, results
in most salutary effect upon the general health. In
particular cases, colds, croup, and tonsillitis are greatly
decreased both in severity and frequency. In children,
an increase in weight is commonly noted, and favorable
effects on the nervous system are most striking. In
children the adenoids are usually removed at the time
of the tonsillectomy (see page 226 for Adenoids).
The Nose and Sinuses as Foci of Infections. — Four
bones of the skull contain distinct cavities which give
rise, at times, to local or even general disturbance.
These cavities are called sinuses, and all open into the
nose or nasopharynx. The frontal simis is located in
the frontal bone immediately above the eyebrows; the
ethmoidal sinus is a series of small cavities in the ethmoidal
cells which open into the upper part of the nasal cavity;
the superior maxillary sinus is a large cavity in the upper
jaw bone on either side of the nose, and the sphenoidal
sirnis is a small cavity in the body of the sphenoid bone.
This opens into the nasopharynx. These sinuses are
lined with mucous membrane. During an acute cold,
"influenza, pneumonia, scarlet fever, measles, diphtheria,
typhoid fever, and other infective diseases"^ infection
and inflammation may develop in these cavities. De-
formities in the nose which prevent free drainage of the
sinuses or an infected tooth in the upper jaw opening
into the sinus of the superior maxillary bone, are not
uncommon ways in which trouble begins. Understand-
» C!oaJdey, C. G. : A Manual of Diseases of the Nose and Throat,
Lea & Febiger, Philadelphia, 1914, p. 200.
HYGIENE OP THE MOUTH, EYE, AND EAR 383
ing of such processes should be helpful in seemg the
futility of the punching or manipulating of the spine
for "subluxations."
Acute inflammation in these centers may require,
and often do demand, surgical atteiition. If not cared
for properly, extension to the brain may occur, with fatal
consequences. The sinuses do not play the same kind
of a r61e as the teeth and tonsils apparently, and yet at
times a chronic sinusities is foimd to be the cause of
general disturbance in health.
Mouth-washes, Sprays, and Gargles. — Liquids are
used for cleansing the mouth cavity during an infection.
During an attack of tonsillitis or pharyngitis local
treatment is very helpful. The chief value hes in the
mechanical washing of the inflamed part, and shght
rehance should be placed upon drugs or chemicals imless
prescribed by a physician.' The reason for insisting upon
medical direction is the variable conditions that may
be found. Shall an antiseptic only be used, an irritant,
or an astringent? What preparation is selected depends
upon the condition of the mucous membrane. A mouth-
wash of salt water, or bicarbonate of soda in water,
is benefiicial for removing mucus, but the claims of spe-
cial curative values for 'advertised gargles and mouth-
washes are grossly exaggerated, to say the least.
Chronic conditions in the nose or throat may require
sprays, gargles, or drops over a long period of time. The
rational procedm-e is to secure from a specialist a pre-
scription for the condition, and then follow his directions.
HYGIENE OF THE EYE
The Eyes Need Care. — ^The eyes of man developed
to perform a function that has been greatly changed
in modem civihzation. The invention of Gutenberg
has thrown enormous strain upon the eye by requiring
' The physician will wish to prescribe in accordance with the
condition of die part to be treated.
384 PERSONAL HYGIENE APPLIED
it, in reading the printed page, to make many more move-
ments than are ever called for in the environment .of
large objects. Many eyes are unable to make this adjust-
ment. About 35 per cent, of the school teachers in
Germany wear glasses, though not more than 15 to 20
per cent, in the United States. This difference Terman^
suggests to be due to the "unwillingness of our women
teachers to risk the disfigurement of spectacles." There
are many women who refuse to wear glasses because
of pride, but this attitude is probably not the explanation
for the condition found in this country. More people
in aU walks of hfe need and wear glasses in Germany
than in America, because as a people the Germans are
inclined to myopia and in America myopia is less frequent.
The use of eyeglasses and spectacles is recommended
to correct abnormaUties of eye structure or eye function.
Myopia (near sight), hyperopia (far sight), presbyopia^
(far-sight condition of advancing age), astigmatism (un-
equal curvature of the cornea — ^front part of the eye)
are structural defects to be corrected by proper lenses
placed in front of the eye. Weakness or insufficiency
of the external muscles of the eyeball may be functional
and disappear if strain is removed by proper lenses.
How to Care for the Eyes. — Intelligent care of the eyes
will provide:
Early and repeated eye examinations. Such examina-
tions should be made if the individual has headaches,
or, if in reading, the book is held nearer than 12 inches.
Examinations should be conducted preferably by oculists
rather than by opticians or optometrists. The oculist
is a physician who examines the eye with reference to
other conditions prevailing in the body. He does not
' Terman, L. M. : The Teacher's Health, Houghton Miffin & Co.,
1913, p. 66.
* Presbyopia is a very interesting condition. The near point of
vision begins to recede at about the age of ten and continues through-
out life. At about forty-five it has reached 12 inches, which is our
distance for reading and many kinds of work, so that glasses are
needed to bring back the near point to the working distance. Glasses
for this purpose need to be changed every one to three years.
HYGIENE OF THE MOUTH, ETB, AND EAK 385
merely refract the eye. The optician or optometrist in
small towns is usually engaged in the jewelry business
and conducts eye examinations free for the purpose of sell-
ing lenses and frames. He may examine quite accurately
the optical defect of the eye, but he is not in a position
to interpret the eye condition in terms of general disease.
Thus, kidney disease with its eye signs, arteriosclerosis,
sarcoma of the eye, and other serious conditions, would
be detected by the skilled ocuhst and missed by the
optician. The eye and forehead ache of malarial fever,
the characteristic pupil conditions in early locomotor
ataxia would be recognized by the physician oculist;
the optician or optometrist would not be able to make
a differential diagnosis.
Avoidance of fine work, especially by children. The
effort to see small relationships, as in sewing, embroidery,
drawing, painting, reading, and so forth, is a strain on
the eye muscles. Such work should not be continuous
for long periods.
Frequent rest for the eyes from study or close work.
It will relieve the eyes to look up from close work and
allow the eye to look into the distance. Objects 20 feet
away are seen by the normal eye without any muscular
effort. To look out of the window when doing close work
indoors is a very desirable relief for the eye.
Good light. Good light for seeing purposes is light
from a steady source, as near like the sun as possible,
coming from above or from the side. In all writing it is
important that the light come from the left for right-
handed persons or from the right for left-handed persons.
Twilight is a poor light with which to do any fine
work. For seeing purposes full sunlight may be unde-
sirable because of too great intensity or glare. Reading
on a moving train or street car is hard on the eyes because
of the wavering source of light, the shadows cast, and the
constant change in the focus and adjustment of the
external muscles of the eyes required by the vibrating
book or paper.
25
386 PERSONAL HYGIENE APPLIED
Good light will have the following characters:
1. Steady source.
2. Sufficient intensity to illumine without glare.
3. No shadows produced on the reading or work surface.
Tinted glasses. In caring for the eyes it will bq helpful
to have tinted glasses for use in the bright sun, especially
at the seashore, and during the winter while the snow
is on the ground. They should also be used in strong
winds, as in automobiling, unless one is obliged to wear
glasses for other purposes.
Good general health. The eye responds quickly to
lowered states of bodily efficiency. Good health means
almost always right Uving, and the eyes will share in the
general effects.
The Cause of Eye Defect or Disturbance. — The proper
care of the eyes results uniformly in good eyes. Lack
of proper care causes a variety of eye defects or dis-
turbances. Viewed from this angle, of course, we find the
following:
1. General ill health, weakness or lowered vitahty.
The loss of tone in general is expressed in the eye
in definite deterioration.
2. Excessive use of the eye. Students, teachers,
laboratory workers, and all sedentary workers
engaged in close eye work are liable to overuse
the eye.
3. Poor light.
4. Irritating forces, such as chemicals, vapors, dust,
wind, and excessive heat.
5. Disease of the eye, such as trachoma, pink eye,
ulcer of the cornea, ophthalmia neonatorum, etc.
6. Hereditary factor may be a cause of certain abnormal-
ities. The generally accepted opinion is that at
birth all eyes are hyperopic, and that as develop-
ment progresses the eyes in time become the
proper size and shape with the refracting media
acting symmetrically. If the cornea and lens
do not refract rays to a common focus then there
HYGIENE OP THE MOUTH, EYE, AND EAR 387
is astigmatism. If the eyeball does not enlarge
to the proper size then there is hyperopia. If the
eyeball tissues stretch or overdevelop then myopia
is the result. Thus myopia is really acquired and
hyperopia is congenital.
Uncorrected eye defects and abnormalities cause a
variety of disturbing conditions that range all the way
from headache to marked general iU health. Use of a
defective eye demands extreme effort on the accommo-
dation powers of the eye. It always strains the eye
and wastes energy. All children should have the relief
and help that scientific oculists can give; all adults
owe it to themselves to secure optimimi working con-
itions.
The Use of Drops and Other Treatments.r-Drops are
used in examination of the eye to paralyze the muscles
of accommodation so that the actual defect in the eye-
ball may be determined. Atropin or homatropin is
used for this purpose. In the care of a skilled oculist
there is no danger from the use of these drugs. Opticians,
jewelers, non-medical "refractionists," and peddlers are
prohibited by layr from using "drops." This is most
fortxmate, because their use in cases of glaucoma pro-
duces serious results. Persons with glaucoma (excessive
pressure within the eyebaU) suffer from failing vision,
and are likely to be seeking for optical aid. The impor-
tance of this law is, therefore, very great.
Eye diseases and abnormalities offer a rich field for
the charlatan and patent-medicine faker. Numerous
cures or remedies are on the market claiming "to restore
defective sight," "to make the eyes young again." As
illustrative of this class of fraudulent preparations the
following from Nostrums and Quackery^ is given:
"The label on Eyelin contained the statements:
Repairs and Rejuvenates the Eye and Sight.
Reshapes and Rejuvenates the Eye and Sight.
* Nostrums and Quackery, American Medical Association, Chicago,
1912, pp. 528, 605.
388 PEBSONAL HYGIENE APPLIED
Analysis of the stuff in the government laboratory dis-
closed the fact that it consisted essentially of vaselin,
perfumed."
One dollar a box for vaselin, perfumed, to correct
eye defects represents the honesty and integrity of the
whole patent-medicine game. Exorbitant prices for
simple preparations that are often worthless for the
condition described.
Another preparation widely advertised is Murine.
Before the advent of the Food and Drugs Act the carton
in which this "eye water" was sold read as follows:
Murine
A positive cure
for Sore Eyes, Red, Inflamed, and Itching Lids.
Since that law has become operative, and a lying label
has become illegal instead of merely inamoral, the carton
bears this legend:
Murine
a ReUable Relief
for Sore Eyes, Red, Inflamed, and Itching Lids.
On analysis. Murine is found to be a water solution
of borax (12 grains to the fluidounce). The price charged
for Murine is $1 per ounce; the estimated cost of the
preparation is 5 cents per gallon.
Common Disorders of the Eye. — Disorders of the eye
are frequently of minor importance, but because of the
delicate structure of the eye and the value of perfect
vision, intelligent care should be given to all abnormahties,
however trivial. The disorders commonly found may
be grouped in three headings: injuries, infections, and
systemic causes.
Injuries to the eye may result from a blow upon the
face, resulting in the condition known as "black eye."
HYGIENE OP THE MOUTH, EYE, AND BAIt 389
The blackness is due to the breaking of blood-vessels
in the soft tissues around the eye with a flooding of blood
into the tissues from the broken vessels. If care can be
given immediately after the injury ice compresses will
be most helpful. After discoloration has occurred hot
compresses will be useful in promoting absorption of the
extravasated exudate. Local medication is useless, and
poultices, beefsteak, etc., are valuable only as they supply
heat. A hot-water bag is more desirable from many
standpoints than sirloin.
Injury from a foreign body in the eye is very common.
The usual -cinder, eyelash, or dust-grain is not a serious
disorder, but until removed it is extremely troublesome.
To remove a foreign substance from the eye gently pull
down on the lower Ud and look in the lower sac for the
irritation. If it is not seen, the upper lid must be everted
for examination. To evert the upper lid grasp the edge
of the lid with index-finger and thimib of right hand,
pulling forward and downward. Ask the patient to
look downward, and at the same time turn the lid up
over the thumb of left hand placed on the margin of the
eye socket with nail side forward. Wipe off the particle
with the comer of a clean handkerchief or wisp of cotton.
If the particle is embedded so that it is not easily removed,
refer the case at once to a physician who can use sterile
instnmients.
Infections of the eye occur more frequently in child-
hood than in adult life. A common disorder is known
as sty of the eye. A sty is an infection and inflammation
of one of the glands along the margin of the eyeUd. Its
cause is not known. Some attribute eye-strain as a
factor. Its prevalence in young children would suggest
need for ocular examination. It may be caused by some
other factor, such as infection due to rubbing the eye
with dirty hands. Stys are not usually serious, but
should be cared for carefully. When "ripe" they should
be opened with a sterile needle, and the pus removed
by gentle pressure with a bit of cotton on a toothpick.
390 PERSONAL HYGIENE APPLIED
After expulsion the wound should be painted with 5 per
cent, argyrol and yellow oxid of mercury salve used in
the eye.
"Pink-eye" is an inflammation of the conjuiictiva.
There are two kinds: one seen in cases with cold in the
head, influenza, eye-strain, or after exposure to wind
or irritating smoke. This type is due to local causes.
The other is an infectious inflammation of the conjunctiva,
a conjimctivitis, that is very communicable. The pink-
eye from irritation should be treated by washing the
eye with saturated solution of boric acid; the infectious
conjunctivitis requires medical attention.
Purulent conjunctivitis of the newborn is commonly
due to gonococcus infection. Before the law requiring
obstetricians and midwives to use silver nitrate in the
eyes of all infants at birth, this condition was a common
cause of blindness.
Trachoma is an exceedingly communicable disease
of the eye characterized by granules in the conjunctiva
of the lids. It is largely seen among children (especially
those of foreign birth) of crowded sections in city schools.
It may result in impairment or even total loss of vision.
Granular conditions of the lids of a simple type are not
to be confused with trachoma. All granular conditions
of the eye should be examined by a physician.
Systemic causes of eye disorders are the diseases that
show certain eye changes. Thus, kidney and heart
disease may be indicated by swelhng and baggy forma-
tions under the eye; locomotor ataxia shows characteristic
pupillary changes, and various poisons indicate their
effects in retinal changes.
Blepharitis is an inflammation of the margins of the
eyelids. If neglected the eyelashes fall out, not to be
replaced. This makes an unsightly deformity.
Chalazions are caused by infections of the ducts and
glands along the inner side of the lids. They occur
quite commonly. They may appear very much like a
sty, and at first it is difficult to decide whether there is a
HYGIENE OF THE MOtPTH, EYE, AND EAR 391
sty or chalazion forming. The latter is sometimes spoken
of as a blind sty.
HYGIENE OF THE EAR
The Ear Needs Care. — ^The ear is subjected in the
modem world to a variety and intensity of sound waves
out of all proportion to the forces acting when the hear-
ing apparatus was evolved, but the adjustment necessary
in modern life affects not so much the organ of hearing
as it does the nervous system in general. Noise wastes
human energy. Quiet and harmonious sounds are very
beneficial. The ear carries to the nervous system all
sounds; unfortunately for modern man it is not more
selective.
The ear itself is important, however, because it is
frequently infected and because it offers a pathway for
infection to the mastoid cavities, and even to the brain
itself. In the upper part of the throat there opens the
eustachian tube that leads from the middle part of the
ear structure. Normally the tube serves to permit
an equaUzation of air-pressure in the middle ear with
that existing outside the body. Any good book on
physiology will explain this structure and function.
This middle part of the ear from which the eustachian
tube leads has another passageway that connects with
the cavities of the bony prominence felt behind the ear,
i. e., the mastoid. Infection carried into the middle
ear by means of the eustachian tube may extend to
the mastoid and thence to the brain, requiring surgical
operation or resulting in death.
How to Care for the Ear. — Prevent so far as possible
all infections of the nose and throat. In children especially
this is to be interpreted to mean also prevention of the
communicable diseases of childhood, namely, measles,
whooping-cough, scarlet fever, and diphtheria. Measles,
whooping-cough, and scarlet fever are not infrequently
complicated by middle-ear disease which may result in
deafness or even in death.
392 PERSONAL HYGIENE APPLIED
Remove adenoids in children. The adenoid tissue
growing near the opening of the eustachian tube causes
deafness of varying degrees by shutting off partially or
completely this opening.
Avoid diving in cold salt water. In aU diving the pres-
sure of the water may force infectious material up the
eustachian tube. This has been noted to occur more
frequently in salt-water diving. Apparently this is due
to the action of salt water in clearing the mucus from
the nose and throat and especially from the opening of
the tube. Exposure to cold causes ear disturbance at
times.
Carefully remove excess wax in the ear canal. The
wax that is secreted in the ear canal is a normal and
useful product. At times it increases to excess and needs
removal to restore hearing. One should never attempt
to clean the wax out oneself. The use of hairpins and
other hard objects should be avoided. The canal may
be cleaned by careful syringing with warm water and
wiping of its walls by means of a wooden applicator with
cotton on its end.
Refer to a physician all disturbances of the ear. At
times foreign substances get into the ear canal. Insects
may fly in or children may put into the ear objects,
such as a pea, grain of com, small toys, beads, etc. They
need careful removal.
Careful watch of the ear must be kept throughout a
cold, an attack of croup, measles, whooping-cough, or
scarlet fever in babies and children. Since they are
usually unable to tell what hurts them, it is necessary
to rely upon daily examination by the physician to avoid
serious complications.
Earache accompanying a cold, croup, sore throat, or
communicable diseases is caused by infection carried
into the middle ear. The practice of putting oil into the
ear is traditional and unscientific. Heat in the form of a
hot-water bag to the ear or gently syringing the ear with
warm water will give relief. During all coughs, colds, etc..
HYGIENE OF THE MOUTH, EYE, AND EAR 393
occurring in children a nightcap will be found very help-
ful in preventing an attack of earache.
The Mastoid. — Prevention of middle-ear disturbance
by avoidance of the communicable diseases is important
not only for the ears but also for the mastoid. Disease
of the middle ear may extend to the mastoid, which com-
municates with the ear. If not cared for properly and
promptly a mastoid infection may result fatally.
INDEX
Abdominal breathingj 216
Absence, illness causing, distri-
bution of, 252
Acetanilid, 274
Acid, uric, fallacy, 258
Acidity of blood, 251
Acne, 266
Activities. See also Exercise.
different, relative value of, 130
distribution of, by age periods,
118
for mature and immature
girls, 128
muscular, habits of, charac-
teristic of different stages of
human development, 116
Acute poisoning, causes of, 350
prevention of, 368
Adaptation of exercise, 123
to age, 123
to cUmate, 129
to individual, 130
to occupation, 129
to sex, 126
Adenoids, 226
injurious effects of, 227
removal of, in care of ear, 392
Adolescence, exercise for period
of. 125
Adulterants in food substances,
196
Adulteration, food, 194
Adults, exercise for, 125
Afferent nerves, 310
Agent of interaction, 72
Ages, adaptation of exercise to,
123
dfferent, energy requirements
of, 181
Air, bacteria in, 214
Air, badness of, 202
causes of, 203
carbon dioxid in, 201, 202
dryness of, excessive, 209
method of combating, 210
expired, composition of, 202
inspired, composition of, 202
mineral dust in, influence of,
on health, 213
movement of, means of secur-
ing, 212
oxygen in, 201, 202
vitiated, 202
Alcohol, 197
and eflaciency, 198
and length of life, 198
and nervous system, 335
as cause of insanity, 333
effects of, on germ cells of male,
336
Alcoholic insanity, 333
Alexins, 259
Alkaline mouth-wash, 380
All factors in health important,
144
Amaurosis, 95
Anchylostoma duodenale, 366
Anchylostomiasis, cause of, 366
prevention of, 366
Anemia, 175, 243
causes of, 244
iron preparations in, 248
medicines in, 245
Animal extracts of glands of
internal secretions, 264
or vegetable protein, relative
superiority of, 191
proteins^ composition of, 164
Anthracosis, 213
Anthrax, cause of, 365
395
396
INDEX
Anthrax, prevention of, 365
Antibodies, 260, 261
Antipyrin, 274
Antitoxin in diphtheria, value of,
87
Antivenom serum, 261
Antivivisection, 101
Approach for knowledge of
health, 64
Aprosechia nasalis, 227
Arches, weak or fallen, exercises
for, 152
Arteries, 268
loss of elasticity of, probable
causes, 268
Arteriosclerosis, 268
possible causes, 268
Artificial resistance to disease,
353
Aspect, dual, 82
Aspirin, 274
Assimilation, 156
Astigmatism, 384
Athletics, 25
value of, as exercise, 130
Attitudes and science, 82
Autacoids, 263, 264
Auto-infections, prevention of,
292
Automatic control of respiration,
217
Autonomic nervous sytem, 310,
311
and cerebrospinal nervous
system, harmony of ac-
tion between, 313
Bacilltjs anthracis, 365
botulinus, 368
enteritidis, 368
of Bordet and Gengou, 356
of Gaertner, 368
of Klebs-Loffler, 360
of tetanus, 365
of typhoid fever, 354
tuberculosis, 229
Back, hollow, 150
Bacteria in air, 214
Koch's law of specificity of, 356
Bad blood, 266, 267
Badness of air, 202
causes of, 203
Basal metabolism, 156
Basis of life, biologic, 65
Bath, cold, 282, 294
influence of, on metabolism
in man, 284
(shower or tub), substitutes
for, 284
hot, 282
pruritus, 294
Russian, 286
sea, 285
shower-, value of, 282, 283
sponge, cold, 284
sun, 286
Turkish, 286
warm, 282
Bathing, 281, 282
cold, 221, 222, 224
habit of, 285
Beautifier, skin, 287
Belt, 300
Beneficial effects of rational
exercise, 119
Beriberi, 166
Biologic basis of life, 65
view, value of, 78
Biology, evidence from, a guide
for hygiene, 68
Biting the nails, 293
Black eye, 388
Blaud's pills, 245, 248
Blepharitis, 390
Blepharospasm, 95
BUnd sty, 391
Blood, 242
acidity of, 251
autacoids in, 263, 264
bad, 266, 267
carbon dioxid in, 251
chalones in, 264
composition of, 243
hormones in, 264
oxygen in, 251
poisoning, 350
protective substances in, 259
proteins in, 254
salts of, 255
special considerations, 255
use of mineral waters, 257
sugar in, 252
waste substances in, 265
Blood-cells, red, 242
white, 249
INDEX
397
Blood-plasma, 250. See also
Plasma of blood.
Blood-vessels, 268
Body, clothing of, 296
human, an energy mechanism,
71
elementary composition of,
171
its adjustment, 71
needs and food values, 178
processes, food to regulate, 165
reaction, mineral salts and, 177
waste, elimination of, by kid-
neys, 301
Bookworm, 26
Bordet and Gengou, bacillus of,
356
Bothriocephalus of fish, 366
Bowel, emptying of, lack of
habit of, 307
Boys, basal metabolism of, 157
height and weight of, tables
for, 182
Braces, shoulder, 150
Brain food, 159
Breadth of view, 330
Breakdown, premature, causes of,
241
Breathing. See also Respiration.
abdommal, 216
exercises, 217
mouth, 216
nose, 216
in health of respiratory
system, 221
Blight's disease, 303
Buffalo lithia water, 258
Calcium in 100-calorie portions
of foods, 174
Calisthenics, value of, as exer-
cise, 131
Call of the occult, 99
Caloric values of different arti-
cles of food, 158
Cancer, causes of, 351, 370
mortality from, 371
prevention of, 370
Candies, 185
Carbohydrates, 159
in plasma, 252
Carbon dioxid in air, 201, 202
Carbon dioxid in blood, 251
Cardiacs and non-cardiacs, oc-
currence of infectious disease
in, 272
Cardiovascular-renal disease, 241
Carriers of disease, 374
Cells, eating, 250
Cereals, vitamins in, 167
Cerebrospinal meningitis, 360
cause of, 360
prevention of, 360
nervous system, 309, 310
and autonomic nervous
system, harmony of ac-
tion between, 313
Chain of Ufe, each individual a
link in, 58
Chalazion, 390
Challenge of scientific medicine,
107
Chalone, 264
Chicken-pox, cause of, 355
prevention of, 356
Children, diseases of, danger of,
272
older, exercise for, 124
Chilling, 223
Chiropractic, 96
Chlorosis, 175
Christian Science and social re-
sponsibility, 93
danger from, 91
kind of disease cured by, 95
Scientist ignores facts, 86
not prepared to judge, 85
position of, 84
Chronic diseases, causes of, 241
degenerative disease, causes of,
350
prevention of, 369
Cigarette smoking, effects of, 275
Circulation, importance of, 239
plan of, 241
vessels of, 268
Circulatory disease, increase in,
240
system, hygiene of, 239
Cleansing of tongue, 380
Climate, adaptation of exercise
to, 129
Climbing exercise, 140
Clothing, color of, 298
hot weather, 297
398
INDEX
Clothing, how to wear, 299
hygiene of, 296
influence of, on metabolism,
297
seasonal, 296
the body, 296
Cocoa, 199
Coelenterata, 65
Coffee, 199
Cold bath, 221, 222, 224, 282, 294
influence of, on metabolism
in man, 284
cures, 274
sores, 267
sponge bath, 284
shower, substitutes for, 284
Colds, 222
causes of, 222
home treatment, 225
prevention of, 221
resistance to, 223
vaccines for, 225
Collars, 300
Color of clothing, 298
Commercial exploitation of min-
eral waters, 257
Communicable disease, causes of,
350
prevention of, 354
Complexion, 286
Conduct, human, forces deter-
mining, 46
instinct, 47
intellect, 48
stages in, 45
sex, 340
Confidence, 328
Confusion of scientific and hu-
manistic principles, 101
Conjunctiva, inflammation of,
390
Conjunctivitis of newborn, puru-
lentj 390
Consciousness and movement,
significance of, 115
Conservation of national re-
sources, 28
Constipation, 224
causes of, 307
Contraction of muscle, 66
Control of dust and dirt, 213
Convalescent heart, 273
Corpuscles, red, 242
Corpuscles, white, 249
Correct eating, 186
posture, 147
Corsets, 299
Cosmetics, use of, 280, 289
Cranial nerves, 310
Cretinism, cause of, 368
prevention of, 368
Criticisms, 324
Croup, mortality from, 361
seasonal prevalence of, 362
Cures, cold, 274
headache, 274
Curling the hair, 294
Curvature of spine, 150
Dairy products, vitamins in, 168
Dancing, value of, as exercise,
131
Danger from Christian Science,
91
Death, causes of, principal, 303
table showing, 30
from disease in three American
Wars, 91
from tuberculosis by occupa-
tion and place, 232
premature, causes of, 241
preventable, 28
Defective inheritance in nervous
system, significance of, 318
Defenders, 259
Deficiency diseases, 166
Definition of health, 17
examined, 20
Deformed feet, 151
causes, 151
Deformities, skeletal, common,
prevention of, 150
Degenerative disease, chronic,
prevention of, 369
Dental defects, cause of, 377
Deodorants, 296
Depulatories, 296
Desirable temperature, 205
valuable experiment in, 205
Development, human, plan of
movement in, 114
stages of, habits of muscular
activity characteristic of,
116
Diabetes, cause of, 367
INDEX
399
Diabetes, prevention of, 367
Diet, fads and fallacies in, 190
German, during World War,
163
Dietary, essential, mineral salts
as, 170
Digestibility of food, 181
Digestion, 156
Diphtheria, antitoxin in, va,lue
of, 87
cause of, 360
mortality from, 361
prevention of, 360
seasonal prevalence of, 362
Diplococcus intracellularis, 360
Dirt, control of, 213
Disease, carriers of, 374
causes of, 349
deaths from, in three American
Wars, 91
functional, prevention of, 369
kind of, cured by Christian
Science, 95
prevention of, 351
general means of, 352
special means of, 353
resistance to, 352
transmission of, 351
types of, 349
umversal distribution of, 348
Diseases, children's, danger of,
272
chronic degenerative, preven-
tion of, 369
from which complete recovery
fa impossible, 373
recoveiy is not sure, 373
is possible, 372
is rare, 373
in which recovery from acute
attack is probable,, but
some chronic injury is
likely to remain, 373
functional cure may be
secured by surgeon, 373
specific, prevention in, 348
venereal, 344
Disinfection, 353
Disorders of eye, common, 388
Disposition, morbid, 335
Distribution of activities by age
periods, 118
of disease, umversal, 348
Distribution of illness causing ab-
sence, 252
Diving in care of ear, 392
Doan's kidney pills, 304
Doubt, 329
Douche, nasal, 224
Draft, 212, 213
Drill, setting-up, value of, as
exercise, 132
Drinking at meals, 188
Drinking-water in goitrous dis-
tricts, 256, 257 1
Droplet infection, 214, 215
Drops, eye, use of, 387
Dryness of air, excessive, 209
method of combating, 210
Dual aspect, 82
Ductless glands, 263
secretion of, 263, 264
Dust, control of, 213
mineral, in air, influence of, on
health, 213
Dynamic action of proteins, 255
force of an ideal, 43
Each individual a link in chain
of life, 58
an heir to inheritance of
life, 58
Ear, foreign body in, 392
how to care for, 391
hygiene of^ 375, 391
middle, disturbances of, pre-
vention of, 393
needs care, 391
oil in, 392
wax, removal of, 392
Earache, 392
Eating cells, 250
correct, 186
technic of, 187
Economic value of good posture,
148
Eczema, 267
Education, 38, 39, 317
and training of young, 41
lack of, in individual in health
problem, 42
necessity for, of individual, in
health problem, 40
sex hygiene, 339
social hygiene, 338
400
INDEX
Efferent nerves, 310
Efficiency and alcohol, 198
Elasticity of arteries, loss of,
probable causes, 268
Electrolysis, 294
Elementary composition of hu-
man body, 171
Elimination, intestines as organs
of, 306
of body waste by kidneys, 301
Emotional and mental reactions
determined by bodily states,
316
Emphasis of hygiene, 348
Endameba buccahs, 380
Endocrinology, 264
Energy, 74
food to yield, 159
manifestations, method of, 74
mechanism, human body as, 71
requirements of different ages,
180
sources of, 75, 156
Entry, portals of, of organisms,
376
Environment as factor in health
problem, 37
role of legislation in, 38
predisposing to tuberculosis,
231
in hygiene of eating, 186
Epidemic parotitis, cause of, 356
prevention of, 356
Equable temperature, 207
Equality, 62
Essentials of respiration, 201
Ethmoidal sinus, 382
Eugenic Marriage Law of Wis-
consin, 40
Evacuation, regular, 189
Evidence from biology a guide
for hygiene, 68
Examination, medical, 305
of eyes, 384
of teeth, 380
a-ray, 378, 379
Examples of methods of scien-
tific medicine, 107
Excessive dryness of air, 209
method of combating, 210
Excretion of sweat glands, 280
Excretory system, hygiene of, 279
Exercise. See also Activities.
Exercise, adaptation of, 123
to age, 123
to climate, 129
to individual, 130
to occupation, 129
to sex, 126
after twenty years of age, 117
as stimulant to growth, 121
breathing, matter of, 217
climbing, 140
for adults, 125
for infants, 123
for lung development, 221
for older children, 124
for period of adolescence, 125
for weak or fallen arches, 152
habits of, 144
jumping, 142
lifting, 137
rational, beneficial effects of,
119
general effects of, 120
running, 142
standing, 133
stretching, 135
suitability of, 119
throwing, 136
walking, 140
Expired air, composition of, 202
Eye, black, 388
common disorders of, 388
defects or disturbances, causes
of, 386
disorders, systemic causes of,
390
examinations, 384
foreign body in, 389
glasses, 384
tinted, 386
how to care for, 384
hygiene of, 375, 383
infections of, 389
injuries to, 388
needs care, 383
pink-, 390
Eye-drops, use of, 387
Ejrelids, granular, 390
inflammation of margins of,
390
to evert, 389
trachoma of, 390
Eyelin, 387
Eye-strain, 389, 390
INDEX
401
Face, skin of, care of, 286
Factors in health problem, 35
Facts and superstition, 103
Fad, hot water, 192
no-breakfast, 193
raw food, 192
sour milk, 193
Fads and fallacies in diet, 190
Failure of instinctive ^ides, 48
Faith in goodness of life, 328
Fallacies and fads in diet, 190
uric acid, 258
Fallen arches, exercises for, 152
Far sight, 384
Fats, 161
in plasma of blood, 253
vitamins in, 168
Fear, 46, 329
and patent medicines, 105
Federal Food and Drugs Act,
limitations of, 106
Feet, deformed, 151
causes, 151
flat-, 151, 152
weak, 151
causes of, 151
wet, 224
Fingers, putting in month, 293
First-aid services, clean hands
for, 292
Flat-feet, 161, 152
Foci of infection, nose as, 382
sinuses as, 382
teeth as, 378
tonsils as, 380
Food, adulterants in, 196
aJdulteration, 194
and Drugs Act, limitations of,
106
and vitamins, 166
calcium content of 100-calorie
portions of, 174
caloric values of different arti-
cles of, 158
classification of, 158
digestibility, 181
functions of, 156
iron content of 100-calorie
portions of, 175
phosphorus content of 100-
calorie portions of, 174
poisoning, 368
poisons, 185
36
Food, raw, fad, 192
r61e of mineral salts in, 171
to build tissue, 161
to regulate body processes, 165
to yield energy, 159
values and body needs, 178
vitamins in, relative amounts
of, table showing, 167, 168
wise choice of, 178
Food-stuffs in plasma of blood,
252
Force, dynamic, of an ideal, 43
Forces defining health today, 22
determining human conduct,
46
instinct, 47
intellect, 48
Foreign body in ear, 392
in eyes, 389
Frontal sinus, 382
Fruits, vitamins in, 167
Functional disease, causes of, 350
prevention of, 369
Gaertner, bacillus of, 368
Games, value of, as exercise, 130
Gargles, 383
Garters, 300
Gases in blood, 250
Germ cells of male, effects of
alcohol on, 336
Girls, height and weight of,
tables for, 183
mature and immature, activi-
ties for, 128
Glands, ductless, 263
sweat, 280
Glasses, eye, 384
tinted, 386
Goiter, cause of, 367
character of water drunk, as
cause of, 256
importance of habitat in con-
nection with development of,
256
prevention of, 367
Goitrous districts, water in, 256,
257
Gonococous, 345
Gonorrhea, 344, 345
ophthalinia, 345
tests for cure of, 345, 346
402
INDEX
Goodness of life, faith in, 328
Gout, cause of, 367
prevention, 367
Granular lids, 390
Gray hair, 294
Growth^ effect of vitamins on, 165
exercise as stimulant to, 121
Guides, instinctive, failure of, 48
Gymnastics, 25
value of, as exercise, 131
Habitat, importance of, in con-
nection with development of
goiter, 256
Habits, health, 54
mental, wholesome, develop-
ment of, 327
of bathing, 285
of exercise, 144
of life in tuberculosis, 235
of muscular activity character-
istic of different stages of
human development, 116
Habitual response, 54
Habituation, 41, 43
Hair, care of, 290
curling of, 294
gray, 294
removers^ 294
shampooing of, 290, 294
superfluous, 294
tonics, 293
Hands, care of, 292
Hang nails, 292
Happiness, 60, 623
Head, 'shaving of, 294
Headache cures, 274
Healers, spiritualist, 100
Health, 17
all factors in, important, 144
and ideals, problems of, 54
and science, 83
definition of, 17, 18
examined, 20
forces, defining today, 22
habits, 54
influence of leaders in defining,
23
of life of people in defining,
24
of organizations is defining,
23
Health, influence on, of mineral
dust in air, 213
knowledge of, approach for, 64
laws of, source, 82
meaning of, 17
of nervous system, factors of
importance in maintain-
ing, 313
relation of training to, 315
of respiratory system, 221
problem, 28
factors in, 35
environment, 37
r61e of legislation in, 38
heredity, 36
the individual, 39
dynamic force of an
ideal, 43
lack of education of, 42
necessity for education
of, 40
rules violated because
of ignorance or indif-
ference of, 43
rules violated because of ig-
norance or indifference, 43
skin as index of, 280
test of, 20
what really defines? 22
worry over, 325
Heart, 271
convalescent, 273
disease, mortahty from, 240
influence of poisons on, 274
of tobacco on, 274
injurious effects of sedentary
life on, 122
muscles of, injury to, 273
valves of, injury to, 271
soldier's, 274
Heating, proper methods of, 205
Height and weight tables for
boys, 182
for girls, 183
for men, 182
for women, 183
Hemoglobin, 242
Heredity as factor in health
problem, 36
in defective nervous system,
315
in tuberculosis, 232
High lifting exercise, 13S
INDEX
403
Hoelth, 17
Hollow back, 150
Hookworm disease, cause of, 366
prevention of, 366
Hormones, 264
Hot bath, 282
water fad, 192
weather clothing, 197
How to care for eyes, 384
to keep mouth and teeth
clean, 380
Human body an energy mechan-
ism, 71
and ite adjustment, 71
elementary composition of,
171
conduct, forces determining, 46
instinct, 47
intellect, 48
stages in, 45
development, different stages
of, habits of muscular activ-
ity characteristic of, 116
place of movement in, 114
life, value of, measured in
dollars, 34
meanings of sex, 341
Humanistic and scientific prin-
ciples confused, 101
Humidity and temperature, re-
lation of, 209
effect of, on metabolism, 211
proper, and means to secure it,
207
Hydrophobia, cause of, 365
prevention, 365
Hygiene, emphasis of, 348
evidence from biology a guide
for, 68
of circulatory system, 239
of clothing, 296
of ear, 375, 391
of eating, 186
of excretory system, 279
of eye, 375, 383
of mouth, 375
of muscular system, 113, 114
of nervous system, 309
of nose and sinuses with refer-
ence to septic infections, 375
of nutrition, 155, 178
of respiratory system, 201
of sexual aspects of life, 338
Hygiene of skeleton, 113, 146
of teeth, 376
of voice, 227
oral, 380
importance of, 376, 377
science of, based on facts of
man's nature, 64
sex, education, 339
social, 338
meaning of, 339
Hygienic knowledge, test of, 80
value of good posture, 148
Hyperopia, 384
Hypochondria, 327
Hysteria, 326, 327
cause of, 369
prevention of, 369
Ideals, 62, 63
and health, problem of, 54
and intellect, 50
and intelligence, 45
dynamic force of, 43
of social responsibility arise
out of nature of life, 57
serve all, 60
si^ificance of social pressure
in relation to, 61
social, 55
Idiosyncrasy, food, 186
Ignorance, health rules violated
because of, 43
Illness causing absence, distribu-
tion of, 252
Immature girls, activities for, 128
Immune senun, 262
Immunity, 260, 261, 353
artificial, 353
Incompatibilities to be avoided
in marriage, 343
Indifference, health rules vio-
lated because of, 43
Indigestion, causes of, 189
nervous, 187
Individual, adaptation of exercise
to, 130
as factor in health problem, 39
dynamic force of an
ideal, 43
lack of education of, 42
necessity for education
of, 40
404
INDEX
Individual as factor in health
problem, rules violated be-
cause 01 ignorance or indif-
ference of, 43
condition of, in hygiene of
eating, 187
each, a link in chain of life, 58
an heir to inheritance of
life, 68
Infant, exercise for, 123
mortality, 29
and temperature changes,
208
Infection, droplet, 214, 215
foci of, nose as, 382
sinuses as, 382
teeth as, 378
tonsils as, 380
local, causes of, 350, 370
prevention of, 370
of eye, 389
septic, 375
Infectious disease, occurrence of,
in cardiacs and non-cardiacs,
272
Inflammation of conjunctiva, 390
of margins of eyelids, 390
Influence of leaders in defining
health, 23
of life of people in defining
health, 24
of organizations in defining
health, 23
of poisons upon heart, 274
Influenza, cause of, 360
prevention of, 360
Inheritance, defective, in nervous
system, significance of, 318
of life, each individual an heir
to, 58.
Injurious effects of sedentary
Mfe, 121
Inoculation against typhoid,
value of, 87
Insanity, 331
alcohol in, 333
alcoholic, 333
causes of, 332
mental habits in, 335
physical diseases causing, 334
syphilis in, 332
syphilitic, 345
types of, 331
Inspired air, composition of, 202
Instinct, force of, in determining
human conduct, 47
sex, 49
in Ufe, 339
Instinctive guides, failure of, 48
Institution of marriage, 342
Intellect and ideals, 50
force of, in determining human
conduct, 48
InteUigence and ideals, 45
Interaction, agent of, 72
Internal secretions, gland of, 263
Interpretations of sex, new, 341
Intestinal tapeworms, cause of,
366
prevention of, 366
Intestines as organs of elimina/-
tion, 306
Iron content of 100-calorie por-
tions of foods, 175
in body, 175
nuxated, 246, 247, 248
preparations in anemia, 248
Isolation, 353
Jot,. 329
Jumping exercise, 142
Kidney remedies, 303
troubles, 303
Kidneys, efliciency of, rules for,
301
elimination of body waste by,
301
injury of, by disease, 302
Klebs-Loffler bacillus, 360
Knowledge, hygienic, test of, 80
of health, approach for, 64
Koch's law of specificity of bac-
teria, 356
Kyphosis, 150
Lack of education of individual
in health problem, 42
Laryngitis, 228
Lateral curvature of spine, 150
Law, Eugenic Marriage, of Wis-
consin, 40
sterilization, 40
INDEX
405
Laws of health, source, 82
Leaders, influence of, in defining
health, 23
Lead-poisoning from hair dyes,
294
Legislation, role of, in environ-
ment as factor in health
problem, 38
Leukocytes, 249
Life, biologic basis of, 65
chain of, each individual a
link in, 58
poodness of, faith in, 328
inheritance of, each individual
an heir to, 58
length of, and alcohol, 198
mental, normal, 319
of people, influence of, in de-
fining health, 24
responsibility for, 59
sedentary, 117
injurious effects of, 121
sex instinct in, 339
sexual aspects of, hygiene of,
338
Lifting exercise, 137
Light, good, in care of eyes, 386
Limitations of Federal Food and
Drugs Act, 106
Linamentum saponis moUis, 290
Lithia water, Buffalo, 258
what is a? 259
Lithium fallacy, 258
Local infections, causes of, 350,
370
prevention of, 370
Lockjaw, cause of, 365
prevention of, 366
Lordosis, 150
Low lifting exercise, 138
Lumbar pain, 303
Limgs, development of, exercises
for, 221
injurious effects of sedentary
life on, 122
Lymphocytes, 249
Malaria, cause of, 363
mortality from, among canal
employees, 363
in American cities, 364
prevention of, 363
Male, germ cells of, effects of alco-
hol on, 336
Man, the organism, 110
Marasmus, 166
Marriage and propagation of the
unfit, 40
institution of, 342
Massage of scalp, 291, 294
Mastoid, 393
Mature girls, activities for, 128
Maturity, perils of, 153
Meals, drinking water at, 188
Meaning of health, 17
Measles, cause of, 356
mortality from, comparative
reduction in, 358
prevention of, 356
Meats, vitamins in, 167
Mechanism, energy, human body
as, 71
Medical examination, 305
Medicated soap, 287
Medicine in anemia, 245
patent, 248, 288
and fear, 105
faking in eye solutions, 387,
388
of kidney-cure type, 303-305
scientific, challenge of, 107
methods of, examples of, 107
Men, basal metabolism of, 157
height and weight of, "tables
for, 182
Meningitis, cerebrospinal, cause
of, 360
prevention of, 360
Menstruation, 344
Mental and emotional reactions
determined by bodily states,
316
habits causing insanity, 335
wholesome, development of,
327
life, normal, 319
Metabolism, basal, 156
effect of humidity on, 211
of wind on, 210
in man, influence of cold bath
on, 284
influence of clothing on, 297
mineral, 170
Methods of scientific medicine,
examples of, 107
406
INDEX
Miasma of soil in goiter, 256
Middle-ear disturbance, preven-
tion of, 393
Milk, sour, fad, 193
Mineral dust in air, influence of,
on health, 213
metabolism, 170
salts and body reaction,
177
as dietary essential, 170
functions of, 170
in food, r61e of, 171
waters, use of, 257
Morbid disposition, 335
Morbilli, cause of, 356
prevention of, 356
Mortality by age periods, 32
from cancer, 371
from croup, 361
from diphtheria, 361
from heart disease, 240
from malaria among canal
employees, 363
in American cities, 364
from measles, comparative re-
duction in, 358
from tuberculosis, 238
in certain occupations, 233,
234
of lungs, 235
infant, 29
and temperature changes,
208
Mouth and teeth, how to keep
clean, 380
breathing, 216
hygiene of, 375 _
putting fingers in, 293
Mouth-washes, 383
alkaline, 380
Movement, air, means to secure
it, 212
and consciousness, significance
of, 115
place of, in human develop-
ment, 114
Mumps, cause of, 356
prevention of, 356
Murine, 388
Muscles, contraction of, 66
injurious effects of sedentary
life on, 123
of heart, injury to, 278
Muscular activity, habits of,
characteristic of different
stages of human develop-
ment, 116
mechanism for respiration, 216
system, development of, 65
hygiene of, 113, 114
Myopia, 384
Mysticism, 85
Myxedema, cause of, 368
prevention, 368
Nails, biting of, 293
care of, 291
hang, 292
scratching body with, 293
Nasal douche, 22!4
National resources, conservation
of, 28
Nation's vitality, 28
estimated losses, 34
losses that cannot be easily
stated, 32
revelations of Selective Ser-
vice Act, 34
Nature of nervous system, 309
Nature's plan for respiration, 216
Near sight, 384
Necator americanus, 366
Necessity for education of indi-
vidual in health problem, 40
Nerve food, 159
Nerves, afferent, 310
cranial, 310
efferent, 310
spinal, 310
Nervous indigestion, 187
system, alcohol and, 335
autonomic, 310, 311
cerebrospinal, 309, 310
defective, hereditjr in, 315
inheritance in, significance
of, 318
health of, factors of impor-
tance in maintainmg,
313
relation of training to, 315
hygiene of, 309
nature of, 309
Neurasthenia, 325, 327
cause of, 369
prevention of, 369
INDEX
407
New interpretations of sex, 341
Newborn, conjunctivitis of, puru-
lent, 390
Nightcap in prevention of ear-
ache, 393
Nitrogen, 161
No-breakfast fad, 193
Non-cardiacs and cardiacs, oc-
currence of infectious disease
in, 272
Normal mental life, 319
serum, 262
Nose and sinuses, hygiene of,
with reference to septic in-
fections, 375
as foci of infection, 382
breathing, 216
in health of respiratory
system, 221
Nostrums. See Patent Medicines.
Nutrition, 156
effect of vitamins on, 165
hygiene of, 155, 178
Nutntional disease, causes of,
350
prevention of, 366
Nuts, vitamins in, 168
Nuxated iron, 246, 247, 248
Obesity, cause of, 368
prevention of, 368
Occult, call of, 99
Occupation, adaptation of exer-
cise to, 129
as predisposing factor to tuber-
culosis, 232
Oil in ear, 392
Oils, vitamins in, 168
Open-mindedness, 330
Opinion, public, 60
Opsonins, 260
Optimism, 329
Oral hygiene, 380
importance of, 376, 377
Organism, man, 110
Organisms, pus-producing, por-
tals of entry of, 376
Organizations, influence of, in
defining health, 23
Osteopathy, 98
Ovaries, 263
secretions of, 265
Overeating, 223, 224
Overwork, 224, 334
Oxygen in air, 201, 202
in blood, 251
Oxyhemoglobin, 242
Pacifist, 318
Pain, lumbar, 303
Pandemic, 349
Paralysis, general, 332
Paresis, 332
Parotitis, epidemic, cause of, 356
prevention of, 356
Patent medicines, 246, 248, 288
and fear, 105
faking in eye solutions, 387,
388
of kidney-cure type, 303-305
Peace losses vs. war losses, 29
Pellagra, cause of, 367
prevention of, 367
Percentage digestibility of food,
181
Perils of maturity, 153
Peristalsis, 306
Perspiration checks, 295
Perspiro, 295
Pertussis, cause of, 356
prevention of, 356
Pessimism, 329
Phagocytes, 250, 260
Phagocytosis, 250
Phenacetin, 274
Phosphorus, 173
in 100-calorie portions of foods,
174
Photophobia, 95
Photosynthesis, theory of, 75
Physical diseases causing insan-
ity, 334
Pills, Blaud's, 245, 248
Pimples, 266, 267
Pink-eye, 390
Pituitary gland, 263
Place of movement in human
development, 114
Plasma of blood, 250
autacoids in, 263, 264
carbohydrates in, 252
chalones in, 264
fat in, 253
food-stuffs in, 252
408
INDEX
Plasma of blood, gases in, 250
honnones in, 264
protective substances in, 259
protein in, 254
salts in, 255
waste substances iu, 265
water in, 250
Plasmodium malarise, 363
Play 329
value of, as exercise, 130
Pneumococcus, 360
Pneumonia, cause of, 360
prevention of, 360
Pointed paragraphs, 293
Points of a good shoe, 151
Poisoning, acute, causes of, 350
prevention of, 368
blood, 350
food, 368
Poisons, food, 185
influence of, upon heart, 274
Portals of entry of pus-organisms,
376
Position of Christian Scientist, 84
Positions, important, 148
Postural curvature of spine, 150
Posture, 145, 281, 316
correct, 147
good, value of, 147
iinportant forms of, 148
Pregnancy, 344
Premature breakdown, causes of,
241
Presbyopia, 384
Prescription fakes, 288, 289
Preventable deaths, 28
sickness, 28
Prevention in specific diseases,
348
of common skeletal deformities,
150
of disease, 351
general means of, 352
special means of, 353
Problem of health, 28
and ideals, 54
factors in, 35
Prohibition, 197, 335, 336
Propagation and marriage of the
unfit, 40
Proper humidity and means to
secure it, 207
Prostitution, 343, 344
Protective substances in blood,
259
Proteins, 161
animal, composition of, 164
or vegetable, relative superi-
ority of, 191
dynamic action of, 256
in plasma of blood, 254
vegetable, composition of,
164
Protozoa, 65
Pruritiis, bath, 294
Psychrometer, sling, 210
Public opinion, 60
Purins, 164
Purulent conjunctivitis of new-
born, 390
Pus-producing organisms, portals
of entry of, 376
Putting fingers in mouth, 293
Pyorrhea alveolaris, 379
QXJABANTINE, 353
Rabies, cause of, 365
prevention of, 365
Race in tuberculosis, 233
Rational exercise, beneficial ef-
fects of, 119
general effects of, 120
Raw food fad, 192
Reaction, body, mineral salts
and, 177
Red blood-cells, 242
Regular evacuation, 189
Relapsing fever, cause of, 355
prevention of, 355
Removers, hair, 294
Resistance to disease, 352
artificial, 353
Resources, national, conserva-
tion of, 28
Respiration. See also Breathing.
automatic control of, 217
essentials of, 201
muscular mechanism for, 216
nature's plan for, 216
Respiratory system, 216
health of, 221
hygiene of, 201
Response, habitual, 54
INDEX
409
Responsibility for life, 59
social, and Christian Science,
93
ideal of, arises out of nature
of life. 57
serves all, 60
Rest for eyes, 385
Revelations of Selective Service
Act, 34
Rheumatic fever, cause of, 363
prevention of, 363
manifestations, recurrence of,
effect of tonsillectomy on,
381
Rickets, cause of, 366
prevention of, 366
R61e of legislation in environ-
ment as factor in health
problem, 38
of mineral salts in food, 171
Round shoulders, 150
Running exercise, 142
Russian bath, 286
Salt, average daily intake of, 255
Salts, mineral, and body reac-
tion, 177
as dietary essential, 170
functions of, 170
r61e of, in food, 171
of blood, 255
special considerations, 255
use of mineral waters, 257
Sanatogen, 159, 160
Scalp, massage of, 291, 294
Scarlet fever, cause, 356
prevention, 356
seasonal prevalence of, 357
Science, 26
and attitudes, 82
and health, 83
of hygiene based on facts of
man's nature, 64
Scientific and humanistic prin-
ciples confused, 101
medicine, challenge of, 107
methods of^ examples of, 107
Scientist, Christian, not pre-
pared to judge, 85
position of, 84
Scohosis, 150
Scorbutus, cause of, 366
Scorbutus, prevention of, 367
Scratching body with nails, 293
Scurvy, 166
cause of, 366
prevention of, 367
Sea bathing, 285
Seasonal clothing, 296
Secretion of ductless glands, 263,
264
Secretions, internal, glands of,
263
Sedentary life, 117
iujurious effects of, 121
Selective Service Draft, revela-
tions of, 34
Self-confidence, 328
Self-consciousness, 329
Self-remedy 264
Sensitization^ 186
Septic iofections, 375
Septicemia, 350
Serum, antivenom, 261
immune, 262
normal, 262
Service, 27
Setting-up drill, value of, as
exercise, 132
Sex, adaptation of exercise to, 126
conduct, _340
human, meanings of, 341
hygiene education, 339
in tuberculosis, 234
instinct, 49
in fife, 339
new interpretations of, 341
tobacco and, 278
Sex-education, 339
Sexual aspects of Ufe, hygiene of,
338
Shampooing the hair, 290, 294
Shaving head, 294
Shell shock, 318
Shock, shell, 318
Shoe, good, points of, 151
Shoulder braces, ISO
Shoulders, round, 150
Shower-bath, cold, substitutes
for, 284
value of, 282, 283
Sickness, preventable, 28
Siderosis, 213
Sight, far, 384
near, 384
410
INDEX
Significance of movement and
consciousness, 115
of social pressure in relation to
ideals, 61
Silicosis, 213
Sinuses as foci of infection, 382
Skeletal deformities, common,
prevention of, 150
Skeleton, hygiene of, 113, 146
Skin as ind^x of health, 280
beautifier, 287
care of, 281
function of, 279
nature of, 279
of face, care of, 286
Sleep, loss of, 224
Sling psychromet6r, 210
Small-pox, cause of, 355
prevention of, 355
vaccination in, value of, 104
Smoking, 229
cigarette, effects of, 275
Soap, medicated, 287
use of, on face, 287, 289
Social diseases, 344
hygiene, 338
meaning of, 339
ideal, 55
pressure, significance of, in
relation to ideals, 61
responsibility and Christian
Science, 93
ideal of, arises out of nature
of life, 57
serves all, 60
value of good posture, 148
welfare laws, 38
Socks, 301
Softening of brain, 332
Soil, miasma of, in goiter, 256
Soldier's heart, 274, 275, 276
Sour milk fad, 193
Sources of energy, 75, 156
Specific diseases, prevention in,
348
Spectacles, 384
Sphenoidal sinus, 382
Spinal nerves, 310
Spine, curvature of, 150
Spirillimi obermeieri, 355
Spiritual value of good posture,
148
Spiritualist healers, 100
Spiroehaeta paUida, 346
Sponge bath, cold, 284
Sporte, value of, as exercise, 130
Sprays, 383
Spurmax, 289
Stages in hviman conduct, 45
Standing exercise, 133
Staphylococci, 376
Sterilization law, 40
Stockings, 301
Streptococci, 376
Stretching exercise, 135
Sty, 389
blind, 391
Sugar in blood, 252
Suggestion, 326
Smtabihty of exercise, 119
Sun bath, 286
Sunlight, value of, 215
Superfluous hair, 294
Superior maxillary sinus. 382
Superstition, 83
and facts, 103
Suprarenal glands, 263
Suspenders, 300
Swamp root, 304
Sweat glands, 280
excretion of, 280
Syphilis, 344, 346
as cause of insanity, 332
stages of, 346
Syphilitic insanity, 345
Tabes dorsaUs, 332
Taenia saginata of beef, 366
soUum of pork, 366
Tapeworms, intestinal, cause of,
366
prevention of, 366
Tea, 199
Technic of eating, 187
Teeth, 376
and mouth, how to keep clean,
380
as foci of infection, 378
defects of, causes, 377
examination of, 380
hygiene of, 376
Temperature and humidity, re-
lation of, 209
changes and infant mortality,
208
INDEX
411
Temperature, desirable, 205
valuable experiment in, 205
equable, 207
Terminology, difficulty of, in
hygiene of reproductive sys-
tem, 338
Test for cure of gonorrhea, 345,
346
of health, 20
of hygienic knowledge, 80
Testicles, 263
secretions of, 265
Tetanus bacillus, 365
cause of, 365
prevention of, 366
Theory of photosynthesis, 75
Thiersche's powder, 295
Throwing exercise, 136
Thymus gland, 263
Thyroid gland, 263, 264
abnormal enlargement of,
due to absence or presence
of salts in diet, 256
extract, 264
Tinted glasses, 386
Tissue building, food for, 161
Tobacco and sexes, 278
effects of, upon youth, 278
general effects of, 277
influence of, need for accuracy
in judgment, 276
on heart, 274
Tongue, cleansing of, 380
Tonics, hair, 293
Tonsillectomy, effect of, on re-
currence of rheumatic mani-
festations, 381
salutary effect of, 382
Tonsils, 225
as foci of infection, 380
Tooth-brushes, 380
Trachoma of eyelids, 390
Training and education of young,
41
relation of, to health of ner-
vous system, 315
Transmission of disease, 351
Trichina spiralis, 366
Trichiniasis, cause of, 366
prevention of, 366
Trichinosis, cause of, 366
prevention of, 366
Tub bath, cold, 283
Tub bath, cold, substitutes for,
284
Tuberculosis, 220, 229
cause, 229
deaths from, by occupation
and place, 232
environment in, 231
habits of life in, 235
heredity in, 232
mortaUty from, 238
in certain occupations,
233, 234
occupation ia predisposition
to, 232
of lungs, mortaUty from, 235
predisposing factors, 231
prevention of, 236
race in, 233
seeds of, 230
sex in, 234
soil for, 230
treatment, 237
vaccines in, 237
Tumors, causes of, 351
Turkish bath, 286
Tjrphoid bacillus, 354
fever, cause of, 354
prevention of, 354
inoculation against, value of,
87
Typhus fever, cause of, 355
prevention of, 355
Underclothing, 299
Unfit, marriage and propagation
of, 40
Universal distribution of dis-
ease, 348
Unselfishness, 330
Uric acid fallacy, 258
Vaccination, value of, 104
table showing, 103
Vaccines for colds, 225
in tuberculosis, 237
Value, food, and body needs, 178
of antitoxin in diphtheria, 87
of biologic view, 78
of good posture, 147
of human life measured in dol-
lars, 34
412
INDEX
Value of inoculation against ty-
phoid, 87
of sunlight, 215
of vaccination, 104
table showing, 103
relative, of different activities,
130
Valves of heart, injury to, 271
Varicella, cause <>f, 355
prevention of, 356
Varicose veins, 270
Variola, cause of, 355
prevention of, 365
Vegetable or animal protein,
relative superiority of, 191
proteins, composition of, 164
Vegetables, vitamins in, 167
Vegetarianism, 190
Veins, 269
varicose, 270
Venereal diseases, 344
Venoms, 261
Ventilation, 202
New York State Commission
on, 203
Vessels of circulation, 268. See
also Blood-^esseh.
Visceroptosis, 307
Vitality of nation, 28
estimated losses, 34
losses that cannot be easily
stated, 32
revelations of Selective Ser-
vice Act, 34
Vitamin A, 169
B, 169
C, 169
Vitamins, 165
and foods, 166
destruction of, 168
effect of, on nutrition and
growth, 165
in food-stiiffs, relative amounts
of, table showing, 167, 168
Vitiated air, 202
Voice, hygiene of, 227
Walking exercise, 140
War losses vs. peace losses, 29
Warm bath, 282
Waste, body, elimination of, by
kidneys, 301
Waste substances in plasma,
265
Water, Buffalo lithia, 258
drinking sufficient, 302
hot, fad, 192
in blood, 250
in goitrous districts, 256, 257
Uthia, what is a? 259
mineral, use of, 257
Wax, ear, removal of, 392
Weak arches, exercises for, 152
feet, 151
causes, 151
Weather, hot, clothing for, 297
Weight and height tables for
boys, 182
for girls, 183
for men, 182
for women, 183
Wet feet, 224
What is chiropractic? 96
is a lithia water? 259
really defines health? 22
White blood-cells, 249
Wholesome mental habits, de-
velopment of, 327
Whooping-cough, average weekly
case rates from, 359
cause of, 356
prevention of, 356
Wind, effect of, on metabolism,
210
Wisdom, 83
Women, basal metabolism of, 157
height and weight tables for,
183
Worms, 65
Worry, 320
over health, 325
over opinions of others, 324
over what we are going to do,
322
have done, 321
s-KAY examination of teeth, 378,
379
Young, training and education
of, 41
Youth, effects of tobacco upon,
278
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